[Question #9313] Follow up to 9149 - Accuracy of treponemal tests many years later
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33 months ago
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Hi Drs. H&H,
A couple of months ago a question was asked on this forum by another user that Dr. Handsfield responded to but which the requester did not answer back or offer any follow up ([Question #9077] Rhinitis Sicca, dry nose - Syphilis). This question has been haunting me ever since I saw it because this is one of the symptoms that I’ve been seeing in my spouse that has me VERY worried that at some point he acquired syphilis from me and it has gone untreated and undetected. I found a site that the person may have found the information on (https://www.healthline.com/health/atrophic-rhinitis), so I wanted to post that here to get thoughts on this condition. As you’ll see, one possibility is that this is “secondary” AR, which can potentially be caused by syphilis.
You’ll also see from my interaction with Dr. Hook that based on low risk factors and low risk exposures, as well as non-reactive TP-PA tests in both me and my former casual partner (who is not my spouse), and no post-blood donation notifications for myself, my former casual partner, AND my spouse (although these tests/donations were all many, many years after my encounters), his assessment is that I never acquired syphilis at any time and therefore never could have passed it on. I know that AR is nonspecific and has multiple possible causes, but because I’ve already been extremely afraid that I acquired syphilis and passed it to my husband, and he has been experiencing these and other highly questionable symptoms, I can’t help but be afraid that it’s this condition that’s possibly caused by the one thing I have the most skepticism about testing.
Somewhat related: Dr Handsfield also answered another recent forum question about TP-PA testing and it’s purpose for when it’s used, and how an EIA test is the more “preferred” test. His response to this question worried me greatly because that’s really the only testing I and my former partner have had, besides the type of test used for blood donations. I’ve aleay
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33 months ago
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So sorry.
I’ve always thought any treponemal test would be adequate to show whether or not antibodies are present to show whether one has or hasn’t had syphilis. That’s the only test I and my former partner had available to us at the time, so now I’m worried that it wasn’t the right test. I just need a definitive way to show I’ve never had it. Is what I had definitive? Do I need to try to find an EIA instead?
Further, do treponemal tests eventually go negative sometimes? In, say, 12-15 years?
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Edward W. Hook M.D.
33 months ago
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Welcome back to the Forum. I'm sorry you continue to worry. The very broad array of syndromes and symptoms caused by syphilis has led it to be called "the great imitator". In doing so the lesion is that clinicians should not forget the possibility of syphilis when a patient present with unexplained problems and that syphilis testing should be included in the evaluation. When the tests are negative, the results should be believed. As discussed in our prior interaction, syphilis tests are extraordinarily reliable. In recent years the TPPA test for syphilis has been replaced by EIA tests, not because it is a better test performance-wise but because it is easier to perform and more cost-efficient for laboratories. Your spouse has donated blood. As we have discussed, all donated blood is tests using state of the art testing (there is virtually no tolerance for potential threats to a safe blood supply). His negative results prove that he does not have syphilis, just as your tests rule out the possibility that you were infected
Regarding your question as to whether or not treponemal tests become negative, the answer is yes- on those occasions when primary (the earliest stage) syphilis is effectively treated. ven then for the tests to become negative is quite uncommon. In persons with untreated syphilis treponemal tests are always positive and do not become non-reactive over time. As I said before, you can have complete confidn3c, based on your testing that neither you nor your spouse has acquired syphilis. it is time to move on. If I might gently do so, it is clear that your lingering guilt over your past casual relationship continues to plague you. I would urge you to consider seeking confidential counseling to explore how you might more on. Clearly this "cloud" continues to trouble and, I presume, impact you,.
Respectfully, EWH
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33 months ago
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Dr. Hook,
Thank you for your reply. I know you’re right. This is clearly a real issue for me. Can I please ask you a few more questions, for peace of mind, I’d greatly appreciate it.
1. Can syphilis or any other STD cause kidney stones?
2. Are there any STDs other than syphilis (and other than HIV -he’s been tested for that) that can cause problems in males long after acquisition if left untreated? I’m mostly wondering about gonorrhea and chlamydia. I have no idea if I ever had either, or anything else for that matter, but whenever my husband has anything, my mind immediately turns to STDs as the potential cause.
3. Can you please expound on how the body’s immune system naturally clears G/C in males? What’s a typical timetable for that? Anything my husband could’ve caught from me would’ve been well over 12 years ago - could anything longer that long and/or cause problems later?
3. Is there a male equivalent of PID or anything that could affect organs like the kidneys?
4. Regarding my earlier questions about syphilis, is it true that my treponemal tests, regardless of the type of test, would HAVE to be positive now in order for my husband to have ever had it, either in the past or presently? And that because they’re negative consistently, that means there’s no way he could have had it?
Thank you. The most important question I have is about kidney stones, since he’s had them in the pst and recently.
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33 months ago
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Sorry, #3 at the end should say “could anything linger that long and/or cause problems later?”
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Edward W. Hook M.D.
33 months ago
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I suspect the real issue here is your lingering guilt. Once again, I urge you to seek professional help in addressing this. In the meanwhile, as for your follow-ups:
1. Can syphilis or any other STD cause kidney stones?
No, syphilis is in no way associated with kidney stones.
