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Distressed by the medical advice and treatment I've received for syphilis
Dear Doctor,
Thank you for volunteering your precious time to help me out. I'm terribly confused and distressed by the medical advice and treatment I've received for syphilis. The following is my detailed case history.
1) Sometime between Dec 15-19, 2014, I had protected vaginal intercourse with a female sex worker from Thailand. I did not engage in french kissing, unprotected oral sex, or any activity that involved the exchange of bodily fluids with the sex worker.
2) 5-6 weeks later, on Jan 23, 2015, I experienced a sudden onset of high fever (38.7 Celsius / 101.66 fahrenheit), intense muscle / joint aches, and a slightly inflamed throat. I saw a physician on that very same day and was prescribed Paracetamol. My doctor also ordered a blood test to rule out dengue; which is epidemic in the country I live in.
3) The following day, on Jan 24, my fever subsided but I detected redness in the head of my penis and swelling in the right lymph nodes of my groin. I revisited my physician who ruled out dengue based on my earlier blood test report and diagnosed me with "bacteria infection" based on the "moderate neutrophilic leucocytosis" and "mild monocytosis" reported in my dengue blood test. He subsequently started me on a course of Curam 625 mg, 1 tab 2 times daily for 5 days.
4) Being extremely anxious about the possibility of STD, I requested for a STD blood test on Jan 24. Meanwhile, I commence my 5 day course of Curam 625 mg. My blood sample was obtain BEFORE I ingested any antibiotics.
5) Four days later, on 28 Jan, I visited my physician to obtain my STD blood test results. The results are as follow verbatim:
STD PROFILE
Herpes simplex Type 1 IgG 0.0
Herpes simplex Type 2 IgG 0.0
Chlamydia species (in C.psittaci, C.trachomatis, C.pneumoniae) IgG 0.0
The results was negative, indicative of the absence of IgG antibodies to Herpes simplex Type 1 & 2. No serological evidence of exposure to Chlamydia.
HIV 1 and 2 Ag/Ab Not detected
HIV Ag/Ab screening assay is performed based on ECLIA principle.
RPR (VDRL) Non reactive
TPHA Reactive
RPR non-reactive and TPHA positive: Evidence of past exposure to treponemal infection. Possible treated infection. If clinically indicated, repeat testing (including FTA Abs) on a fresh sample is recommended to confirm the result.
6) This is when my whole treatment experience started going downhill. Based on the above results and recent symptons, my doctor diagnosed me as infected with syphilis and requested that I performed further tests immediately with a fellow physician who is a gastroenterologist!
7) I pointed out to my doctor that by now I'm on my 4th day of Curam, and that it's not logical to perform further tests because the syphilis bacteria would be severely inhibited if not destroyed by the antibiotics. Also, my fever, the redness in the head of my penis as well as the swelling in the right lymph nodes of my groin have subsided. Even if the tests returns a negative result, I will still not have peace of mind because I wouldn't know if the test results have been influenced by the antibiotics.
8) There is also the further problem of the cost of the tests, which would amount to more than USD 130 and I have to show up at the referral clinic on the same day when I have a family event; guaranteeing unwanted attention to my condition.
9) I requested that the doctor treat me preventively. And then after the treatment is complete, I will submit to further tests at a time when I can do so confidentially, without drawing attention to my condition.
10) The doctor would have none of it. He chastised me verbally and advised me to come clean about my syphilis to my wife and family! It's not unusual for physicians in my religiously conservative country to see STD patients as sinners that deserve to suffer.
So now I'm terribly anxious and confused about the following:
a) Should I submit to further syphilis tests and when is the optmimal time to do it?
b) Am I a risk to my family members. Do I need to take special precautionary measures to avoid transmitting syphilis to them? (e.g. avoid sharing food and drinks)
c) Should I be concerned about the throat redness/discomfort I'm still experiencing despite taking Curam? Is this an indication of an antibiotic resistant strain of syphilis?
d) How do I know if I'm really cured and can resume normal sexual relations with my spouse. I'm currently abstaining from sexual relations with my spouse until I'm 100% sure.
These questions have paralyzed my daily life and given me sleepless nights. Thanks in advance for your help Doctor. I'm having a hard time getting good medical advice in my country.
