Suggest Treatment For Syphilis

Posted on Sat, 13 Dec 2014

Question: I am a married man. This summer I stepped out of my relationship this summer - I received oral sex around July 15th August 13th-I visit clinic. I was tested for Gonorrhea, Chlamydia, Syphilis, and HIV all results return negative (even though I was early for the syphilis window). I was also treated with Rocephin 250, 1g Azthromycin, and of course 2.4 MU BPG. On August 15,16th I had sex with my wife where we conceived. I was confident that i was fully covered from STD even though I had not cleared the window. I had read a post from Dr. Handsfield on medhelp saying that you are non infectious 24 hours after the shot of BPG (http://www.medhelp.org/posts/STDs/How-long-are-you-contagious-after-treatment-for-syphilis/show/0000) On 9/17 (4 weeks after last exposure) My wife has all her normal tests done with OB/GYN. To both of our suprise the RPR turns up positive (1:1) and the confirmatory done by chemiluminescence (which I though was weird) was negative. I freak out, tell her about the indsicretion She is tested for syphilis via RPR and EIA again 2 weeks later just over 6 weeks from our last sex(Which I have read on medhelp a number of times is conclusive via Dr. Handsfield). The doctor was satisfied but I had read the Trep-Sure test they used, would not be the best test during Primary syphilis.

Are these test sufficient for my wife?

Could I have passed syphilis to her even being treated about 48 hours before our sex

Answered by Dr. Sankaranantham Murugan (4 hours later)

Brief Answer:
RPR likely to be a false positive result

Detailed Answer:
Hi, Welcome to HCM.
Thanks for posting your query.
RPR test for Syphilis is a nonspecific test and Biological false positive results can occur. Especially a low titre less than 8 dilution might be likely to be a false positive one. Conditions other than syphilis also, it can produce a reactive result.
Chemiluminescence test for syphilis is highly specific, but a TPHA test would be preferred better to rule out Syphilis totally.
Injection BPG LA 24 has action in the body for 3 weeks and Treponema Pallidum, Syphilis causing organism is a comparative slow reproducing organism. So we used to advise our patients to resume sex after a month following Anti-syphilitic treatment.
DR S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sankaranantham Murugan (30 minutes later)

What about the non reactive rpr taken two weeks later as well as the eia (igg/igm). Both of those were negative. Would they prove original 1:1 to be a false positive.

Answered by Dr. Sankaranantham Murugan (16 hours later)

Brief Answer:
Confirms that she is free from Syphilis.

Detailed Answer:
Hi,
Welcome back.

Biological false positive could be reactive for a very short duration (acute) or persist for a longer duration (Chronic). With acute Biological false positive test could become non-reactive subsequently with a repeat tests. So your wife is free from Syphilis and you need not worry.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sankaranantham Murugan (59 minutes later)

Im still a little worried, is it possible that the second roind of testing 6+ weeks adter pir last sex coild be false negative?

Answered by Dr. Sankaranantham Murugan (7 hours later)

Brief Answer:
False negative RPR uncommon after 6 weeks

Detailed Answer:
Hi,
Welcome back.

RPR is highly sensitive than any other test. So this test is used frequently and widely in spite of it being a non-specific test. False negative test is uncommon after 6 weeks of the contact.
So you need not worry about the possibility of false negative result with the second test.
DR S.Murugan

Note: Consult a Sexual Diseases Specialist online for further follow up- Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar