Thank you for your time and expertise on this site. You were helpful to me many years ago on MedHelp and I’m very grateful for all the help you provide to so many on this site. 

I am female and had an ongoing extramarital relationship with a married acquaintance from 2006-2010 . During this time I performed unprotected fellatio probably around 20 times, and had unprotected vaginal intercourse once. He performed unprotected cunnilingus on me about 3 times. He was the only partner I’d ever had besides my spouse, and I am aware of all of his partners before me (3), including his spouse. He was very low risk as far as I could tell, and he’d only had unprotected sex with his wife and me. Around 2009 I started having some symptoms that at the time I thought might be HSV, but in 2011 I tested negative for both 1 and 2 via westernblot, and he tested positive for 1 and negative for 2 in 2015, at my request. In addition to the HSV testing 2011, I also had RPR and HIV blood tests and urine tests for chlamydia and gonnorhea — all negative. My problems have really started in the last 7 years with being worried about syphilis. I’ve had 2 TPPA tests (non-reactive) and have donated blood 25 times (MHA-TP) with no known issues (my partner was also a regular blood donor for many years, also with no known issues). This past April I was finally able to convince him to get a TPPA test as well, and it too was non-reactive. My deep concern is with symptoms I’m perceiving in my spouse. He’s donated blood for the first time recently (MHA-TP), and no subsequent issues came to light. In the last 14 years I have taken antibiotics (my spouse has not) but I am aware IF there’s been an infection, with the types of tests taken, regardless of antibiotics, they should remain positive for life. I’ve read an awful lot on this forum, MedHelp (although they’re all old posts now), and have done ridiculous amounts of research on NIH, FDA/AABB regulations, medical journal studies, etc. my head tel

Among STI’s syphilis is relatively rare.  In addition, during the interval you described, the 1st to 2 decades of the 21st-century, Syphilis was disproportionately common amongst men who have sex with other men and was decidedly unusual amongst heterosexual men and women. From everything you say, your casual partner was low risk and quite unlikely to have syphilis. In addition, syphilis is transmitted only through direct Sexual contact and the exposures you described are unlikely to lead to syphilis transmission. Finally, and most importantly, as you are already aware, when persons acquire syphilis their treponemal blood tests such as the TPPA are positive virtually forever. Given the history that you provide of your own blood transfusions (all transfused blood is checked on every occasion it is donated for syphilis) you can be 100% confident that you have not had syphilis and, therefore, cannot have transmitted it to your husband.  The fact that your regular partner has also’ donated blood on regular occasions provides further proof that he has not acquired syphilis from you or anyone else at any time. 

I hope the information I provided has been helpful to you. Please don’t worry about the possibility of having it sit for us. Your laboratory test prove that this is not the case. EWH

Regarding the symptoms that you have noticed in your spouse, let me remind you that the purpose of testing is not only to make diagnoses but to rule out diagnoses. Particularly with nonspecific symptoms, it is valuable to have a negative test to rule out certain problems. This is the case for your spouse and his symptoms as far as Syphilis is concerned. Believe your ( and his) test results.  Don’t let your own possible guilt lead you astray.  It is time to move past any concerns about syphilis you may have.  I believe you know this intellectually and hope that my comments will help you to accept this emotionally as well. . EWH

1. Although you mention the (assumed) negative blood donation tests specifically as being proof of either not currently having or never having been infected with syphilis, do you extend this same confidence to the non-reactive TPPA tests that both I and my former casual partner had, even though they were done many, many years after exposures? To me, for some reason I feel like the tests done at labs are more legitimate due to their definitive yes/no results than a blood donation test where you only hear back if something’s wrong. You’re not donating to get tested, and they’re not there to provide you with results. So while I know regulated donation collection sites use some of the best tests to ensure a safe blood supply, I do wonder what they allow to go through and what they don’t, especially when there’s an increased need. The FDA’s guidance suggests all true positive donations are discarded, but I don’t feel comfortable relying on this system as a good way to gauge past syphilis infection, although it does help in the larger picture.

2. I’ve seen a lot of confusion and mixed interpretations on this forum about active/current infection vs past infection, so I really want to make sure that it’s clear that my concern isn’t whether I have syphilis now, because I know I don’t, but whether I’ve ever had it in my life, whether I’ve ever transmitted it to my spouse, whether he, not taking antibiotics, has it now (or ever), and what the best way is to show that.

3.  For those who do become infected, but abort (early cure) the infection from ever producing symptoms and therefore from ever producing positive blood test results, is this the only instance that one acquires syphilis and never develops a positive treponemal test later, by curing during incubation?

4. As it relates to my situation, if my former casual partner had transmitted it to me, his treponemal test would have been positive or reactive, right? And if I transmitted it to my spouse, my treponemal test also would have been positive or reactive, correct? I’m really not putting as much stock in “successful” blood donations as I am in my and my former casual partner’s non-reactive lab-based TPPA results.

9. I’ve read on the Captia EIA insert, under the limitations of the test, that negative results on tests done 10+ years after exposure may not be reliable. I couldn’t find any supporting documentation to their claim. Additionally, in this same insert, it mentions a figure of 85% of past infections being positive for life. These were concerning claims that go against everything that says treponemal tests are positive for life. I do know that different tests have different positivity rates during different stages of the infection.  What do you make of this caveat that they have in their test materials?

10. Finally, my educational question: I’ve researched extensively about gumma, a benign manifestation of tertiary syphilis, but have only found information in terms of its existence. I have read one UK-based case study from 2009 that very briefly described gumma presentation and their response to treatment, in the study’s particular patient’s case. I searched this forum and medhelp a lot to find anyone else who’d ever asked about them and never really found anything of substance, so I thought that asking about them may benefit others like myself who seek information about them. My questions regarding them are: what is the process of gumma development? How long do they last? How long can one have gumma? Do they go away without treatment? What’s their life cycle? Does having gumma only occur with “active” syphilis, or can it also occur with latent? Will all blood tests be positive (or reactive) when one has visible gumma? How long can someone have tertiary syphilis for? If one does have tertiary syphilis, can it go back to being latent, or does it eventually progress to death? 

Dr. Hook, your help, guidance, and shared knowledge is very much appreciated. As you mentioned, intellectually I feel like I logically know the answers to much of what I’m asking, but unfortunately there is an emotional/mental component to all of this that is excruciatingly difficult to overcome, so I’m thankful to have your responses that I can go back and read when I start to get nervous or worried.

Thank you again for your extensive help - I really hope finally asking about my specific circumstance as opposed to reading about others’ can help me move on. What you provide here is truly a godsend. 

1.  Your skepticism regarding safety measures to keep the American blood supply safe is misplaced. Laboratory test performed on transfuse blood are extraordinarily accurate. Your TPPA results serve to validate the fact that you do not, and never had Syphilis.