inconsistent rpr results

[medquestions533]

Thanks in advance for your help.  I have been monogamous for 10+ years.  Last year, check up showed me and my husband to be RPR negative.  This year (new doctor), my husband was still negative, but I was RPR positive, undiluted, and FTA-abs positive.  I was totally incredulous, so we re-did the test for me.  Same results.  Zero chance of third party contact by me.  Other potentially pertinent facts:  
-- extensive travel to 40+ countries, including malaria zones in the year between tests
-- some years ago, I spent several weeks volunteering in a leper colony in India, treating and dressing wounds, etc.  Was definitely exposed to blood during that time
-- not aware of any symptoms related to yaws, pinta, or bejel
-- I've had lots of live vaccinations, including Japanese Encephalitis, Yellow Fever, etc. (but not in the last 7 years)
-- I don't recall ever showing syphilis symptoms; limited/conservative sexual history in general
-- I took penicillin only once, as a teenager, when I had a severe cold/cough.  Had strained breathing afterwards, so haven't taken it since.  About 5 years ago, I started allergy tests, but didn’t complete the full course, and didn’t get confirmation re: any penicillin allergy.  I just don't take it, and haven't since I was a teen (which may rule out false negative for last year’s rpr)
-- I had major surgery between checkups, in the hospital for a week, but didn't show signs of infection
-- recent ANA test was negative
-- I have had hormone shots between checkups, am anemic and severely vitamin d deficiency (taking supplements), and i am definitely not pregnant (we would like to have a baby, though, which is why these strange results are so worrisome).

(1) in light of the above facts, any ideas what this rpr negative, turned undiluted positive and fta-abs positive a year later (with intervening travel and surgery) could be about?, and (2) if you think further testing is appropriate, what kind of testing do you recommend?  Sincere thanks.

[Edward W Hook, MD]

Welcome to the Forum.  Your problem is a very uncommon one but not unheard of.  If you have not acquired syphilis you have developed what we refer to as a double false positive, meaning that your antibodies which react on the RPR also, by chance happen to react in the FTA.  A small proportion of the general population have false positive RPR tests and a slightly lower proportion of the general population also have false positive FTA and related tests.  As you might imagine, on the basis of the statistics alone, a VERY few people have falsely positive results on both tests - you may be one of these.   I suspect that you would like the peace of mind provided by a negative test of some sort.  My advice would be to seek additional testing using a test such as a TPPA which is an improvement over the FTA in terms of false positive results and may be negative (it also may not be but it’s worth a try).  

Do you know if you have had syphilis tests before?  I ask because I wonder if this is something you've had for some time or something that has developed more recently.  If the latter, there are several possible causes.  False positive tests for syphilis come from lots of things including just about anything that can cause you to make lots of antibodies - i.e. vaccines, recent viral infections, new medications, etc.  Autoimmune illnesses can cause false positives as well and then some people just get them because of plain old bad luck.  If your false positive test is due to
something like a vaccine or recent viral infection, it may become negative in the future (months from now).

Finally, given your extensive travel history, I need to ask if perhaps you could have been in contact with someone who had a non-syphilis treponemal infection such as yaws, etc (mentioned by aunt jessie in her post on the community site) or perhaps could have had a needle stick or other procedure which have introduced infection.

I hope these comments are helpful.  You may never sort out what has caused this test.  I would re-test in a month or so to make sure that the titers are not increasing.  EWH

p.s.  My thanks to Vance and auntijessie, on the Community site for their help.  their comments are right on target.  EWH

[Edward W Hook, MD]

Thank you for your kind words, I'mgla I could help.  Please let me know how things sort out.  Take care.  EWH

[medquestions533]

I just wanted to say thank you, Dr. Hook.  I've been offline, but my husband read your response to me over the phone, and wanted to let you know that we both agree that you're a kind and thoughtful person -- we very much appreciate your attempts to help us sort this out.  I'm still a few weeks away from final tests, etc., but will let you know what results.  

[Edward W Hook, MD]

This is foriegn territory for me and I'd suggest you discuss it with your fertility specilist. the effects of syphilis on pregnancy and developing fetuses are due to the organism and I suspect that when your eggs were harvested and feritized it was done in a setting in which it is unlikely that the embryos would have been infected.

The doxycyline is active against Treponema pallidum, the bacteria that causes syphilis and would prevent or cure infection, depending on when it was taken relative to infection (if it occurred) and how long it was taken.