Thank you for volunteering your precious time to help me out. I'm terribly confused and distressed by the medical advice and treatment I've received for syphilis. The following is my detailed case history.
1) Sometime between Dec 15-19, 2014, I had protected vaginal intercourse with a female sex worker from Thailand. I did not engage in french kissing, unprotected oral sex, or any activity that involved the exchange of bodily fluids with the sex worker.
2) 5-6 weeks later, on Jan 23, 2015, I experienced a sudden onset of high fever (38.7 Celsius / 101.66 fahrenheit), intense muscle / joint aches, and a slightly inflamed throat. I saw a physician on that very same day and was prescribed Paracetamol. My doctor also ordered a blood test to rule out dengue; which is epidemic in the country I live in.
3) The following day, on Jan 24, my fever subsided but I detected redness in the head of my penis and swelling in the right lymph nodes of my groin. I revisited my physician who ruled out dengue based on my earlier blood test report and diagnosed me with "bacteria infection" based on the "moderate neutrophilic leucocytosis" and "mild monocytosis" reported in my dengue blood test. He subsequently started me on a course of Curam 625 mg, 1 tab 2 times daily for 5 days.
4) Being extremely anxious about the possibility of STD, I requested for a STD blood test on Jan 24. Meanwhile, I commence my 5 day course of Curam 625 mg. My blood sample was obtain BEFORE I ingested any antibiotics.
5) Four days later, on 28 Jan, I visited my physician to obtain my STD blood test results. The results are as follow verbatim:
STD PROFILE
Herpes simplex Type 1 IgG 0.0
Herpes simplex Type 2 IgG 0.0
Chlamydia species (in C.psittaci, C.trachomatis, C.pneumoniae) IgG 0.0
The results was negative, indicative of the absence of IgG antibodies to Herpes simplex Type 1 & 2. No serological evidence of exposure to Chlamydia.
HIV 1 and 2 Ag/Ab Not detected
HIV Ag/Ab screening assay is performed based on ECLIA principle.
RPR (VDRL) Non reactive
TPHA Reactive
RPR non-reactive and TPHA positive: Evidence of past exposure to treponemal infection. Possible treated infection. If clinically indicated, repeat testing (including FTA Abs) on a fresh sample is recommended to confirm the result.
6) This is when my whole treatment experience started going downhill. Based on the above results and recent symptons, my doctor diagnosed me as infected with syphilis and requested that I performed further tests immediately with a fellow physician who is a gastroenterologist!
7) I pointed out to my doctor that by now I'm on my 4th day of Curam, and that it's not logical to perform further tests because the syphilis bacteria would be severely inhibited if not destroyed by the antibiotics. Also, my fever, the redness in the head of my penis as well as the swelling in the right lymph nodes of my groin have subsided. Even if the tests returns a negative result, I will still not have peace of mind because I wouldn't know if the test results have been influenced by the antibiotics.
8) There is also the further problem of the cost of the tests, which would amount to more than USD 130 and I have to show up at the referral clinic on the same day when I have a family event; guaranteeing unwanted attention to my condition.
9) I requested that the doctor treat me preventively. And then after the treatment is complete, I will submit to further tests at a time when I can do so confidentially, without drawing attention to my condition.
10) The doctor would have none of it. He chastised me verbally and advised me to come clean about my syphilis to my wife and family! It's not unusual for physicians in my religiously conservative country to see STD patients as sinners that deserve to suffer.
So now I'm terribly anxious and confused about the following:
a) Should I submit to further syphilis tests and when is the optmimal time to do it?
b) Am I a risk to my family members. Do I need to take special precautionary measures to avoid transmitting syphilis to them? (e.g. avoid sharing food and drinks)
c) Should I be concerned about the throat redness/discomfort I'm still experiencing despite taking Curam? Is this an indication of an antibiotic resistant strain of syphilis?
d) How do I know if I'm really cured and can resume normal sexual relations with my spouse. I'm currently abstaining from sexual relations with my spouse until I'm 100% sure.
These questions have paralyzed my daily life and given me sleepless nights. Thanks in advance for your help Doctor. I'm having a hard time getting good medical advice in my country.
