[Question #6904] I Want a 2nd Opinion: VDRL converted back to reactive 1:1 after 2 years!

63 months ago

Dear Dr Handsfield / Hook,

I was diagnosed with Syphilis in Nov 2017 (titre 1:32). My next follow-up tests went like this:

4 months = reactive 1:1

8 months = non-reactive

12 months = non-reactive

I didn't follow the 3,6,9, and 12 month schedule cos I wanted to go to the same facility each time and, with my job, it wasn't possible. The doctors were satisfied and I even saw an infectious disease specialist once (at the 12 month test). I was advised not to come back for any more tests; case closed.

But now, just yesterday, I went for a health check-up (different hospital) for a foreign work permit which included a VDRL as part of the check-up. The test was reactive 1:1 again.

Before I even told this doctor my history he said, "It is so weak; it looks like you had a previous infection." I confirmed this to him and I expressed my concerns due to previously converting back to non-reactive already at the other hospital. He told me not to worry; the test is just very sensitive and can sometimes pick up old infections. He even spoke with the lab nurse who did the test and she agreed with him. They told me to consider it the same as non-reactive and he even wrote that on my work permit health certificate.

What do you think? Let it go? Or investigate more?

I just want to make sure I don't still have syphilis.

Thank you

Edward W. Hook M.D.

63 months ago

Welcome to our Forum and thanks for your question. I'll be glad to comment. I agree with all that the doctor told you, your syphilis has been cured. When syphilis is treated the amount of antibodies to the bacterium go down but they do not go away completely. As a result, with repeated tests the test titers may fluctuate a bit and it is not uncommon for a person who has had successfully treated syphilis to sometimes have titers which vary a little bit, such as going from a 1:1 dilution to non-reactive and back. I would not worry about this. The exception to this would be if there is a substantial chance that you might have re-acquired syphilis is the interval between tests. If that were the case, the test titer should rapidly (within a week or two) become higher.

I hope this explanation is helpful. Measuring the response to syphilis treatment can be complicated but as I said, I would not worry about this 1:1 titer. EWH

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63 months ago

Thank you! This was helpful.

I have been sexually active (orally and vaginally) and it has been a while since my last sexual health check up.

I haven't noticed any skin problems or anything else that would make me suspicious of STDs, however it wouldn't be a bad idea to go for a routine screening anyway.

Perhaps I will wait a few months and visit an STD clinic.

I will expect the titer to be 1:1 or non-reactive. I just wanted to make sure this was normal behaviour for these tests even after successful treatment.

Thanks again.

Edward W. Hook M.D.

63 months ago

I totally agree with your strategy. Compared to problems like Gonorrhea or chlamydia Syphilis is a rare disease, particularly for persons engaging in heterosexual contact. I would anticipate that if you test in the future at your convenience your test will, once again, be non-reactive or reactive at a 1:1 dilution. EWH---

63 months ago

Would it change your mind about my being cured if I told you I was treated with 2 weeks of Doxycycline (twice daily), rather than Penicillin injection?

My diagnosis and treatment were in Thailand. I don't know why I didn't get Penicillin.

I was at the 2nd stage, I think (rash on body, palms, titer 1:32). And in hindsight I recall seeing the ulcer around 3 months prior, but unfortunately paid little attention it it at the time.

Or are you happy that I am cured by looking at the titer response anyway?

Does the treatment being Doxy change your opinion in any way?

Edward W. Hook M.D.

63 months ago

Doxycycline for two weeks is a highly effective alternative to penicillin as long as all of the medication is taken. Your test results since therapy indicate that your therapy was successful. I urge you to believe the test results.

I hope that my comments have been helpful.as I suspect you know, we provide up to three responses to each question. This is my 3rd response. Thus this thread will be closed shortly without further replies. Take care. Please don’t worry. EWH

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