[Question #774] syphilis reinfection or other STD

52 months ago

I am a male (40). Every day I wake up into a painful night mare. My VDRL is non reactive for the last 4 years, but i keep having either sypmtoms, increases in treponemal titers or I am being reinfected so frequent (which is shocking since I meet ‘only’ like 3 guys a year).

Serology:

Mar 2011: VDRL 1/128 ; penicillin 3 x

Apr 2012: VDRL NR, TPHA: 1/10240

Avg 2014: VDRL NR, TPHA: 1/81920

  Avg 2014: penicilin 3 x

May 2015: VDRL NR, TPHA: 1/81920

  Oct 2015: described bellow

Dec 2015: doxycycline 100 mg PO bid, 14 days

Jan 2016: RPR NR , TPPA: 1/10240, Hiv neg.

Mar 2016: RPR NR, TPPA: 1/10240, Hiv neg.

May 2016: I have an app.with my dr., full of shame

 

Oct 2015: 7 months ago i started to experience the following symptoms: 3 days after my intimate encounter my tongue started to burn heavily. A week later, i started to feel pressure in my pelvic region and groin. My abdominal wall became firm like a shield, or it hurt as if i had done 1000 crunches. After another week passed i'd got a cut-like ulcer in the oral commissure (perhaps 3 mm wide), that resolved in a week. In addition to that, some white canker sores developed on my mouth walls) – they were coming and going for a few weeks. 7 weeks after symptoms onset I started to take doxycycline (100 mg PO bid, 2 weeks) (I shouldn’t have, but I was nearly delirious, scared and stupid). 3 and 5 months from the beginning, I tested: hiv negative, RPR non reactive, TPPA 10240, but my inguinal lymph nodes (pubic area, lower abdomen) remained painful even after 7 month (dull, painful feeling 24/7). I also feel axillary nodes occasionaly. Abdominal ultrasound is normal, also general blood check (CRP..).

Questions:

- In case VDRL will still be nonreactive now (after 7 months), would you retreat because of my symptoms?

- Could it be some other infection? What shall I do, to what to appoint my doctor?

Problems in my groin/pelvic region hinder my sports activites and ruin my daily life.

God bless you.

Edward W. Hook M.D.
Edward W. Hook M.D.
52 months ago
Welcome to the Forum.  I will try to help.  From what you report, it sounds as though you had syphilis inMarch of 2011 and were adequately treated.  It is not clear to me that any of the treatment you have had since then was needed.  There are two different types of syphilis blood tests, non-treponemal tests such as the RPR or VDRL and treponemal tests like the TPPA or TPHA.  The RPR and VDRL are quantitative tests whose values are markers of syphilis activity and which decline, sometimes but not always to non-reactive following successful treatment.  Tests like the TPPA or TPHA however may remain positive and not change or even fluctuate despite successful treatment.  Your test results suggest that you have been successfully treated, that you do not need additional syphilis treatment, and that your more recent symptoms are not due to syphilis.  Thus, in answer to your specific questions:

1.  I see no reason for additional syphilis treatment from the information you have provided.
2.  I doubt that your current symptoms Re related to active syphilis.  I would discuss them with your regular doctor.  If you do not have a regular doctor, I would consult an Internal Medicine specialist.

I hope these comments are helpful.  EWH 
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52 months ago
Thank you for a quick answer. I have a GP,who doesn't know what to do with my abdomen. I am getting retreated almost on yearly basis-always the similar story: like after a possible contact i get a mouth ulcer, and my inguinal nodes begin to swell..or my Tpha(tppa) increases (2-3 fold!) and i panic so we treat. Although, my vdrl/rpr remains nonreactive. Q: 1. Okt15: is it possible, that i caught the infection early enough, and i aborted it with doxycycline, so that RPR in January and March remained nonreactive? 2. in case of a treatment failure in presumable syphilis infection, would vdrl/rpr begin to rise again? 3. Do control checks with nontreponemal tests every 6 months suffice to catch possible reinfection in the future (i am gay) and avoid possible false nonreactive result (with being in secondary or early latent phase, and avoiding early primary and late latent)? Sensitivity of rpr/vdrl in those phases should be near 100% , right?
3. Palpable and painful lymph nodes  next to my pelvic and pubic bone, as well as in my groin persist after 7 months..although it is much better than it was. it doesn't feel acute now, but rather chronic. but it is improving in mouse steps. Do i need to check it out with infectologist, internist or urologist?
Thank you very much
52 months ago

I would kindly and desperately ask you for some additional answers, because I appreciate the fact that your opinion is also based on practical experience in that matter. I have a strange feeling that I either never got rid of the bug completely and it somehow keeps reactivating or I was just so unlucky that I caught it again (by oral sex). I strongly believe the latter is the case, since I have no other possible explanation for my symptoms.   