Syphilis is not a plausible cause of the illness you describe. The blood test results indeed are suggestive of a distant past syphilis infection -- now gone (either because it was treated or cleared on its own).
If your recent exposure was the source, and if the symptoms were due to syphilis, your RPR would have been positive, probably at a very high level (at least a titer of 1:16, possibly much higher than that).
All things considered, it is unlikely that your fever etc had anything to do with the sexual encounter described.
My advice is that if you haven't done so, you locate an infectious diseases specialist. There is certainly no point in trying further to sort this out by online research or by web forums, this one or any other you can find. See an ID specialist in person and take it from there.
Good luck with it.
If your recent exposure was the source, and if the symptoms were due to syphilis, your RPR would have been positive, probably at a very high level (at least a titer of 1:16, possibly much higher than that).
All things considered, it is unlikely that your fever etc had anything to do with the sexual encounter described.
My advice is that if you haven't done so, you locate an infectious diseases specialist. There is certainly no point in trying further to sort this out by online research or by web forums, this one or any other you can find. See an ID specialist in person and take it from there.
Good luck with it.
Bumped up for Vance, Howard and other knowledgeable community members to further comment upon.
Hi Vance,
Thanks very much for your helpful comments.
I've carefully checked the surface of my body including the genital area and oral cavities and find no canker.
On the possibility of an old infection: In addition to the protected vaginal intercourse with a female sex worker 6 weeks ago, I had one other similar episode more than 6 months ago. Since then I've developed no symptoms (and no canker) and hence have not sought or received any prior treatment for syphilis. So the bit about "Evidence of past exposure to treponemal infection. Possible treated infection." in my report is very puzzling. Could it be possible for me to contract syphilis from the earlier sexual encounter and yet show absolutely no symptoms for 6 months?
On the possibility of a false positive: This would imply that some other bacteria has caused my recent symptons (sudden onset of high fever, intense muscle / joint aches, slightly inflamed throat, redness in the head of my penis and swelling in the right lymph nodes of my groin) and produce the TPHA positive result above. Is this likely in your opinion?
In any case, the 5 day course of Curam has completely alleviated my symptoms. I've noticed that the testing window for my Herpes test (5-6 weeks) is incorrect. So I'm thinking of the submitting myself to another full STD blood screening and additional syphilis tests in end Mar 2015 - slightly more than 3 months after my last exposure and 2 months after treatment to be 100% sure. Do you think this is a sound approach?
Thanks very much for your helpful comments.
I've carefully checked the surface of my body including the genital area and oral cavities and find no canker.
On the possibility of an old infection: In addition to the protected vaginal intercourse with a female sex worker 6 weeks ago, I had one other similar episode more than 6 months ago. Since then I've developed no symptoms (and no canker) and hence have not sought or received any prior treatment for syphilis. So the bit about "Evidence of past exposure to treponemal infection. Possible treated infection." in my report is very puzzling. Could it be possible for me to contract syphilis from the earlier sexual encounter and yet show absolutely no symptoms for 6 months?
On the possibility of a false positive: This would imply that some other bacteria has caused my recent symptons (sudden onset of high fever, intense muscle / joint aches, slightly inflamed throat, redness in the head of my penis and swelling in the right lymph nodes of my groin) and produce the TPHA positive result above. Is this likely in your opinion?
In any case, the 5 day course of Curam has completely alleviated my symptoms. I've noticed that the testing window for my Herpes test (5-6 weeks) is incorrect. So I'm thinking of the submitting myself to another full STD blood screening and additional syphilis tests in end Mar 2015 - slightly more than 3 months after my last exposure and 2 months after treatment to be 100% sure. Do you think this is a sound approach?
a) I would just to make sure you do not have it anymore. I suggest 3 weeks after medication just to be certain.
b) No
c) That medication is not recommended for syphilis
d) It is likely you had a false positive or it is an old infection that has been treated. If it is a new infection (which I doubt) then you must have recently had gotten it which means you would most likely get a canker.
b) No
c) That medication is not recommended for syphilis
d) It is likely you had a false positive or it is an old infection that has been treated. If it is a new infection (which I doubt) then you must have recently had gotten it which means you would most likely get a canker.
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Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
