[Question #8114] Syphilis

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48 months ago
Hello I have spoken your Dr hook, this is the same exposure as last time which is 9 months ago, so when I Tested one month post exposure everything was negative but last Friday I did another test and syphilis came back positive But I never had any symptoms no sores didn’t feel sick But I did get the penicillin shot they gave me two this past Monday an  I go in next Monday for another test and another shot of penicillin


At 9 months is syphilis curable? because I read the the tertiary stage can start at 1 year and that can’t be curable from what I read

Why didn’t I show symptoms during these pass 9 months?
 
 
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H. Hunter Handsfield, MD
48 months ago
Welcome back to the forum. I was on call for this question, but I reviewed your discussion with Dr. Hook four months ago. I agree with all he said, and I'm happy to address your current (and quite interesting) question.

Something doesn't compute. Please provide details of your syphilis test results. What kind of test was positive? Exactly when was it done, i.e. how long after the sexual exposure described in your previous thread? If it had a numerical component, can you provide that information? (For example, if an RPR or VDRL test was positive, it will have a "titer" value, such as 1:4, 1:16, etc.) Was a second, i.e. confirmatory test done? If so, what specific test? Is your doctor or clinic experienced in syphilis and did s/he confirm the diagnosis? If so, what stage of syphilis was diagnosed? And was any syphilis testing done in the 1-3 months after the exposure described? If so, exactly what test was done and what was the result?

Even if syphilis is confirmed, it is almost impossible you were infected during the sexual exposure described previously. Not only did you have a low risk exposure, but the treatments you received (ceftriaxone plus azithromycin) would have prevented syphilis or would have cured an incipient, i.e. incubating infection. Have you had sex since then? (Including sex with a spouse or regular partner?) If not, and if the diagnosis was confirmed by proper testing, it might be a distant past infection now coming to light. Or, perhaps most likely, you had a false positive test result.

I look forward to helping further with the additional information requested!

HHH, MD
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48 months ago
My first test at 27 days was a rpr it didn’t give me a value it just said RPR my partner test positive on her RPR which was 1:2 but her treponema palliudum was negative her doctor said it could be a false positive but when I tested last Friday it came back positive reading at 1:1 
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48 months ago
All of my sexual encounters are heterosexual but I have never seen a sore or any symptoms related to Syphilis ask my partner she said  she has always been testing  even when she lived in Peru and she has never had symptoms 
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H. Hunter Handsfield, MD
48 months ago
As per your other info, things remain uncertain. I'll just add that syphilis rates are high in Peru, including a lot more heterosexual transmission than in the US. Keep your upcoming doctor appt, ideally with both of you, with both re-tested with titered RPR plus a standard confirmatory test such as FTA-ABS or TPHA. I won't have any further comments or advice until after that visit and those results are available. In the meantime, it seems unlikely that either of you has active, transmissible syphilis -- but cannot yet tell with certainty.---
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48 months ago
Is there other stuff that can cause a rpr cause a false positive, they say hiv can cause a rpr test to cause a false positive but that test came back negative this past Saturday and my hepatitis b and C are negative, I was positive for hsv1 (2.11) and my hsv2 (<.10) negative for,  and her Terepona AB test was negative 
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H. Hunter Handsfield, MD
48 months ago
As I said, I’ll comment once more after you report the results of repeat and proper testing, but not until then.---
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48 months ago
Updated: this passed Monday i retested my RPR came back negative and the confirmation test was a FTA-ABS an it also came back negative
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H. Hunter Handsfield, MD
48 months ago
OK, thanks. You had a temporarily false positive RPR when first tested. People with persistent false positive RPRs sometimes have underlying health conditions like autoimmune diseases, and it also can occur in pregnant women. Certain drug reactions also can do it. However, there has been no research at all on the causes of transient false positive results, which obviously is the case here. But this situation is not known to be associated with any health problems of any kind.

So I cannot say anything more except that you definitely do not have syphilis now and have never had it in the past. You did not need the penicillin treatment, which should not have been given without a positive test (like FTA-ABS) to confirm the RPR result. But from here on out, no worries and all is well! 

That concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.
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