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What Is The Cause And Treatment For Syphilis?
Question: I was treated for latent syphillis(seems I contracted it 6 yrs ago) with 3 IM injections of Bicillin 6 mos ago, my initial titers were 1:16 and I just got tested and there was no drop in my titers. I was told not to worry that every person is different and since my numbers didnt rise and that I should come back in 6mos. I'm still freaking out. should I see a different doctor? I was seen at a PH STD clinic.
Brief Answer:
The dose and periodicity of Injection is important
Detailed Answer:
Hi,
Welcome to HCM.
Thanks for posting your query.
You had your exposure 6 years back and now reactive for syphilis. That means you are having a late latent Syphilis.
1. Have the re-activity of non specific test been confirmed with specific test for Syphilis? Sometimes conditions other than Syphilis can also produce reactive results and it is called as 'Biological False Positive" result.
2.For late latent Syphilis we used to prefer to give Injection Benzathine Penicillin weekly once for 4 weeks instead of 3 weeks.
3. You had mentioned that you had received 3 Inj. Bicillin IM 6 months ago. But you had not mentioned at what intervals the injections were given to you and at what dose it was given. It has to be given in the dose LA 24 weekly once and LA12 would not be adequate.
4. As your physician told in some individual it would be delayed to become non-reactive till a year or more, but descending titre would be seen within 6 months.
5. Of late I observed that some individuals were not responding to the standard treatment. For those we used to give Inj. Procaine penicillin IM once daily or Inj. Benzyl Penicillin G IM/IV twice daily for 4 weeks.
You can consult somebody who has good experience in the field of STD management.
Dr S.Murugan
The dose and periodicity of Injection is important
Detailed Answer:
Hi,
Welcome to HCM.
Thanks for posting your query.
You had your exposure 6 years back and now reactive for syphilis. That means you are having a late latent Syphilis.
1. Have the re-activity of non specific test been confirmed with specific test for Syphilis? Sometimes conditions other than Syphilis can also produce reactive results and it is called as 'Biological False Positive" result.
2.For late latent Syphilis we used to prefer to give Injection Benzathine Penicillin weekly once for 4 weeks instead of 3 weeks.
3. You had mentioned that you had received 3 Inj. Bicillin IM 6 months ago. But you had not mentioned at what intervals the injections were given to you and at what dose it was given. It has to be given in the dose LA 24 weekly once and LA12 would not be adequate.
4. As your physician told in some individual it would be delayed to become non-reactive till a year or more, but descending titre would be seen within 6 months.
5. Of late I observed that some individuals were not responding to the standard treatment. For those we used to give Inj. Procaine penicillin IM once daily or Inj. Benzyl Penicillin G IM/IV twice daily for 4 weeks.
You can consult somebody who has good experience in the field of STD management.
Dr S.Murugan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The Bicillin LA dose was 2.4mu once a week for 3 consecutive weeks, the biological false positive was confirmed by TPPA on 3/25/14 and I was asked to retest in 6 mos. which was on 10/1/14 but the results came in today and the RPR still at 1:16. They want to retest me in 6 more months, Do you recommend I go somewhere else and get retested? am I able to retake the penicillin regimen one more time? The provider didn't seem worried but I don't feel very confident if I should wait 6 more months to see if the RPR drops.
Brief Answer:
Wait for another 3 months to have a fall in titre.
Detailed Answer:
Hi,
Welcome back.
As you provider's advice, you can wait for another three months to expect a drop in RPR titre. If it is not falling, then you consider the alternative penicillin regimen for syphilis.
Nothing to worry at present.
Dr S.Murugan
Wait for another 3 months to have a fall in titre.
Detailed Answer:
Hi,
Welcome back.
As you provider's advice, you can wait for another three months to expect a drop in RPR titre. If it is not falling, then you consider the alternative penicillin regimen for syphilis.
Nothing to worry at present.
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
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