[Question #4834] Follow-up re massage and possible syphilis

25 months ago
Hello Doctors,

Following up on  my previous question regarding possible primary syphilis. To summarize:
-Per Dr. Hook's advice that if the symptoms I'm experiencing were syphilis an RPR would be positive, I took an RPR test about 4.5 weeks after event of possible exposure, which showed a negative result.

-As the symptoms are still continuing / evolving (the lesion continues to itch, is more red and noticeable, and now slightly weeping a yellowish/serum-color that very subtly shows up on white clothes), I went to a dermatologist who advised that it's most likely not syphilis but some kind of other infection. He prescribed some topical steroids / ointment to hopefully address the issue. As requested, he ordered a Treponema AB syphilis test. 

Can you please assist with the following questions?

-If i took the test tomorrow it would be about 2 or 3 days shy of the 6 week mark mentioned here and on medhelp. If negative, would the Treponema AB syphilis test conducted 3 days short of 6 weeks be conclusive and that combined with the negative RPR at 4.5 weeks I can stop worrying? Should I wait until 6 weeks has passed to take the test?

-Would alcohol consumption have any impact on the Treponema AB test's reliability? 

-If i should wait until 6 weeks, would the prescribed topical medications have any impact on test results?

Thank you again.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
I'm sorry you found it necessary to return to the forum with these questions after the repeated, science based reassurance you have had. You came here for expert professional advice but obviously either don't believe us or are having trouble understanding.

Although it can take up to 6 weeks for syphilis blood tests to be positive, almost always they are positive sooner. Second, as Dr. Hook said, if your symptoms were due to syphilis, the RPR at 4+ weeks would have been positive. And I'll also repeat that you had an exposure of a type that would virtually never transmit syphilis anyway. By any rational standard, you didn't need to be tested at all.

"-If i took the test tomorrow....?  Those tests at those times would prove once against you do not have syphilis. They will be negative. But Why not just wait until the full 6 weeks have gone by? 

Alcohol consumption has no effect on syphilis test reliability. And topical medications of any kind also cannot have any such effect. 

25 months ago
Thank you for your reply. Despite reassurances I guess it's easy for me to leap to the most dramatic possible scenario in the presence of strange symptoms.

The Treponema AB test taken at 6 weeks was negative. If you agree that this test and the RPR are equally definitive at 6 weeks, I will move on.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
Indeed those test results are conclusive at 6 weeks. For sure you do not have syphilis.---