[Question #9963] Clarifying Question

27 months ago

Hi Doctor,

It seems my previous question was closed, so sorry to ask another question, but just wanted to clarify a few things about syphillis:

1. Since my treponema eia test was non reactive, does this mean that I never had a syphillis infection?

2. How likely is it that I could have had syphillis in the past but my treponema antibodies are no longer detectable (keeping in mind that I had an EIA test this year, 2022, 2021, 2019- all negative/non reactive)

3. Every thing I read says treponemal test usually, most likely always remain reactive. How many cases have you seen where these tests didn’t stay reactive?

Edward W. Hook M.D.

27 months ago

Welcome back to the Forum. Your prior question was closed because you had succeeded your question limit. We provide up to three responses to each client's questions- you had more than 3 responses so, as per Forum Guidelines, the thread was closed. Questions in the Forum, withthe exception of questions about herpes, are assigned randomly to Dr. Handsfield and me- we do this as we have worked together for over 40 years and while our verbal styles vary, the substance of our responses have never differe4d. In preparing to address your follow-up quesitons, I reviewed all that Dr. Handsfield said and agree entirely with his assessments and advice. As for your new questions:

1. Since my treponema eia test was non reactive, does this mean that I never had a syphillis infection?

This result means that you have NEVER had syphilis. Treponemal tests, including the EIA test become positive very early in infection and with the exception of becoming negative on VERY rare occasions when persons are treated in the earliest stages of infection (within a few days of infection), they remain reactive for life. Having reviewed the scenarios you have described you can assume that you have NIVER had syphilis.

See my comments above. There is no evidence or reason for you to worry that you have EVER had syphilis. This is not something to continue to worry about.

3. Every thing I read says treponemal test usually, most likely always remain reactive. How many cases have you seen where these tests didn’t stay reactive.

See my comments above. For treponemal tests to become negative is extraordinarily uncommon.

I hope these responses will be helpful and will allow you to put your concerns aside. EWH

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27 months ago

Thanks for putting this in perspective doctor. I also read a CDC article that says 15-25% of those treated at the primary stage may revert to non reactive

1. What does the cdc mean by primary stage? How early would these people need to be treated?

2. Does a shot of rocephin and 1g of azithromycin treat already established syphillis? I ask because a doctor gave me that shot as a “just in case” for chlamydia and gonorrhea. Could that have cured syphillis if I contracted that ?

Edward W. Hook M.D.

27 months ago

I'm sorry you are having so much trouble moving forward. I hope these somewhat repetitive answers will help:

1. Primary syphilis is the syphilis stage when a visible open sore, the chancre is present. It is a small proportion of the total ways that syphilis presents to clinicians. The CDC's estimate is on the high side- the data suggest that a smaller proportion (certainly less than 10% of persons diagnosed with syphilis will revert.

2. In the earliest stages of syphilis there are data (from my published research) which indicate that this therapy would reliably prevent development of syphilis when administered for gonorrhea treatment.

EWH

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27 months ago

Thanks doctor! Regarding your last answer:

- does that mean that a rocephin shot wont cure an established syphillis infection? It will however stop an infection from developing before the person is able to infect someone?

Edward W. Hook M.D.

27 months ago

This will be my final answer. You should not need to return with further questions on this topic since there is NO evidence that you have ever had syphilis.

A single shot of Rocephin, particularly when given with azithromycin would prevent syphilis but it would not necessarily cure established disease since the duration the antibiotic is in the blood stream would be briefer than what is thought to be needed to cure syphilis.

It's time for you to move on. EWH

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