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Syphilis questions
Dear Doctor(s),
In 2006 - I was pregnant with #1 child and all std blood test came back negative. Healthy beautiful baby girl was born.
Nov 2008 - I am pregnant with #2 child (Due in Aug 09) and syphilis blood test came back positive with RPR of 1.128 with my OB Doctor.
I was then referred to see an Infectious Disease Specialist in Dec and RPR came back with 1.128 titer.
I had one dose of penicillin weekly for the next 3 weeks.
After the 3rd week of treatment of penicillin, my RPR remained at 1.128 titer when I was tested on 2 separate occasions.
ID specialist would like me to retest again in 6 months. I am 20 weeks pregnant today and live in the United States. He said that the baby and I are treated and we should be okay and free from syphilis.
My husband and #1 child have been tested and RPR’s are non-reactive.
I am still worried for the unborn child and would like some more thoughts / opinions on my situation.
If I am positive, wouldn’t my husband (monogamous relationship for 11 years) have the same results? Or I would have been positive with syphilis when I had child #1?
Is there an underlying illness besides syphilis? Where should I go from here?
What could have possible change in 2006 to 2009?
Please help as this does not make sense.
Thank you for your time.
In 2006 - I was pregnant with #1 child and all std blood test came back negative. Healthy beautiful baby girl was born.
Nov 2008 - I am pregnant with #2 child (Due in Aug 09) and syphilis blood test came back positive with RPR of 1.128 with my OB Doctor.
I was then referred to see an Infectious Disease Specialist in Dec and RPR came back with 1.128 titer.
I had one dose of penicillin weekly for the next 3 weeks.
After the 3rd week of treatment of penicillin, my RPR remained at 1.128 titer when I was tested on 2 separate occasions.
ID specialist would like me to retest again in 6 months. I am 20 weeks pregnant today and live in the United States. He said that the baby and I are treated and we should be okay and free from syphilis.
My husband and #1 child have been tested and RPR’s are non-reactive.
I am still worried for the unborn child and would like some more thoughts / opinions on my situation.
If I am positive, wouldn’t my husband (monogamous relationship for 11 years) have the same results? Or I would have been positive with syphilis when I had child #1?
Is there an underlying illness besides syphilis? Where should I go from here?
What could have possible change in 2006 to 2009?
Please help as this does not make sense.
Thank you for your time.
Thank you so much for your input.
Many regards,
M
Many regards,
M
MEDICAL PROFESSIONAL
I have little to add to Dr. Handsfield's responses. Like Dr. Handsfield, my bias is that this is some sort of biological false positive reaction but I also concur that the safest course of action is to go on and take the treatment as you have done.
Sometimes sorting these things out takes time. In the meantime, my judgement is that the course you have been on, including treatment is the safest thing for both you and your unborn child.
As I was writing this, one other thing occurred to me which may well be "overkill" but is appropriate for managment of a situation such as this. Your husband should have preventative treatment with benzathine penicillin, 2.4 million units. Having made the decision to take treatment (which I think is the right decisoin), since he is your sexual partner, he too should recieve treatment although in his case only one tratment, not three is needed.
EWH
Sometimes sorting these things out takes time. In the meantime, my judgement is that the course you have been on, including treatment is the safest thing for both you and your unborn child.
As I was writing this, one other thing occurred to me which may well be "overkill" but is appropriate for managment of a situation such as this. Your husband should have preventative treatment with benzathine penicillin, 2.4 million units. Having made the decision to take treatment (which I think is the right decisoin), since he is your sexual partner, he too should recieve treatment although in his case only one tratment, not three is needed.
EWH
Thank you so much for your input. If Dr. Hook has any input, I look forward to his opinion as well.
Most sincere,
M
Most sincere,
M
MEDICAL PROFESSIONAL
OK, that information helps. However, some atypical aspects remain and I am not 100% convinced you have syphilis. Certainly the likelihood is high enough that the penicillin treatment was ppropriate to protect your health and your baby's. As for lumbar puncture (spinal tap), this is somewhat controversial. Personally, I recommend it and to that extent disagree with your ID specialist -- but because of the controversy, I respect his or her perspective and am not critical of it. (LPs really are not a big deal, certainly not a procedure to be frightened about. I tell my patients that, properly done, the overall stress and discomfort level of an LP is comparable to the average visit to a dentist.)
Still, a few considerations raise the possibility you do not have syphilis despite the test results. First, there is no apparent source of infection. Apparently your husband is your only sex partner since your previous pregnancy (when, it can be safely assumed, you didn't have syphilis), but he doesn't have it. Nonsexual acquisition of syphilis is too rare to be a serious consideration.
Second, the FTA-ABS itself can, uncommonly, be false positive, especially if the result is associated with a "speckled" pattern -- which in turn can be associated with some causes of BFP RPR results. This is a bit complex, but it is something you should raise with your ID specialist. If you were my patient, I would in fact do another type-specific syphilis test like the TPPA or an ELISA test. And I would also test you for certain underlying immunological abnormalities that are associated with false positive FTA-ABS results, in particular a test for anti-nuclear antibody (ANA).
If you really have syphilis, your RPR titer should begin to decline as a result of the penicillin therapy. But 3 weeks is too soon; your continuing titer of 1:128 doesn't say anything one way or another. This is an area of minor disagreement with your ID specialist: you should have monthly RPR tests until 3 months after treatment, then again at something like 6, 9 and 12 months. If the RPR remains 1:64 or higher by 3 months, it will be additional evidence against syphilis.
