[Question #7421] Testing accuracy-syphillis

4 months ago
Hello, Thank you for taking
My question. I will try to be clear but this is a little complicated.  I have asked you previous on this subject but I wanted to get some advice on what else I should do moving forward.  
On sept 9th I tested non reactive for syphillis chlamydia and gonnarhea
On oct 15th I did a follow up test for same STI’s negative on everything and a false positive on syphillis, 1:1 rpr non reactive TPA..
Since my previous test in September I Had  unprotected oral exposures mostly with the same woman 3x, she performed on me and the  last encounter with her was  October 10th.  Protected vaginal sex with a different woman October 3rd.
I have hsv2, take valacyclovir to prevent transmission and normally get breakouts in testicle area, not usually on shaft of penis.  On October 14th I had a pretty bad breakout with a couple of lesions on shaft.   Not sure if this could be the cause of false positive test for syphillis?
When I received my BFP I went into a walk in clinic to discuss results.  They tested me again for gon and chlamydia and gave me  azithromycin and a shot of rocephin before the results came back negative.  These meds were for chlamydia and gon
On oct 22 I went to my doctor and she swabbed the lesions for a pcr test and it showed herpes 2 only, no syphilis. 
Here are my questions
1) could the herpes breakout cause the false positive?  It was pretty severe
2) is it possible I had syphilis even with a non reactive TPA? am concerned that I may of had it and passed it on to my regular partner.
3) I tested two weeks later non reactive. Does azithromycin cure syphillis and if so would it work that fast?  (2 weeks)I read that antibodies will show in most people for quite some time.
4) I tested again nov 17 non reactive about 6 weeks should this be conclusive
5) are the test for chlamydia and gon conclusive at 5 and 7 days?
I have also tested multiple times for hiv hepatitis and did a CBC and cmp all came back normal.
Sorry for the long message just wanted to give the

4 months ago
To clarify my main question is if there is a chance the single dose of azithromycin cured an early syphilis infection and I tested negative two weeks later?  Considering the swab test showed no syphilis and following two tests were completely non reactive.  If you can answer the others that would be great also.  Thanks so much 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
Welcome back to the forum. Sorry for the somewhat longer than usual delay in responding.

I reviewed your recent discussion with Dr. Hook and agree with all he said. I have the feeling you're still overthinking all this (and maybe still poking around the internet and finding information that inflames your anxieties?). My first comment is that it is 100% certain you do not have syphilis. At any point in time, 1-2% of all people have BFP syphilis test results with RPR or VDRL. That means around 6 million Americans, compared with about 30,000 new cases of syphilis annually. And in your case, even the BFP went away promptly. It is simply impossible you have syphilis.

Another factor you're not taking into account is the rarity of syphilis in female sex workers in the US or following exposures like yours. The large majority of those ~30K new syphilis cases each year are in men having sex with men. The chance your any particular female partner has syphilis is extremely low, including sex workers. And you used a condom for vaginal sex.

Those comments address most or all your questions, but to be explicit:  

1) Herpes, whether initial infection or recurrent outbreaks, are not known to cause biological false positive syphilis blood tests, but I can't say it's impossible. Some BFPs may result from other inflammatory conditions. In any case, your result definitely was BFP and has now gone away, so this should no longer be a concern.
2) Your negative TPPA proves you didn't have syphilis.
3) Treating and curing syphilis can make RPR negative, but it takes many months to do so. Your azithromycin treatment is irrelevant at this point. 
4) Yes, your additional negative test at 6 weeks adds to the evidence you do not have syphilis.
5) Yes, gonorrhea/chlamydia testing is conclusive at 5+ days after exposure.

It was a waste of money, time, and probably emotional energy to have had all those "multiple" tests. Stop it.

You're spinning your wheels over nothing. All this has earmarks of heightened anxiety due to a sexual decision you may regret. I hope these comments help you move on without worry. Let me know if anything isn't clear.
4 months ago
Thanks so much for the response.  The guilt this has causes is overwhelming and has led to extreme anxiety.  Bottom line you both feel no need for additional testing and are confident I never had syphilis.  If am incorrect let me know
Your work and this site is very appreciated.  It is difficult to get solid answers from GP walk in clinics etc about sti risk testing etc. which only leads to more anxiety.  I will say my GP was absolutely sure it was a false positive even before the swab test came back
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
Thanks for the thanks. I'm glad to have helped.---
4 months ago
Dr one final question.  I had an infection under my foreskin that I have been applying topical cream prescribed by my doctor.  It seems to be working but I am concerned this maybe another bacterial infection.  It had a discharge that smelled and didn’t appeAr until after my breakout (same location) and after I took azithromycin which either I believe can cause a yeast infection.
Is it possible this is another infection? Even though I tested twice for gon and chlamydia negative at 5&7 days and was treated for both could it be this?
I am asking because my partner who has hsv2 also had a minor breakout around same time I did which gave me anxiety also.  Thanks this will be my last question 
4 months ago
There is no discharge out of my urethra also
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
This sounds like nonspecific balanitis, a common condition in uncircumcised men, usually caused by overgrowth of normal bacteria or sometimes yeast. It might develop in the context of a recurrent herpes outbreak, but more likely the two issues are not related. It is not sexually acquired or transmitted and I'm confident has nothing to do with any sexual exposure. Usually balanitis is prevented by careful hygiene, i.e. soap and water wash with foreskin retracted at least once a day.

That completes the two follow-up exchanges included with each question and so ends this thread. Repeated questions on the same topic are discouraged -- so this should be the last about the exposure on your mind, and STD risks and testing related to it. I do hope the two discussions have been helpful and have achieved the reassurance you need to stoo all worry about it. Best wishes and stay safe.