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Syphilis - RE re infection??

Dear Dr.Hook,

I was in touch with you earlier this year. My post has been closed.
I had posted regarding myself and my partner.

http://www.medhelp.org/posts/show/699997?personal_page_id=46850&post_id=post_3765368


I was treated for neursyphilis and my partner for syphilis. His VDRL count is raised to 1:16 March 2009 from 1:8 Dec 2008.
The doctors are really confused.

I had taken your word that it was fine to have sex and both of us were treated.
Now I am really confused that if I am reinfected. Or did i reinfect him.

VDRL in my case is still 1:16. (Via bloodtest) Also March 2009.

We are both HIV - and no other STD. We also have not had any other partners.
I have not had a LP yet to take a look at the response to neurosyphilis
.
Your comments please.

2 Responses
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300980 tn?1194929400
MEDICAL PROFESSIONAL
My thanks to Dr. Handsfield for taking this post in my absence.  I have little to add.

There is conjecture that HIV effects both syphilis and the way we measure syphilis activity in a variety of ways which are hard to predict – you are in that group who are impacted by this tendency.  I am comfortable that the therapy you have received is, as Dr. Handsfield has suggested, more than adequate both for your infections and your partner.  I also fear that if you should change doctors in the not too distant future, concerns about your syphilis blood test come up again.  Hence, I agree 100% with Dr.   Handsfield, that at this point the best thing you and your partner can do is to get relatively regular blood tests so that you and your doctors can be comfortable that your RPR or VDRL test results are not rising.  In addition, should you have an unusually high blood test in the future (beyond the 1:4 to 1:32 limits suggested by Dr. Handsfield, the first step should be to repeat the test.  The only exception to that advice would be if you or your partner have sexual contact with others outside of your now currently mutually exclusive relationship

Take care.  EWH
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome back to the forum.  Dr. Hook and I take questions interchangeably, and in any case Dr. Hook is away from the forum for a couple of days.  But our careers have been intertwined and we have been close professional colleagues and personal friends for 3 decades.  For practical purposes, we never disagree with on another.

I reviewed your other thread.  I agree with the extensive advice you received from Dr. Hook and was pleased to see that you coordinated his advice with your doctors.

True treatment failure probably never occurs following the penicillin doses you and your partner received.  Unfortunately, the VDRL and RPR are flawed measures of treatment outcome.  While the results usually correlate well with disease activity and treatment response, there have always been a few in which the titers do not decline despite cure.  The technical term is serofast.  That's you.  There is no known medical explanation or reason -- it just happens once in a while.  Admittedly it is a surprising coincidence that both you and your partner are serofast, but that is the only realistic explanation -- assuming, of cours, that your sexual histories are accurate, i.e. that neither you nor your partner is at risk for reinfection by other persons.

Accordingly, you can consider yourself cured.  To be entirely safe, you and your partner should have repeat tests once in a while.  There is no set schedule, but if you were my patient I would repeat your tests 3, 6, and 12 months after the end of treatment, then once a year for the next few years.  As implied by your discussion with Dr. Hook, you should ask your provider to order an RPR or VDRL every time, and ideally each test should be done in the same laboratory as the years pass.  Most likely the results won't change much; any titer from 1:4 to 1:32 should be considered equivalent to your current 1:16.  Unless the titers rise again, or of course if either of you develops new symptoms that suggest active disease, no further treatment is required.

Although Dr. Hook and I normally don't comment in each other's threads, I will ask him to take a look and add any additional remarks he thinks are appropriate.

Best wishes--  HHH, MD
Helpful - 0

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