This is a much more complex issue than we usually deal with on this forum, and I am uncomfortable getting any more involved in your care. But I think you should print out this reply and discuss it with the ID specialist. Then continue to rely on his judgment and advice about treatment, follow-up, etc. But most important, you can be relaxed about your baby's health. If you have syphilis, the penicillin you received will protect his or her health.
Finally, on this forum generally Dr. Hook and I do not comment on each other's threads. However, he is even more engaged than I am in the nuances of syphilis. I will ask him to read this thread then make any additional comments he feels are appropriate.
Still, a few considerations raise the possibility you do not have syphilis despite the test results. First, there is no apparent source of infection. Apparently your husband is your only sex partner since your previous pregnancy (when, it can be safely assumed, you didn't have syphilis), but he doesn't have it. Nonsexual acquisition of syphilis is too rare to be a serious consideration.
Second, the FTA-ABS itself can, uncommonly, be false positive, especially if the result is associated with a "speckled" pattern -- which in turn can be associated with some causes of BFP RPR results. This is a bit complex, but it is something you should raise with your ID specialist. If you were my patient, I would in fact do another type-specific syphilis test like the TPPA or an ELISA test. And I would also test you for certain underlying immunological abnormalities that are associated with false positive FTA-ABS results, in particular a test for anti-nuclear antibody (ANA).
If you really have syphilis, your RPR titer should begin to decline as a result of the penicillin therapy. But 3 weeks is too soon; your continuing titer of 1:128 doesn't say anything one way or another. This is an area of minor disagreement with your ID specialist: you should have monthly RPR tests until 3 months after treatment, then again at something like 6, 9 and 12 months. If the RPR remains 1:64 or higher by 3 months, it will be additional evidence against syphilis.
This is a much more complex issue than we usually deal with on this forum, and I am uncomfortable getting any more involved in your care. But I think you should print out this reply and discuss it with the ID specialist. Then continue to rely on his judgment and advice about treatment, follow-up, etc. But most important, you can be relaxed about your baby's health. If you have syphilis, the penicillin you received will protect his or her health.
Finally, on this forum generally Dr. Hook and I do not comment on each other's threads. However, he is even more engaged than I am in the nuances of syphilis. I will ask him to read this thread then make any additional comments he feels are appropriate.
Thank you for your time and quick response.
The confirmatory test was the FTA-ABS test which showed that I was positive and my husbands and daughter (#1) was negative. I had asked for the ELISA test but the ID doctor said that it was not necessary since the FTA-ABS test was the same.
Both doctors wanted to make sure the unborn child was safe so I had the treatment done. My OB/family doctor has been in practice for 19 yrs and she has not seen a case like mine. She also wanted me to do a spinal tap. I am very nervous and fearful of getting the spinal tap. The ID specialist (5 yrs practice) said that it was very unlikely that I would need the spinal tap. I am very healthy, 37 yr old and have never had any syphilis symptoms.
Thank you Doctor for your time.
The confirmatory test was the FTA-ABS test which showed that I was positive and my husbands and daughter (#1) was negative. I had asked for the ELISA test but the ID doctor said that it was not necessary since the FTA-ABS test was the same.
Both doctors wanted to make sure the unborn child was safe so I had the treatment done. My OB/family doctor has been in practice for 19 yrs and she has not seen a case like mine. She also wanted me to do a spinal tap. I am very nervous and fearful of getting the spinal tap. The ID specialist (5 yrs practice) said that it was very unlikely that I would need the spinal tap. I am very healthy, 37 yr old and have never had any syphilis symptoms.
Thank you Doctor for your time.
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help. However, you have not provided the most important information: What did the confirmatory syphilis blood tests show? Since you're seeing an ID specialist, s/he probably explained that the RPR is a preliminary test; it is not evidence of syphilis unless a confirmatory test also is positive -- such as TPPA (Treponema pallidum particle agglutination), FTA-ABS (fluorescent treponemal antibody-absorbed), or one of the newer syphilis ELISA tests.
As the ID doc also might have explained, there is a condition called biological false positive (BFP), in which the RPR (or its cousin test, the VDRL) is positive in the absence of syphilis. Of all known causes of BFP results, pregnancy is the most common.
Having said all that, since your doctors are treating you with penicillin, it seems likely your confirmatory test was positive, i.e. that you have had syphilis. On the other hand, perhaps they are just being extra careful -- i.e. treating you for syphilis even though they are not certain you have it.
Please come back and let us know whether a confirmatory test was done and, if so, which specific test and the result. Then I'll try to answer some of your questions. However, don't get your hopes up; it is not very likely that I can give you any more definite answers than you already have had from the ID specialist. But I will try.
Regards-- HHH, MD
As the ID doc also might have explained, there is a condition called biological false positive (BFP), in which the RPR (or its cousin test, the VDRL) is positive in the absence of syphilis. Of all known causes of BFP results, pregnancy is the most common.
Having said all that, since your doctors are treating you with penicillin, it seems likely your confirmatory test was positive, i.e. that you have had syphilis. On the other hand, perhaps they are just being extra careful -- i.e. treating you for syphilis even though they are not certain you have it.
Please come back and let us know whether a confirmatory test was done and, if so, which specific test and the result. Then I'll try to answer some of your questions. However, don't get your hopes up; it is not very likely that I can give you any more definite answers than you already have had from the ID specialist. But I will try.
Regards-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