2. Are there any STDs other than syphilis (and other than HIV -he’s been tested for that) that can cause problems in males long after acquisition if left untreated? I’m mostly wondering about gonorrhea and chlamydia. I have no idea if I ever had either, or anything else for that matter, but whenever my husband has anything, my mind immediately turns to STDs as the potential cause.
This is a "what if" question. Certainly there are complications of gonorrhea and chlamydia which can cause subsequent problems but in such situations these complications typically occur within weeks of initial infection and have obvious genitourinary signs and symptoms.
3. Can you please expound on how the body’s immune system naturally clears G/C in males? What’s a typical timetable for that? Anything my husband could’ve caught from me would’ve been well over 12 years ago - could anything longer that long and/or cause problems later?
The body's immune system cures most infections. this has been studied by following persons (women and men) who have intial positive tsts for gonorrhea or chlamydia. Typically when they return for treatment many of the infections are no longer present.
3. Is there a male equivalent of PID or anything that could affect organs like the kidneys?
Yes, epididymitis, an infection within the scrotum and testicles which, as I said above, occur within weeks of initial iinfection and have clear symptoms of testicular and scrotal pain and swelling. These are not problems that occur years after infection
4. Regarding my earlier questions about syphilis, is it true that my treponemal tests, regardless of the type of test, would HAVE to be positive now in order for my husband to have ever had it, either in the past or presently? And that because they’re negative consistently, that means there’s no way he could have had it?
Yes, there is no way that your husbanc could have had untreated syphilis.
Please seek counseling. These sorts of unwarranted concerns cannot be good for you or for your relationship. EWH
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33 months ago
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Thank you, Dr. Hook, for your patience in answering my questions and your concern about me seeking help. I know it must be frustrating to see people like myself be twisted up by guilt and irrational in thought. I can assure you, being on this side of things is both horrible and scary and is causing many problems for me and in my relationship. I have extreme anxiety over the possibility of harming the health of my spouse.
For my final questions I wanted to elaborate on what I previously asked about other STDs causing long-term issues. Is there any possibility that chlamydia or gonorrhea could be ping ponged back and forth for well over a decade, going unnoticed and untreated, and, not being intimate in any way for the past 1.5 years until recently, I could have still had either one pharyngeally and recently transmitted it to my spouse, thus causing new infection and possibly epididymitis? Our only contact with each other is me performing fellatio, if that helps add anymore context to infection/transmission possibility. We’ve not had intercourse in nearly 6 years. I’ve also not been with anyone else in over 12 years, since my former casual partner. I’ve also tested negative vaginally for both g/c in the last year. Never had oral testing. It sounds like chlamydia might not be as much of a concern orally as gonorrhea, but it also sounds like chlamydia lingers in women longer than men. One thing I read about kidney stones is they could also be caused by UTIs, which are caused by bacteria, so that’s why I’m worried about bacterial STDs. I’m not sure my spouse is very observant were he to have something wrong, like noticeable symptoms of an infection. Plus there’s also the possibility of him being asymptomatic. I’ve read a lot on this site about immunity clearance, but nothing definitive regarding long-term, ongoing reinfection in couples.
Is epididymitis dangerous if left untreated? Does it eventually clear like DGI?
To your earlier comment about treponemal test positivity in untreated persons: in persons with treated syphilis, their treponemal tests are also always positive, right, save for those treated very early after infection?
And to confirm, treponemal test type is basically negligible?
Is it possible he tested negative b/c it was dormant at the time and now it has reactivated and is causing his symptoms?
Is the bottom line that to have had syphilis at any time in one’s life, one would also always have a positive treponemal test, regardless of time passed? I just want to make sure my spouse hasn’t had it ever, treated or not.
Thank you again. I wish I didn’t have more questions. My fear is a prison, but it does help to get answers to my specific situation and not just read answers to others’, so I thank you again.
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Edward W. Hook M.D.
33 months ago
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As you know, we provide up to three responses to each clients questions. These will be my final responses. Should you return with more anxiety driven questions your thread may be closed without a response and without return of your posting feel. We do this out of compassion, nothing more. While I appreciate your acknowledgement of anxiety in the origin of your concerns. what you have not done is indicated plans to seek professional help in addressing it. I am skeptical that your unfounded concerns will go away without professional help which can be provided confidentially. In response to your questions
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The idea that an STI, any STI could "ping-pong" back and forth without being detected or causing symptoms is simply not scientifically possible. The likelihood of a lingering, asymptomatic infection is likewise not a reasonable possibility. Give it up.
Is epididymitis dangerous if left untreated? Does it eventually clear like DGI?
Epididymitis can cause urethral strictures. These are typically quite obvious. Nothing you have said suggests epididymitis.
To your earlier comment about treponemal test positivity in untreated persons: in persons with treated syphilis, their treponemal tests are also always positive, right, save for those treated very early after infection?
Correct, treponemal tests would be persistently positive in treated or untreated persons with syphilis
And to confirm, treponemal test type is basically negligible?
Correct
Is it possible he tested negative b/c it was dormant at the time and now it has reactivated and is causing his symptoms?
No, this is not possible
Is the bottom line that to have had syphilis at any time in one’s life, one would also always have a positive treponemal test, regardless of time passed? I just want to make sure my spouse hasn’t had it ever, treated or not.
Correct
End of thread. Please seek professional help. EWH