[Question #5073] Confused

25 months ago
Hi doctor, 
I had a  few questions regarding the rpr syphillis test. I am pregnant and have gotten my first and third trimester rpr tests done that both came out as non reactive. I was reading  that after x amount of time of having syphillis or with pregnancy they can come out as false negatives.  Pregnancy is my first time getting tested for syphillis and I have been sexually active since 2006 with a total of 7 partners 8 if you include my husband and I have not always been careful. I have also made out with a lot of guys and read that there is a chance of getting it through kissing. My questions are 

1) If I acquired syphillis after and amount of that time can the rpr be negative?

2) why is that the test used in pregnancy if it can cause a false negative assuming people have had more than one partner? 

3) is there a chance I can have syphillis and the test didn’t pick it up? If so what can I do about this? I am very worried for my baby.

I also tested for everything else which was negative and have only been with my husband for the past two years.  He tested for everything and was clear.  Thank you 
Edward W. Hook M.D.
Edward W. Hook M.D.
25 months ago
Welcome to the Forum.  I'll do my best to help.  Please realize that syphilis is a relatively rare disease, that the RPR test is highly accurate and that with two RPR tests taken during your pregnancy you can be entirely comfortable that you do not have syphilis.  Your brief description suggests that you are at low risk for infection and irrespective of high vs low risk, your tests prove that you do not have syphilis.  In answer to your specific questions:
1.  Very early in the course of syphilis (the first week or so of infection, the RPR test may be negative.  Having been tested twice, you can be quite sure that you do not have syphilis.
2.  Syphilis tests are done routinely during pregnancy because the infection, although rare, can have devastating consequences.  A woman who has been in a monogamous relationship for the past two years and has two negative syphilis tests can be completely confident that they do not have syphilis.
3.  Be confident in your tests, really.  I understand that you want he best for your baby and that syphilis has been in the news a lot lately but with your relationship and the testing you have had, you can be confident that you do not have syphilis.  Really

I hope these replies are helpful.  EWH
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25 months ago
Thank you doctor. I was reading about something called prozone phenomenon with rpr saying pregnancy and having syphillis for a longer time can make it turn negative so would taking two of the rpr tests rule out syphillis completely? The internet is a scary place for health information so I wanted to make sure there were no other measures I can be taking. Also if I had a question about a different disease transmission risk do I need to order a new question or can I post it in the follow up? 
Edward W. Hook M.D.
Edward W. Hook M.D.
25 months ago
I hope the answers I provided are helpful.  You are correct, when it comes to health-related issues, the internet causes more harm than good- it is full of out of date statements, statements which are taken out of context and many which are just plain wrong.  Further the lack of context makes it difficult to determine how what is there pertains to you and your own circumstance.  Both the statements, that you found, regarding the prozone phenomenon, which occurs only in persons with syphilis acquired in the last year or two, and the fact that people who have syphilis for decades may have their RPR titers become non-reactive do not apply to you.  Be confident that you do not have syphilis.  Try to stay off the internet for these sorts of topics.

If you have another sexual health related question, you may ask.  We provide up to three responses to questions from clients so you will get just one more follow-up response before the thread is closed.  EWH
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