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Neurosyphilis
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Neurosyphilis

Hello i am very concerned about neurosyphilis last December i went to hospital under my neurologist for tests my complaint was headaches fatigue cognitive decline lower limb pain hair loss and vision problems all my tests were normal including RPR of blood and TP abbot architect,my condition is getting progressively worse so i asked my neurologist for a lumbar puncture the results were cell count normal protein normal TPPA negative and RPR of csf positive 1:2,the csf was analysed on october 15th my neurologist said it is a false positive as my serum is negative for syphilis and was probably weakly positive due to cross contamination his logic is that a normal cell count and protein rules out infection.I have read that tppa should not be done on csf is it possible to have negative syphilis tests for blood yet positive for csf,how could my rpr of csf be positive although weakly and still i am being told i dont have syphilis i await your observations thank you Pat
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Welcome to our Forum.  There are some inconsistencies with your history which make it difficult to advise you. The good news however is that you are under the care of a trained specialist in neurology who is just the sort of person who should be addressing your concerns.  I will make several comments which may be helpful for you to discuss with your neurologist - he should be guiding your care.

Your symptoms could be caused by a huge list of possible problems and the job of your doctors is to narrow them down in step by step fashion.  Among the tests which were appropriate as your evaluation began were tests for syphilis. Based on your blood test results however, I would not have considered neurosyphilis among the possibilities to explain your symptoms.  All persons with neurosyphilis have at least a reactive serum TPPA tests - yours was negative.  Your CSF tests confirm that you do not have neurosyphilis. All patients with neurosyphilis would have a reactive CSF TPPA. Furthermore, there are no patients who truly have syphilis who have reactive RPR tests and negative TPPA tests (although the converse can happen, i.e. the RPR can be falsely positive).  Finally, the RPR is not recommended for testing of CSF.  For CSF testing the proper test is the VDRL test.  Taken together all of these facts indicate that your CSF RPR is falsely positive and there is little evidence that you have neurosyphilis.

Put another way, I agree completely with your neurologist.  I would suggest you continue to work with him to sort out what is going on while, at the same time, feeling confident that it is not neurosyphilis.

Hope this is helpful.  Take care.  EWH
7 Comments
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Avatar_m_tn
Thank you Doctor so basically if i had neurosyphilis i would have positive csf and serum for a specific TP test, if i had any other stage of syphilis including tertiary but not neuro i would have negative csf but positive serum.Do you have any thoughts on why my RPR of csf was positive? you said my symptons could be caused by a huge list of problems could you please name a few that you might suspect finally are you happy that the TPPA AND TP abbott architect are reliable tests or what in your opinion is the gold standard TP specific test.

yours sincerely

Pat
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300980_tn?1194933000
Many false positive test results turn out to be unexplained.  To pursue possible causes would be a wild goose chase. This is something you should discuss with your doctor who can examine you and take a fuller history than is appropriate over the internet.  EWH
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Avatar_m_tn
One final question Doctor can i be absolutely certain that if i had any stage of syphilis my serum TP specific test( in my case the test was TP abbott architect) would be reactive?

thank you

Pat
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300980_tn?1194933000
If you had syphilis and you had not been treated, you can be confident that your specific, treponemal test would be postive. EWH
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Avatar_m_tn
Hello Doctor i read in one of your other answers that blood tests for syphilis are rarely false negative save in very early infection and in very late infection ie having untreated syphilis for decades.The reason i am so anxious is that neurosyphilis symptons match what i am going through severe cognitive decline balance problems also excessive hair loss much more than male pattern baldness,having said that my csf tppa was negative so even if syphilis was undetecable in blood if i had neurosyphilis my csf tppa would be positive am i right?. The reason i am so hung up on syphilis is that in 1996 after a weekend in Paris i had a sexual encounter with a prostitute and two weeks later i had an acute episode of sudden dizziness and numbness in my left leg i left it a few days to go to my doctor and he diagnosed a panic attack i spent the next three months having various tests ecg eeg brain scan all blood work hiv test but not syphilis and all tests were normal i did not have a spinal tap in 1996.It is just that i have researched that syphilis can attack the cns at any stage and i read about acute syphillitic meningitis and i read that acute syphillitic meningitis can be self limiting and spontaneously go with no sequale,i got better in 1996 and had no health problems at all till july 2008.I believe my current problem is related to my problem in 1996 and the only thing that stacks is undiagnosed syphilis that presented acutely in 1996 and then became latent untill 2008,do you have any advice Doctor?

yours sicerely

Pat
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300980_tn?1194933000
This will be my last comment.  If  your CSF TPPA was negative you do not have neurosyphilis.  In addition, the time course of events you describe really does not mesh well with neurosyphilis.  I knw these things can be frustating but I urge you to not spend further time worrying about neurosyphilis, there is just no evidence to support it.  My advice is to work with your doctors on other causes fo your symptoms.  There really is nothing to support the possiblity of syphilis. EWH
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