Syphilis

Hi. I have had un protected oral with another guy who I just met. I was gettin the oral. I don't give at all. I went to the doctor and he did blood work and urine tests for std and HIV. The results were all negative except positive for syphilis. I don't have any sores etc. Since I don't give oral my question is how can this be? Could it be a false positive? The only way I could have got it if I do have it is if the sores were in his mouth and we kissed or he performed oral on me with the sores in his mouth even though I don't have any cuts on my penis. Can you explain??

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help but I believe that you will need more information.  Syphilis tests are typically blood tests and depending on the test could reflect relatively recent infection, longstanding, previously acquired infection, or be falsely positive.  In addition, because of the possibility of a false positive test, two typically different and unrelated tests are usually done to make a syphilis diagnosis. The broad categories of these two types of test are usually referred to as either non-treponemal tests (examples are the RPR and VDRL tests) or as treponemal tests (examples include the TPPA, Treponemal EIA, and FTA tests).  In addition, because syphilis blood tests can be positive following syphilis treatment, we need to know if you have been treated for syphilis before.  Finally, for the non-treponemal tests, knowing the "titer" of the test is also helpful in determining what is going on.

Thus, before I can help you, I need to know:
1.  Have you been tested before and the results.
2.  What sort of test was done, i.e. the name of the test.
3.  The test results.

Your doctor should incorporate answers to the same question in his/her decision making.  When you know the answers to these questions I can comment further but you should also be asking the same question you asked me of your own doctor.  EWH

[jd1203]

1. I have been tested before and the results were negative. 09/2012

2. Syphilis screen EIA

3. Positive

The doctor called me yesterday evening to tell me this and has prescribed meds for 14 days.

[Edward W Hook, MD]

Very helpful, thanks.

The EIA test is a treponemal test is a treponemal test which has problems with false positive results.  It is recommended that persons with positive EIAs have follow-up quantitative RPR tests to determine the state and activity of their possible infection.  If the RPR is positive you clearly have acquired syphilis at some point since you were last tested and need treatment.  If the RPR is negative, you may have had syphilis at some point in the past, you may have a falsely positive test or you may have very recently acquired syphilis and will be developing a positive RPR within a week or so of when your EIA test was performed.  

Given your history and lack of lesions, I might not treat you for syphilis and would need to discuss this further.

If I were going to treat you, unless you are penicillin allergic, I would not treat you with pills but with a single penicillin treatment as recommended by the CDC.  EWH

[jd1203]

Actually doctor I am penicillin alergic (allergic). What are the chances of acquiring  HIV this way? I don't know if the other guy has it or not.

[Edward W Hook, MD]

there are no proven cases in which anyone has gotten HIV from receipt of oral sex.  I would not worry.  EWH

[jd1203]

Thanks doctor the only reason I ask is that on the Internet it states that if you have syphilis it's in conjunction or its likely to also get HIV also or vice versa.

[Edward W Hook, MD]

These statements are genralizations relevant to ano-genital sexual contact, not oral.  Further, as I tried to outline, its not clear to me that you have syphilis.  EWH

[jd1203]

Hey doctor, I retested for syphilis and it came out negative. I tested a week after the first test. I also found out the ratio for the positive result on the first test was 1:32 I don't know if that explains anything. So my question is the first test was positive, the second test was negative and my doctor wants me to retest in end of march again. So which test do I believe? Also, would the medication doxycycline the doctor put
me on after the first test result would clear up the syphilis in a week causing the negative result?

[Edward W Hook, MD]

It would be most unusual for a syphilis blood test positive at a 1:32 dilution to become negative in just a week.  Something is still wrong here.  If you have not, you still need testing with a treponamal test.  EWH

[jd1203]

Hey Dr Hook, I'm a little confused. My doctor said the second test was negative so the first test could have been a false positive. So do u believe the first test which is positive or the second test which is negative? Even though i dont have any chancre or sores.

[Edward W Hook, MD]

I'm not sure what you are saying.  As I said earlier, if you were tested with both a treponemal test and a non-treponemal test and they are not both positive, then your positve test was falsely positive.  On the other hand if you had two tests using the same test a week apart using the same test and got different results then there is something wrong with the testing - syphilis tests should not change so abruptly.  

It seems like either you are reporting things out in a disjointed fashion or your doctor is not explaining what is going on well.  EWH

[jd1203]

Hey Dr. Hook, I tested again this week with a different doctor and he said i was positive.

Here are the results:

SYPHILIS SCREEN  reactive
RPR                           reactive
           TITER 1:2 DIL
T.PALLIDIUM, FTA-ABS reactive
                                 3+ reactive

So, Im confused.. The first test at kaiser was positive. I started taking doxycycline ( 2 week course). I retested one week later and the Syphilis EIA test was negative. I went to see this docotor and he told me that the first test was a false positive (even with a 1:32!!) he said it could be lab error. I was not satisfied witht the answer so I went to a private doctor who retested me (the results above) this is my 3rd test and he said I am positive and that i should take 4 weeks of doxycycline! What do you think? also, If i do have syphilis which through my understanding is spread through blood contact if the person had hiv would i get that too since i got syphilis from him? I only have had un protected oral sex and I am the one receiving as well as hugging and kissing. My 2 lymph nodesin my groin area are swollen too.

[Edward W Hook, MD]

Once again, this is disjointed statement which is difficult to evaluate in isolation.  If you wish to list the tests you have had by name, their results and when they were done, as well as what treatments you've had, I can try to comment.  Trying to interpret isolated test results may just confuse things more.

The isolated test results you report above are consistent with having or having had syphilis.  These tests can remain positive following successful therapy and need to be interpreted in relationship to prior test results.  EWH

[jd1203]

Sorry I forgot to state the date.

The last tests were done on 2/12/13.

I had a syphilis screen test which was reactive.
The RPR test was reactive with a titer of 1:2 dil
The t.pallidium, Fta-abs test was reactive.

This is what my doctor sent to me. I have been taking doxcycline 2 weeks prior to 2/12/13. Also, i have been taking care of my neice who is  3 months old. Just want to make sure I dont give her syphilis by hugging or kissing her on the cheeks. I dont have any sores etc.

[jd1203]

Hi Doctor,

Also, i have been taking care of my neice who is  3 months old. Just want to make sure I didnt  give her syphilis by hugging or kissing her on the cheeks. I dont have any sores etc. Can you spread syphilis that way?  Or should I not touch, kiss, shake hands etc?

[Edward W Hook, MD]

A " syphilis screen" is un-interpretable as I mentioned above,. Your RPR reactive at 1:2 along with a reactive FTA-ABS indicates that you had syphilis.  This test will probably decline in titer (strenght, i.e. to a 1:1 or non-reactive) over the next 6-12 months, although in about 20% of patients with syphilis the blood tests can stay positive for long periods of time.  Your doxycycline is recommended therapy for syphilis in penicillin allergic persons.  

This will be the final reply to this thread.  You need to sit down and discuss your concerns with someone who has ALL of your test results available to help you with your understanding.  Syphilis blood tests can remain positve long after successfull treatment.  The doxycycline you took is recommended therapy and will render you non-infectious to others.  Even if you were infectious (you are not), syphilis is spread through DIRECT contact with a syphilis sore, NOT by hugging, kissing, shaking hands, etc.  There is no risk to your niece from the activities you describe.  

End of thread.  EWH