Concerns about Syphilis

[Razr4]

I recently tested positive for Syphilis - reactive FTA-ABS, repeated and confirmed - nonreactive RPR, repeated and nonreactive again.  The reason why my Doctor ordered the FTA-ABS was because of Neurological symptoms: stiff neck, memory problems, concentration problems, balance problems, chronic headaches.  My positive result was in early April and I have an appointment to see an infectious disease specialist on May 31st. I was diagnosed with Sarcoidosis in late 2005. I have had no lung symptoms from this but other systemic symptoms. There are only two occasions in which I could have contracted Syphilis. One was close to 7 years ago and the other was unprotected Oral sex from a prostitute 11 Months ago. I have a girlfriend now for now for 8 months and have had unprotected sex with her for that duration (we have stopped until this is resolved).  She has tested negative for syphilis.  I have never had any primary symptoms and have always been very conscious of my genital area. Back in 2005 when I was diagnosed with sarcoidosis it was because of bilateral hilar adenopathy & swollen symetrical ankle arthritis.  I also had hair loss, weight loss, fevers, intense fatigue and malaise. Upon the onset of my neurological problems early this year, I have been losing more weight, loss of appetite, muscle aches and intense fatigue.

Recent Results: HIV - negative, possible form of hemolytic anemia - elevated indirect bilirubin, elevated retic count, near zero haptoglobin. I also have yellowing of my eyes and sometimes skin. My symptoms have always been very intermittent. A spinal tap and MRI of the Brain were both very normal.

Should I be concerned about Neurosyhpilis with a normal spinal tap and negative RPR?
Could an RPR be negative just after 11 Months of contracting Syphilis?
Do you think Sarcoidosis can cause a false postive FTA-ABS?
Is it possible Secondary or tertiary Syphilis has caused my Sarcoidosis diagnosis?
    

[H. Hunter Handsfield, M.D.]

The key information you provide is that your RPR was negative and your cerebrospinal fluid (CSF) (i.e., your spinal tap) was normal.  This assumes, of course, that the CSF exam included all the standard tests, i.e. measurement of white blood cells, protein level, and a syphilis test on the fluid.  If those were normal, you do not have neurosyphilis, or any other kind of active syphilis.

Personally, I would have recommended no syphilis testing once the RPR was negative; it is rare for neurosyphilis or any other complication of syphilis to occur with a negative RPR.  Had the FTA-ABS not been done, the question of syphilis never would have come up.  However, I am not blaming your doctor for doing the FTA-ABS; most physicians are trained that way.

Putting all this together, there is no reason for you to believe you have anything other than sarcoidosis.  Certainly you do not have active syphilis, if you ever had it at all.  (And the sexual exposures you describe were essentially zero risk for syphilis anyway.)  The FTA-ABS is said to always indicate past syphilis, but there are exceptions.  Some diseases sometimes cause false positive results, and sarcoidosis probably is one of them.

Bottom line:  Forget syphilis.  Continue to trust your own doc in management of your sarcoidosis.

Best wishes--  HHH, MD

[Razr4]

Just an idea of my profile
29 year old white heterosexual male
Zero homosexual encounters in lifetime
Zero heterosexual anal sex
A few unprotected vaginal & oral sexual encounters between 1998 & 2003
One unprotected oral receptive encounter with prostitute 11 months ago