[Question #8733] Oral Syphilis positive?

40 months ago

Dear dr,

History: I had a sensual massage with happy end in september 21 (no oral, no intercourse, no genital contact)

I had protected sex very short in january without skin2skin contact. (I am carefull)

Now:

I performed oral on a guy 4,5 weeks ago. (Which I never did before and heavily regret)

His penis looked clean, he didnt cum and no lessions were seen. It took maybe 1 minute, no deepthroat.

I did a full std check at 23 days (I know too early)

Hiv, chlam and gon negative (penile and oral test)

(To be mentioned I had confirmed influenza and high fever on the day of sample)

Syphilis result:

Syphilis undecided:

Rapid test: positive

TP EIA antibody test: 1.24 (i think cut off value is 1.5, not sure, according test website)

Igg blot = negative

Igm blot = weak positive

Ig17,….: negative

Ig15: positive

I have no ulcers nor any symptoms.

They advice to retest in a few weeks as it could be too early or false positive

Panicking!!!!

Questions:

1 what would you do? Retest or treat?

2 is syphilis possible without having seen lessions nor having them?

3 if test is positive, do I need to treat my wife (hadnt had sex since)

I’l keep you updates, but I am very anxious now and losing will to live.

40 months ago

I have to add: VDRL was rejected because of Gross hemolysis (same sample as other tests)

Edward W. Hook M.D.

40 months ago

Welcome to our Forum and thanks for your detailed history. Thanks as well for your commitment to safe sex. Oral sex only very, very rarely leads to acquisition of syphilis. Your test results are most likely falsely positive. The tests that are positive each test for what are called treponemal antigens and you appear to have reacted falsely with them. The fact that you had influenza at the time you are tested slightly increases the likelihood that this was a falsely positive (actually, it was not even positive, it was undecided)result. In answer to your specific questions:

1 what would you do? Retest or treat?

I would re-test. I would also retest soon with the VDRL or RPR test, if this is negative, this too is compatible with a falsely positive treponemal tests (the rapid test and the EIA test)

2 is syphilis possible without having seen lessions nor having them?

If you had syphilis, you would have most likely had a lesion inside your mouth. This, as well as the fact that your partner did not have a visible lesion make syphilis unlikely.

3 if test is positive, do I need to treat my wife (hadnt had sex since)

Unless you have had sex with your wife, there is no reason to treat your wife.

Again, my recommendation at this time is for your to get a VDRL or RPR test performed as soon as can easily be done. I anticipate that these tests will be negative. If so, your results are almost certainly a falsely positive. EWH

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40 months ago

Thanks for the answers.

I have a test scheduled for monday, maybe I’ll do a second at a different lab to be sure.

Some more questions:

1: the rapid test was a tppa (I think) are false positives possible with this test?

2: The eia was a tp igg (ASI): you mention this is positive, but the value is 1.26 (while cutoff index is 1.50), sl it js correct this is negative or doubtfull?

There was not mentioned positive or negative, only the value.

3. The VDRL was not performrd due to to gross hemolysis, but there was only 1 sample bottle, does this also influence the other tests performed ?

4: if I have Syphilis orally, can I transmit this to my children or partner? (Cheek kissing?)

5: if I have syphillis orally, is my penis then also contagious?

6: the tp igm tp15 was positive (doubtfull), is one antigen sufficient to diagnose syphilis, or do all need to be positive??

7: where do I have to check for lessions, or do you think that now (5 weeks past encounter) will not come anymore?

Thanks and I’ll keep you updated of the results

Edward W. Hook M.D.

40 months ago

Your follow-up questions get into complex technical issues related to test components and formats. I will try to provide brief answers to your questions but to be honest, these sorts of questions are best discussed directly with your own healthcare provider:

1. The TPPA, as well as the EIA test, our tests with use treponemal antigens for detection of antibodies to the syphilis bacteria. Data on precisely how common false positives to each of these tests are are scant however, because both tests use similar antigens, when one test is falsely positive, both tests may be false positive. Falsely positive test results certainly do occasionally occur with these tests.

2. I am not familiar with the values used for defining positive versus borderline test results with this test. Certainly however the results to report are not positive.

3. No, Hemolysis would not impact the performance of the other tests.

4. Most unlikely

5. No

6. No, this single result is not sufficient to make a diagnosis syphilis. In fact, most experts recommend against the use of IGM testing for syphilis diagnosis. Unfortunately however the test is still available and some clinicians choose to use it.

7. Most likely, if there were lesions they would’ve appeared by now. Syphilis lesions can be highly variable and really require an expert diagnostician for identification.

I look forward to hearing your further test results. I anticipate the RPR and/or VDRL test will be negative/non-reactive, proving that the result do you have gotten is falsely positive. Take care. EWH

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40 months ago

Dear Dr.

So I did a new test (at a different lab (B) for Syphilis.

It was a ECLIA test and the result was 0.1 (positive >1.0)

As they use the reverse testing, they didn't do any other tests.

This time the sample was taken by a doctor (in a vein) while previous time it was a self-collected sample through fingerprick. (and it was very hard to collect the blood)

(I also discovered the previous lab (A) used the same ECLIA, and there my result was 1.24)

What do you advice?

1. Is this new test conclusive 5 weeks post encounter or do you advise to retest at 12 weeks?

2. Is there any risk for infecting other partners?

3. Could the hemolytic sample + Influenza caused the false positive?

Thanks for the answers

Edward W. Hook M.D.

40 months ago

thanks for your follow-up and the additional information. If particular potential import is that your original positive treponema test was from a finger-stick process in which you needed to squeeze your finger to obtain sufficient specimen for testing. This not only explains the hemolysis which was noted but may also explain the test result - squeezing to obtain the specimen may have release "tissue juices" which increase the risk of falsely positive test results. Given the questions involved, I still wish that the doctor had specifically requested a RPR or VDRL test. that said, your results are really most consistent with a falsely positive test result. I would not feel the need to treat you or notify partners at this time. In the spirit of being conservative, I might suggest repeating the syphiiis test on another venous blood specimen in a few weeks. I anticipate that such a test would again be negative and would consider this as conclusive evidence that the original result was falsely positive.

In answer to your specific questions:

1. Is this new test conclusive 5 weeks post encounter or do you advise to retest at 12 weeks?

See my comment above. To be entirely sure and approach this conservatively, I would repeat the test, probably as sooon as 8 weeks but 12 would be OK too. Either way, I'd consider another negative absolutely conclusive.

2. Is there any risk for infecting other partners?

Not at this time.

3. Could the hemolytic sample + Influenza caused the false positive?

Again, see my comment above. While influenza may have contributed, I think it is far more likely that having to squeeze your finger would help explain to falsely positive result

I hope this information is helpful. EWH

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