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What should I do on my situation?
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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What should I do on my situation?

dear sir:
    On Nov 10, I had a sexal intercourse(Condom & French kiss) with a syphilis patients(Trust 1:8; TPPA 1:320).  One week after the contact(Nov 17), my serological tests were Trust negative, TPPA negative.
    At the same day(Nov 17),I received the epidemiologic treatment. I have received 2.4 million units of Benzathin
Penicillin once a week, interval one week, total 4 injections. Because I was worry about TP penetrate into my CSF,I received oral Doxycycline 200 mg one time, two times a
day, maintained 15 days.(Nov 17-Dec 3)
    I have finished my treatment on Dec 14 and I repeated my serological test on Dec 14 (5 weeks after contact). The
result were  Trust negative ; TPPA negative.
    Now my questions are (I have asked you  same similar questions, but I am facing a medical examination in the
next month for entering a company. I holp you can forgive me )

    (1) Is there any possible that my TPPA will turn positive in the future ? (I am so worry about the TPPA, because the physical examinztion includes TPPA test)
    (2) Is there any possible that some TP still hide in my CSF now ?
    (3) Should I need other treatment or test? If I need, what should we do?

    (4) I have read some paper during this period. Some make me ease, but others make me anxious. Most paper about epidemiology (such as MOORE, Epidemiologic Treatment of Contacts to Infectious Syphilis and yours Azithromycin Compared with Penicillin G Benzathine for Treatment of Incubating Syphilis.etc) report that epidemiologic treatment with Benzathin Penicillin are 100% effective. However, others report some patients or
rabbits received preventive treatment on seronegative stage but TPHA or FTA-abs turn positive at last. (Eg:J.LESInISKI, Specificity, sensitivity, and diagnostic value of the TPHA test)    
    Those papers make me confuse. If you convenience, would you give me some explanation or offer me some paper which include the answers
     Thanks for your help
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Welcome back to our Forum.  As you remember, after your first injection of benzathine penicillin I assured you that you were protected from the possibility of having gotten syphilis from the exposure you described.  Now, after 4 weekly injections of penicillin, plus a course of doxycycline there is simply no way that you could have active syphilis form your exposure of concern.  Most exposures do not lead to infection and you have been (over) treated in a manner which would prevent syphilis following exposure.  Your serological test conclusively prove that you do not have syphilis related to your exposure of concern in November.

In answer to your questions:
1.  There is no way you can develop syphilis from the exposure you describe.  The only way you could get syphilis going forward is if you have sex with another infected partner in the future.

2.  No, no possibility that treponemes are present in your CSF.

3.  You do not need further testing or treatment.

4.  I will try to provide a brief explanation.  In some instances preventative therapy may fail. this is very unusual.  In your own case, following multiple treatments with two different medications and in the absence of re-exposure you simply have no reason whatsoever to worry.

I hope this comment is helpful to you.  EWH
4 Comments
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dear sir
       Thanks for your detailed answer first.

       Your answer told me "Your serological test conclusively prove that you do not have syphilis related to your exposure of concern in November". Will the using of antibiotics prolong the window period of TPPA test on my situation?

       OR more directly, I assume that there were some TP penetrated into  my body during the courese of sexal contect, and now the TP have been eliminated by preventive treatment. BUT, Will the TP cause some immunological trace which can be detected in the future in my body?

       I have no choice but consult you, I have no chance to communicate with expert as you in local. Hope you can understand and forgive my repeated questions. Thanks
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No, the antibiotics woul not prolong the "window perio". They woul haver cured any infection present.  There will be no "trace" of infection in future tests. You are really overly worried about this issue.  EWH
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Thank you very much
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H. Hunter Handsfield, M.D.Blank
University of Washington
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