[Question #7565] Syphilis?

2 months ago

Hi doctors...

I’m not sure why i keep getting locked out of my account but I asked a question a few weeks on the account kaycv90...


Over the span of 3.5 months i have been getting tested for HIV, Syphilis, Ghonorrea, Chlamydia, and Hepatitis. 


My worry is that i haven’t been tested accordingly. My syphilis test came back negative, but i am just now finding out that VDRL and TPHA tests should have also been taken as it could have missed a syphilis infection.


Here are my questions: 


1.My syphilis tests up till 3.5 months have been negative. Do i need to take a VDRL test and a TPHA test to fully rule out a syphilis infection?


2. I have gotten a small white painful bump (maybe a pustule?) on my foot and white fluids came out of it when i popped it. Does this sound like a syphilis related symptom? 


3.Since i am still worried about late-seroconversion of HIV, should i retake an HIV test in any case of it turning positive after 3.5 months?  


This whole situation has caused me severe depression and anxiety and i just feel like I can’t get to the end of this. 

Thank you so much for your help. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
Repeated questions on the same topic are against forum rules, especially when anxiety driven or when users seem to have difficulty accepting the advice already given. Some users have been blocked after repeatedly asking such questions despite being asked not to do so. Perhaps that's the problem? On that assumption, my replies now are brief.

1. Probably you had either an EIA syphilis antibody test or an RPR. If either of these was negative more than 6 weeks after the sexual contact, it is 100% proof you don't have syphilis. In that situation, neither VDRL nor TPHA is ever done and isn't necessary.

2. This symptom doesn't suggest syphilis.

3. If you had either an AgAb (4th generation) at 6+ weeks after the event, or a newer antibody test (3rd generation) after 8+ weeks, the result is conclusive. There has never been a reported case, anywhere in the world, if these tests taking more than 3 months to become positive (not counting persons who were taking anti-HIV drugs, which could delay a positive result).

I hope these comments help. Best wishes.

HHH, MD
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2 months ago
Thank you for the reply Dr HHH.

I realized the email i used for that account does not work anymore so it wouldnt let reset my password on here. 

But regardless thank you for the help. Your answers have been very helpful and I will try to get over this situation.

 All the best 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
Thanks for the explanation. And glad to hear it's been helpful so far. You have one more follow-up comment coming -- if anything comes to mind. Otherwise I'll close the thread in a. few days.

Best wishes and stay safe.
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2 months ago

Thank you 


1)The test that was used for syphilis was a CMIA test (the same test method used for my HIV test) and it reads “The CMIA test detects both IgG and IgM antibodies to Treponema pallidum.” I don’t know what that means but does this still mean my syphilis test is conclusive? 


2)i have some issues with iron-deficiency and i was wondering if that could impede testing in any way? ive read that having a somewhat weak immune system can cause false negatives or need a 6 month confirmation test. 


I apologize if these are starting to sound repetitive and i am seeking professional counselling for it soon. 


thank you so much for your help once again


Best regards 

2 months ago
Sorry i forgot to mention that on the website they state that they will only use an RPR test for syphilis if it comes back reactive. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
1) The CMIA IgG/IgM syphilis test is absolutely reliable by 6 weeks after the last possible exposure. This and other similar tests are now the routine for syphilis testing, and it is normal to reflex to RPR and TPHA only for positive results.

2) Iron deficiency would have no effect on reliability or timing of this or any other STD test.

It does seem you're pretty obsessed with a sexual exposure and decision you may regret. Deal with those issues as you need to -- perhaps including counseling -- but don't confuse these feelings with STD risk. They aren't the same. And as previously discussed, the exposure itself was low risk for STD transmission even if your partner was infected. Do your best to put your STD concerns aside.

That concludes this thread. Best wishs and stay safe.
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