Syphilis cured or not ?

[kartikbright]

Dear Doctor,
Long back in 1990, I had an intercourse with a female sex worker in india, I fell sick after 3 weeks, but I just ignored it assuming as a common fever, in 1992   I got married and we had to see a doctor in 1994 for infertility, doctor tested my blood for vdrl, it was weak positive, without any further investigations he treated me and my wife with penidure inj. 6lacs  intra muscular Weekly one inj. For six weeks, then later in 1997 again I consulted another doctor, as sperm analysis was found azoospermia, then I had to undergo all blood tests where it was diagnosed (VDRL weak Positive and TPHA 1:320) that I have syphilis, doctor prescribed penidure inj. 24 lac, intra muscular, after a month again the same inj was repeated.
After treatment when I got my blood tested. VDRL became negative but TPHA showed 1:70,
When consulted the doc he said, the parasite is totally dead but the antibodies are still present in the blood, now almost it is 9 years after my treatment. Very recently again I got my blood tested ,still TPHA is positive 1:70, but VDRL is negative.
Now my concern is

1.How do I know that I am fully cured of the disease?( its deadly if I neglect it ) And parasite is totally dead?  What tests will confirm that I am fully cured?

2. How long will it take TPHA to become negative?

3.Do I need any CSF examination (I am scared of this)?


Thanks in Advance

[Edward W Hook, MD]

I am not familiar with the doses of penicillin your received (here in the US we treat with 2.4 million unit injections) but will presume they are equivalent to what we use in this country.

Regarding your tests, you are cured.  Penicillin treatment twice is highly reliable (I suspect your first treatment was sufficient).  When you were treated the first time the disease had been present for more than a year.  Once the disease is established, the VDRL blood tests may not respond at all or may respond very slowly.  Having a persistently positive blood test is a marker of past infection, not an indicator or active, insufficiently treated infection. In addition, as a rule, tests such as the TPHA remain positive for life, indicating not that you have failed therapy but simply that you once had the infection.

The outcome you describe tells me that your syphilis is cured.  

The TPHA is likely to remain positive for life.  That it is positive does not mean that you have active syphilis.

You do not need a CSF examination.

I hope this information is helpful.  You have nothing to worry about.  EWH

[kartikbright]

Thank you Doctor,
Thank you very much.. I am releived of my tension now..
2.4 million =  24 lac
the treatment what you mentioned and what i had is of same dosage.