[Question #7017] Syphillis testing

9 months ago
Good morning. I had two unprotected encounters  almost two years ago (same day and same person)
 Had tested for all std’s after that except for syphillis (didnt cross my mind) later that same year and the next year. Primary doctor ordered a syphillis test (amongst many other ones)  last month during an annual physical after I expressed concern about my hair was falling out. Last syphillis test was in November 2017 and was straight negative.  Recent screening  result was Immunoassay IGG/IGM “equivocal”.  I’ve never had this result before, it had always been straight negative. The “equivocal” screening report stated that the test result suggested infection sometime in the past. Two follow up confirmatory tests were done: RPR and TPPA which were both negative. Final confirmatory  results report (with RPR and TPPA) states no serological evidence of syphillis and to re-test if incubating Syphillis suspected.  I know wouldn’t have incubating syphillis if exposure almost two years ago.  Is this confirmatory result conclusive? Have two more follow up questions (included with this). 
Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago

Welcome to our Forum and thanks for your questions.  I'll be glad to clear things up.  Let me start by assuring you that your test results show that you did not acquire syphilis through your exposure to this partner.  I'll now provide some additional explanation.

1.  Even if your partner had syphilis at the time of your encounters, syphilis is not transmitted at 100% of exposures, instead only being transmitted about 1/3 of the time. 

2.  Your test results reflect recent changes in the way syphilis testing is done.  The newer tested for syphilis IgG/IgM unfortunately occasionally give falsely positive results.  The way that we know that your tests were falsely positive is because, as I read your post, the lab then went on to do two additional tests, the RPR and TPPA which are unrelated to your first test. If you had acquired syphilis all three tests would be positive.  When only one test is positive, this indicates that it is the test that is wrong (falsely positive) 

Thus you can be confident that you did not acquire syphilis from this exposure.  FYI, we cannot say whether or not future tests will be falsely postiive or not.  Sometimes the false positive tests are transiet, sometimes they are persistent. 

I hope this clariifies things.  If you have additional questions or if any of this is unclear, please use your up to tow follow-up questions for clarification.  EWH

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9 months ago
Thank you so much for your very clear response. It makes me feel a little calmer/better. The same screening test was used when I last tested in November of 2017 and it was a clear negative so I was concerned why this time it was “equivocal” with the same test. Since I wasn’t familiar with syphillis and what it was or looked like, I began reading what the symptoms were and what it looks like and I did experience some of them. I had a weird dark red flat palm rash (non-itchy, non-painful) which was brief only lasting probably less than half an hour. Had a lot of hair loss as well and some lesions on my lips which lasted only a few days. Two months after my two time “encounter”, I got together with my boyfriend whom I’m in a loving monogamous relationship with. We’ve been together a little over one a half years and are very happy. We have not used protection during our relationship. I’m confident that he is not cheating on me. He developed a few months, ago red bumps on the soles/bottom of his feet, those lasted awhile.  They did not itch and they did not hurt. He had one sore/lesion in side stomach area, did not last long. He has hypertension, a lesion/growth on knee (severe knee pain/problems) and has experienced dizziness, headaches, body aches, and malaise. It should be noted that I got my symptoms first, before he did. Due to this, was scared and worried that I gave him this infection. He says he’s been tested during his annual physical exams (two of them since we’ve been together) and that he’s fine (I believe him) but don’t know if those tests included syphillis tests. I know that a rash on your palms (me) and soles of your feet (him)  are main symptoms and I know now that my confirmatory tests indicate negative, however, considering the symptoms described,  should I re-test? 
Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago
You are correct that a rash on the palms and soles can be due to Syphilis. On the other hand, rashes of this sort can occur for many other reasons. I would have confidence in your test results but your peace of mind is also important. If you would feel better with repeat testing then I would certainly do it. The test is easy to do and not overly expensive.

Regarding your boyfriend’s test, your assessment is a wise one. There are so many possible tests that can be done that to assume the testing includes any  specific tests for any particular problem, including Syphilis, has the potential to be misleading. I would urge you and your boyfriend to always be sure that you know what you are being tested for.  EWH
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9 months ago
Thank you again for your responses and expertise. You have made me feel much calmer and at ease. One last question, I was drinking alcohol approximately 32-34 hours prior to taking syphillis test. I read that alcohol can produce a false negative RPR result. Is this true? 
Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago
No, neither alcohol nor medications would interfere with the accuracy of your tests.  EWH---
9 months ago
Ok thank you so much for your help and information. Re-tested today. Have a nice weekend. 
Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago
Great. Normally now that I have made three responses, this thread would be closed however I will keep it open for another few days in case you get another problematic result. I am confident it will show that you do not have Syphilis. EWH---
9 months ago
Good afternoon. My GYN called me today stating that an RPR syphillis test was negative (which it was before). Very relieved to hear this. They use the RPR as the screening test in that office for everyone (as opposed to my primary who uses the IGM/IGM as the screening which I came out “equivocal” in).  I do have a question/concern though, I read that if you are in the late latent stage, you can come up as a false negative on the RPR test. If my two “encounters “ were almost two years ago (will be two years next month), that would put me in the late latent stage (currently have no symptoms). What is the probability of this being a “false negative”? If I had it, would it still show on this RPR test two years later? Thank you....
Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago

Thanks for the follow-up.   I know this is reassuring.  You are in the clear.  Just beware that in the future, if screened again with  an IgM/IgG test, you may once again have a false positive test. 

Two years is too soon for this to have progressed to late latent infection and for a previously positive test to have become negative.  Furthermore, the other syphilis test you had, the TPPA, would have been positive if this were late latent infection. Be confident that you do not have syphilis.

With this, as per Forum guidelines, this thread will now be closed.  Take care. Stay safe.  EWH

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9 months ago
Thank you so much! You were extremely helpful, so grateful for your input, I really do appreciate it. The anxiety and stress surrounding  this was debilitating. So happy to go and feel,  back to normal. Will relax now and continue living life......all the best.
Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago
Glad we could help.  That is our goal.  EWH
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