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RPR Test Time to become Neg
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RPR Test Time to become Neg

Dear Dr,

I was infected with Syphilis (primary) and treated on Aug 09 with two penicillin shots one week apart each. My tier the day of treatment as 1:128. After treatment I went in October and did another test and never go the results but the doctor said over the phone that it lowered and I was clear of the infection. I recently (feb 2010) went again to the doctor and got tested again the new tier was 1:2. with a positive RPR. IgG was positive and IgM was negative.
I have to take a blood exam in June and would like to test Negative on the RPR. If I get another penicillin shot can this help? Is there anything that could? Or am I going to test positive for lifetime?

Thanks!
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Welcome back.  Interesting that your titer was that high, which is somewhat unusual for primary syphilis.  Having a titer of 1:128 suggests that you might have been in transition to secondary syphilis by the time you were treated, as we discussed last September.

The decline in your RPR titer is right on schedule.  The expectation after successful treatment is a 2-diliution drop within 3 months -- i.e. if you were tested in November and your titer was 1:32 or lower, you met the definition for cure.  Given 1:128 as the starting point, a titer of 1:2 at 6 months is excellent.  You do not need further therapy.  Most likely it will be entirely negative or perhaps 1:1 in June and eventually will probably become negative, although that sometimes takes a year or more.

As for testing positive for life, sometimes that happens.  If the RPR is positive at all a year after treatment, yearly testing is recommended to make sure the titer remains low.  But don't worry about that now; this is unlikely.  You were cured.

But a word of caution about future tests.  Many labs in the US and worldwide now use newer tests like TPPA (for Treponema pallidum particle agglutination) or ELISA for initial screening tests.  These tests usually remain positive for life.  You should make sure your doctors in the future know of your syphilis history, and if you are ever tested, tell your provider about the likely positive result, perhaps for your entire life.  It doesn't mean anything; these tests remain positive despite cure.  If there is real suspicion of syphilis, an RPR (or VDRL, equivalent to RPR) will then be done.  As long as the RPR/VDRL remains negative or very weakly positive, it will indicate you were cured and not reinfected.

But yet one more heads-up, so you aren't surprised:  Blood banks use the newer tests like ELISA or TPPA, and most likely your blood will never be accepted in donation programs. This might vary from one blood bank to another, however.  If you are inclined to do a fine civic duty and donate blood, ask about the local policy ahead of time.  It could avoid embarrassment.

Regards--  HHH, MD
3 Comments
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Avatar_m_tn
Dear Dr. I forgot to Mention before the test that was done at the time of treatment one was done two weeks after which was when it was diagnosed my tier that time was 1:16 which was what lead the Dr to believe it was primary. With this new information do you agree with the assessment, or you still believe it was secondary? And my main question was wether an additional shot would help lower the tier?

Thanks!
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239123_tn?1267651214
I didn't say that I "believe it was secondary" -- only that this is a possibility, based on the possible skin spots described last September plus the high RPR titer.  But it makes no difference now.  The treatment of syphilis is the same for primary and secondary -- and you were over-treated, since you received 2 doses of penicillin rather than the recommended single dose.  And I already responded to the question about additional treatment; re-read my reply.  It would make no difference in your RPR titer now or in the future.

You need to let this go.  Your syphilis is cured, over and done.  Other than being aware of the likelihood of future positive tests, this no longer is an issue in your health or life.

That will be all for this thread.
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