 

My questions:

-if I had started taking doxycycline (200mg) 1 month after the onset of the symptoms (beginning with burning tongue, continued with mouth ulcer and pelvic pain – all within 1st month), would 3 months after the symptoms onset RPR be non reactive? (7th month from the start VDRL is still non reactive). I imagine that RPR had been non reactive even before taking doxycycline, because I would had been in the early primary phase.     

 

-if I test my blood with nontreponemal tests (VDRL/RPR) every 6 months for the next 2 years, would the result become reactive in case of a treatment failure?

 

-even after taking doxycycline, problems with my abdominal and groin pain worsened. Inguinal lymph nodes increased in tenderness for a few months, axillary nodes became painful too. The pain is subsiding (after 7 months), but all that indicates some kind of infection. Hiv is negative. Is it normal for the lymph nodes to remain painful so long?

 

Million thanks for your answers in advance.

Edward W. Hook M.D.
Edward W. Hook M.D.
52 months ago

Sorry for the delayed response.,  I was traveling internationally and the time zones have gotten the best of me.  the symptoms you resort (as well as your lab tests) are in no way suggestive of active syphilis but do clearly indicate that you have had syphilis in the past (presumably around March of 2011).  At this time further retreatment for syphilis is truly a waste of time and medicine and will not change your test results.

Your recurring mouth ulcers could have many other possible explanations and are virtually certainly not due to syphilis. the same is true for your swollen and uncomfortable inguinal lymph nodes. Both your mouth ulcers and your swollen lymph nodes are non-specific and probably unrelated processes which could have very many possible causes other than syphilis.  I think you need to seek other reasons for your swollen and uncomfortable lymph nodes.

If you were to get syphilis again or were failing therapy for your original infection, it would show up with an change of your VDRL or RPR tests to reactive.


Again, sorry for the delayed response.  EWH


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52 months ago

Thank you for your comforting answer. I do not want to bother you too much, but I am in desperate need of help. For my third post, I will be very thankful if you could just confirm (or refute) my thinking.

Let us assume my infection was a syphilis reinfection (and at the same time, I sincerely hope that I am wrong with the assumption, of course):

 

Q: If I presumably had been reinfected in October 2015 and then began to take antibiotics 1.5 month  after the first onset of the above described symptoms, is it possible that the infection could have been aborted before nontreponemal antibodies were produced by the body (since the sensitivity in primary stage is 75%)? And therefore, all subsequent VDRL(RPR) tests (on quarterly or half-yearly basis) in the next 2 years will show as non-reactive, unless the treatment would fail?

 

I just assumed that the quick onset of the acute condition and persistent general lymphadenitis would point towards an ID specialist or venereologist. My GP does not know what to check, since on the outside I do not look ill, and my CBC as well as my abdominal ultrasound are OK. 

Thank you for your help. 

Best regards from EU 

Edward W. Hook M.D.
Edward W. Hook M.D.
52 months ago

The assumption that you suggest makes no sense, given the test results and treatment that you have had.  Your question is like saying, "suppose that I had been invaded by an alien from space".-  we need to believe the tests and the data, not give in to your internet fueled fears.  If you had been exposed in October 2015 and infected, your test would have become positive.  If your antibiotics cured the infection, your test would remain negative.  Either way there is no evidence that you are infected.  You need to stop worrying about syphilis.  IF there is something going on (which is simply not a realistic possibility) you would not be infected at this time with the therapy you have taken.  To perseverate on syphilis if something is going on will keep you from looking for other possibilities. 

This is your third reply.  As per forum guidelines, there will be no further relies to this thread and the thread will be closed in a few hours.  I hope my comments have helped.  EWH

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52 months ago
Thank you for your time and answers. I am pretty sure I am gonna use your service again and I will gladly open a new thread, for sure.
I will take your answer to my last question(s) as a 'yes' and will keep checking my blood (RPR) on a half-yearly basis (which should cover either a treatment failure or a new infection, if it happens - I am single, and I just can not say that I will not meet anybody again till the end of my life. I will keep leading my life as 'monastic' as I can).