Sorry I can't be much more help.  I contunue to operate under the hoe and expectation that this will turn out to be a false positive laboratory test.  EWH

[medquestions533]

I did have cipro and doxycycline, never penicillin, though.  sorry for the multiple additions of information.

[medquestions533]

To clarify, the retrieved eggs have been fertilized and are now frozen, awaiting uterine transfer, which will happen when this new issue re: inconsistent blood test results is sorted.  Thank you.

[medquestions533]

Dr. Hook, I had a very worrisome thought this weekend, and I thought I would ask you since you seem to be one of the most knowledgeable people in this area that I have come across so far.  The reason these inconsistent rpr results came up is because annual blood tests are required for fertility screening.  if i was negative rpr last year, had eggs retrieved through ivf, never took penicillin, and then came up rpr positive undiluted this year, assuming the worst case scenario that this is not an error but some kind of communicable disease, does that mean the retrieved eggs have it, too?!  Is there any way to confirm whether they have it, one way or another?  Thank you in advance.  The rest of my blood screening tests are some time off, but I will keep you posted as to the result on the final outcomes.  Thank you again.

[medquestions533]

Many thanks -- I definitely appreciate your input.  Because these results seem very unusual (negative rpr followed a year later by a weak positive rpr/fta-abs with negative-testing spouse and no third party contact in-between), no one really seems to have definitive answers.  Your input helps add to the collage of information I'm gathering -- I haven't used it (and wouldn't use it) to second guessing the doctors I'm seeing in person.  It's just helpful to have another perspective, so many thanks.  We will see what results.  Kind regards.

[Edward W Hook, MD]

I'm glad to hear you're getting your questions addressed sooner than later.  My approach would be to do the RPR/TPPA test first, before doing the lumbar puncture.  LPs are really not all that big a deal but why do it if you don't need to.  

Please realize that we're in very unusual territory here.  I am not challenging your doctor or his/her opinion and I have no desire to get between you and them.  I do look forward to hearing more of your test results as things progress however.  EWH

[medquestions533]

Dr. Hook, it turns out I have an update faster than I thought.  I have two appointments -- one with an ID specialist, and another with a reproductive immunologist so that I rule out any autoimmune diseases that could affect a pregnancy.  Both appts are for a month out, but there was a cancellation at the ID dr's office, so I went.  The conversation was a little frustrating because, although i'm willing to treat whatever i need to treat, i would really like to figure out if something else is driving these results, if possible, because if, say, Lyme Disease is behind it, and penicillin doesn't treat Lyme Disease, then I haven't really solved my problem, have I?  Anyway, another battery of tests ensued, and this time we'll use the RPR/TPPA at a different lab. To make sure all bases are covered, the doctor also suggested getting a sample of CSF, which I find a little daunting, but I will do it if it means covering all bases re: good health.  If you have any thoughts about the course of action (or whether there are other doctors I should be seeing), please let me know.  Thank you.

[medquestions533]

Good to know!  Thank you very much.  I will seek out the TP-PA test.  I appreciate your help.

[Edward W Hook, MD]

The IgG test for syphilis tends to have, if anything, more flase postives than the FTA.   If yours is negative, believe it but if not, I'd try the TPPA.  Let me know what transpires.  EWH

[medquestions533]

Thank you for your response, Dr. Hook.  You're exactly right that I would love a negative result!  More important, though, I just really want to know what's going definitively before trying to have a baby, as I am very worried about potential autoimmune issues or passing something on in utero.  In answer to your question, prior to last year, I was never tested for any STDs to my knowledge because I never thought it was an issue.  The only reason we did them now was in connection with fertility screening (all other STD tests came back negative).  I will soon be having an IgG test for syphillis as a follow up to this year's test.  Is that comparable to the TP-PA test?  In answer to your other question, it's likely that I've been exposed to people with all kinds of illnesses given the nature of some of the volunteer-related and other travel that I've done.  I'm very careful about getting the right immunizations, and I've never shown any symptoms personally, or been sick upon my return (other than a SEVERE struggle with vertigo upon return from a trip to several countries in South America prior to my negative rpr last year), but I couldn't begin to say what I've been exposed to over the years.  I only know that I haven't typically shown symptoms of anything upon my return.  Anyway, if you have thoughts on whether an IgG for syphilis is sufficient (or whether I should try to have the TP-PA instead or in addition), please let me know.  Thank you very much.