[Question #8835] Worried about late stage syphilis

39 months ago

About 10 years ago, I was NOT careful in my sexual life and had multiple sexual partners. Before meeting my wife, who I married 10 years ago, I was an idiot and didn't get an STD test. Neither of us have ever had any symptoms that we can remember. I've also never cheated. Two years ago, we welcomed a baby girl into the world. After recently Googling one night out of boredom, I was in a panic when I learned that syphilis can remain asymptomatic—and how congenital syphilis can impact a child after they turn 2! And my daughter is about to turn 2! My wife told me that they did VDRL testing when she was pregnant, and it would have caught anything. But after researching, I learned that VDRL does NOT catch "late syphilis" because antibody titres drop. So after telling her I was still worried, my wife and I both got Syphilis TP (CMIA) tests. We both came back nonreactive for treponemal antibodies. But I don't know enough about the CMIA test or if it can detect syphillis that would be 10 years old. Is the CMIA test conclusive at 10 years? Would it detect “late syphilis” or tertiary syphilis? II’ve read treponemal stays detectable for life — is this true?)

H. Hunter Handsfield, MD

39 months ago

Welcome to the forum.

I'm happy to answer this question -- and sorry to learn you are concerned about syphilis in this situation and that you have been worried about it. There is nothing to be concerned about.

You have misunderstood something you read or found in your online searching. First, a negative VDRL proves that active syphilis is not present and cannot be transmitted, so your child was not at risk. And although it indeed is possible for VDRL to become negative without treatment, the TP CMIA does not; once infected, the test is positive for life. So your and your wife's negative TP CMIA tests mean neither of ever had syphilis.

So all is well. Do not worry about syphilis in you, your wife, or your daughter. All is well.

I hope these comments are helpful. Let me know if anything isn't clear. (And by the way, stop searching the Internet about all this. I seems you have been drawn to information that inflames your fears, and have missed the reassuring information that also is there. Anxious persons need to be very careful when internet searching about the problem they are concerned about!)

HHH, MD

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39 months ago

Thank you for the reassurance — I’ve read your response about a dozen times. I’m so overwhelmingly grateful. :) Anxiety and guilt over my past life/mistakes has clearly been reeking havoc on me. Last follow up and you can call this resolved after posting: so it wouldn’t matter if it was 10, 15 years, and even had an antibiotic treated it, the CMIA test specifically (I see there’s all kinds of tests, TPPA, etc) will identify TP for life. Right?

H. Hunter Handsfield, MD

39 months ago

Yes, correct. Once positive, all those tests are positive for life. The "nontreponemal" tests (VDRL, RPR) are the only type that can become negative with treatment or with infection control by the immune system.---

39 months ago

Thank you so much. You’re a godsend.

H. Hunter Handsfield, MD

39 months ago

You're welcome. Thanks for the thanks. Best wishes and stay safe.---