[Question #7453] Syphilis?!?!

5 months ago
Hi! Thanks for the service you provide!

I was recently screened for STIs. My RPR was reactive, RPR quant is 1:1. Treponema pallidum antibodies are non-reactive/ normal. 

37 year old straight female. Last sexual experience was 5-6 weeks ago, new boyfriend/ relationship. Neither of us have been symptomatic. The only reason I got tested is seriously just for the sake of being tested due to the new relationship. I spoke with him and he says again, zero symptoms. I have had no symptoms. 


I am HSV1 positive, have been my entire life with oral outbreaks since age 8-10 years old. I have Hashimoto’s autoimmune Thyroiditis and take Synthroid and Cytomel. Other than this, perfectly healthy other than occasional sinus issues. 

False positive or do we need to go to the clinic?  Should I be worried about something further? 
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago

Welcome to our Forum.  congratulations on your sensible approach to your sexual health.  We certainly endorse the practice of both partners getting screened for STIs as they enter a new relationship and congratulate you for doing so.  Unfortunately however, sometimes our tests let us down which is what I suspect has happened to you.  This result is most likely a false positive result.  Had you acquired syphilis, both the RPR and the treponemal test would have been positive.  Let me elaborate a bit on the basis of my assessment:

1. Test results are entirely consistent with a false positive result.,  When persons have syphilis, both tests are typically positive and if one test is positive and the other is not yet, it is the treponemal test becomes positive first.

2.  Most false positive tests have low RPR values such as yours.

3.  Persons with autoimmune diseases (such as thyroiditis) have a somewhat increased risk for false positive RPR results.

4.  Epidemiologically, over 70% of recently acquired syphilis amongst U.S. adults occurs in men with other men as sexual partners.  Thus assuming your partner has not had sex with other men, he is very low risk for having syphilis and transmitted it to you.

Finally, I will add, false positive RPRs are funny things. In many persons they will be transient in nature, then going away.  In other persons they may be chronic.  As a person with an autoimmune process you are at somewhat increased risk for future false positives- just want to make you aware of this so there will be no confusion with future health care providers.


I hope this information is helpful.  If anything is unclear or there are further questions, please don't hesitate to use your up to two follow-ups for clarification.  EWH

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5 months ago
Thank you for the information and super quick reply. Your reply is what I assumed it would be, after much research of my own, but it always feels better to as an expert! 

As I’m sure you know I will ask, is there any reason for further testing or disclosing this information to my partner? I was tested through an online service that prompted me to go to labcorps for my blood and urine, and have not yet seen an MD, as I got my results over the weekend. Is there any need for me to schedule an appointment? I see no reason for treatment as my ag/ab tests are negative and I’m sure the autoimmune disorder is what is flagging the RPR. I just want to be safe with our health and honest with my partner. 
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
I see no medical need for having your partner tested because of your result.  OTOH, if you choose to tell,him about your experience and might adopt your good example:).  EWH ---
5 months ago
Thank you! I will keep this quiet until my annual GYN appointment, and only mention it to her as a forewarning in case she chooses to screen me for STIs in the future. This forum saved me a copay, a headache, and a needless PCN injection.  Happy and healthy holidays to all. 
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
Thanks for your thanks. I am pleased that my comments were helpful to you. Take care. Stay safe. EWH---