[Question #7009] Syphilis RPR

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62 months ago
Between Feb 2019 and March 2019 I was dating a girl and had a handful of protected vaginal sex and received unprotected oral sex. 

In between July and Sept 2019, I was having red spots on my trunk and arms that would come and go, some quickly over a couple days, some would take a week or two. Some were flat and faint, some were strong and almost pimple like. I did not have health insurance that year, I spent this time eating lots of garlic, manuka honey, and applying topical ointments to the spots as they came. There was also a few weeks where I felt like my armpits and groin area were tender and uncomfortable when my arms were by my side or legs pressing together. I could not see swelling, but I assumed it was my lymphnodes.  By Oct this had all seemed to stop.I was worried about Hiv and syphilis. 

In March 2020 (a year after possible exposures) I had a rapid HIV test and an RPR syphilis test at the health department. Both were negative.I then fell down the rabbit hole about how Syphilis RPR tests can read non reactive after it moves into the latent stage.

In May 2020 I asked my primary doctor who admitted he never saw a syphilis case before, I asked him for a specific trepenomal test to put my mind at ease. However there was a misunderstanding and it turned out it was another RPR test. He also did an Hiv antibody/antigen test. Both were negative. He also checked my Rheumatoid Factor, which was 14, which is the first number of being raised at this lab, read could be high in syphilis. Also, some of my toenails have beau’s lines about halfway down, which also lists a possible cause being syphilis. 

Also, over the past two weeks, I have noticed I’ve been getting red spots again, and that feeling in my armpits and groin is back, however not as intense this time so far. If I missed primary chancher and had secondary between July-Sep 2019, would the RPRs in March and May 2020 be reliable? And could this be a recurrence if I was non reactive last month? 
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Edward W. Hook M.D.
62 months ago

Welcome to the Forum.  I'll be glad to help.  Syphilis is a challenging disease to understand and is widely misunderstood.  Misinformation found on the internet just compounds this.  I have seen hundreds of cases of syphilis and do research on the disease.  Let me address your concerns in a point by point fashion.

1.  Your encounter was relatively low risk.  While U.S. syphilis rates are rising, over  nearly 2/3 of all syphilis occurs amongst men who have sex with other men and the disease is relatively rare in women.

2.  syphilis is almost never spread through receipt of unprotected oral sex and your use of a condom for the encounter is highly protective for syphilis acquisition.

3.  None of that however does not mean that uncommon things do not happen.  HOWEVER, your negative RPR results a year after the event is strong evidence that you did not get syphilis.  If your rash or swollen arm pit lymph nodes were due to syphilis, I can assure you that your RPR would have been positive. 

4.  On those rare occasions when untreated latent syphilis is associated with negative RPR or other tests for syphilis, the disease has been present for decades, not months or years.  Even then, for a blood test to become negative is vanishingly rare. 

5. That your rash is recurring in this was suggests some other, likely non-infectious dermatologic problem, not syphilis.

Bottom line, based on your multiple negative tests you can be entirely confident that you did not acquire syphilis (or HIV for that matter) from the February/March encounters you describe.  While I cannot tell you what is causing your current rash, I can assure you that it is not syphilis.  I hope this explanation is helpful.  EWH

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62 months ago
I appreciate it... So I know this may seem silly, but you know, anxiety.... 

So eating all that garlic and honey (I would consume a lot, every day)  and using antibiotic ointments wouldnt have “treated” a syphilis infection, causing the RPR to drop to negative?  I know that doesn’t make sense seeing as I’m getting some issues again now, but let’s say if this recent episode is something else... consuming  those natural antimicrobials wouldn’t have been enough to treat syphilis and reduce the RPR to negative? 
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Edward W. Hook M.D.
62 months ago
Correct, consuming naturally healthful items and ointments would not cure syphilis or change your test results.  Of this I am entirely confident.  Have faith in your test results.  I am absolutely confident that you did not acquire syphilis from the exposure you described.  EWH
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62 months ago
Thank you so much. It’s one thing to read things either in favor of or against a fear, but much different to have a direct answer from an expert about the specific situation. 

I am going to take away that a negative RPR a year after a possible exposure is definitive, despite symptoms, and try to put this out of my mind.
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Edward W. Hook M.D.
62 months ago
Great.  I endorse your plan of action whole heartedly and enthusiastically.  Take care.  EWH---
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62 months ago
One last follow up, I apologize.

If the red spots and tenderness in the lymph node areas that I’m starting to have again were a recurrence of secondary syphilis, then it would be impossible that the two RPR’s I’ve had between the episodes would have been negative? 

Like in the rare case that my body self cured in September, and I was non reactive in both March and May, then it couldn’t be another recurrence of it starting up in the last couple weeks? 
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Edward W. Hook M.D.
62 months ago
Correct.  If the “spots” were Syphilis, the RPR would be positive.

When last time. This is not Syphilis. The findings you describe are not particularly suggestive and you were testing proves that is not the case. At this point, as perform guidelines, the thread will now be closed. Take care. Please, please don’t worry. EWH
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