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When is syphilis testing ABSOLUTELY Conclusive?
Dear Dr, thank you in advance for your reply. I am a 47yo male who has made bad choices over the YEARS. Over 2 yrs ago was my LAST episode of oral sex with a csw. But there have been MANY episodes prior to that Of oral sex. I had an rpr test about six weeks after that last episode(2009)which was negative. About three weeks prior to that I was having sex with my wife and AFTERWARDS I noticed an abrasion on the head of my penis. It is something I hadn't noticed at all prior to that. It wasn't hard, but looked like a round flat patch of skin missing of about 4mm. It healed within around 4-5 days. Over the past few years I have had numerous strange symptoms that nobody has been able to figure out, alot seem
Neurological. I have had in all around 5-6 rpr since last episode somewhat equally spaced with last one being around 6 weeks ago. At approx. 18 months of last episode I had a fta-abs and a Trep-Sure EIA which both were negative. I have never had a positive syphilis test. Reading upon things and the new screening algorithm it seems conclusive neg. I continue to have bad muscle tremors, pin/needles/numbness in extremities and right side of face, joint&muscle pain, muscle atrophy, and recently some visual changes(eye exam normal). I know it can be the great intimidator but Could you please answer these questions.
1)is it possible that an infection years ago can still show negative on all tests?
2)Could I have latent, tertiary, or neurosyphilis and be undetectable on all tests?
3)is the EIA as sensitive as it gets or would it be adviseable to have a tp-pa test done?
4)my last EIA Was April 2011 (18 months last exposure),do I need to repeat it?
5)are there limitations to these tests?
6)are there any more tests to do regarding syphilis to 100% rule it out?
7)is a CSF vdrl ever done in absence of other positive tests and maybe the only one to show infection?
Thank you very very much
Neurological. I have had in all around 5-6 rpr since last episode somewhat equally spaced with last one being around 6 weeks ago. At approx. 18 months of last episode I had a fta-abs and a Trep-Sure EIA which both were negative. I have never had a positive syphilis test. Reading upon things and the new screening algorithm it seems conclusive neg. I continue to have bad muscle tremors, pin/needles/numbness in extremities and right side of face, joint&muscle pain, muscle atrophy, and recently some visual changes(eye exam normal). I know it can be the great intimidator but Could you please answer these questions.
1)is it possible that an infection years ago can still show negative on all tests?
2)Could I have latent, tertiary, or neurosyphilis and be undetectable on all tests?
3)is the EIA as sensitive as it gets or would it be adviseable to have a tp-pa test done?
4)my last EIA Was April 2011 (18 months last exposure),do I need to repeat it?
5)are there limitations to these tests?
6)are there any more tests to do regarding syphilis to 100% rule it out?
7)is a CSF vdrl ever done in absence of other positive tests and maybe the only one to show infection?
Thank you very very much
MEDICAL PROFESSIONAL
"This thread is now closed to any further comments" meant what it said, and these questions are irrelevant given my previous replies. If you post anything more, including future negative test results, the entire thread will be deleted.
I saw my primary today and he is going to run lots of other bloodwork. He is doing a syphilis cascading test and repeat rpr. I asked him these questions which he didn't know answer. Would you please?--I will not reply with any further.
1) how long does it take for a treponemal EIA to become positive?
2) how about an FTA-ABS?
3) they both will remain positive for life and therefore no false-negative whether it be four weeks four months or four years Of last exposure?
4) after that last exposure I treated myself with doxycycline 100 mg twice daily for 10 to 14 days that I had in the house. Could that alter reliability of any of these tests?
I'm asking because he was unsure. He says he hasn't had alot of experience with syphilis and would have to ask his peers.
Thank you very much. I will not return unless you want to know the final diagnosis.
Take care
1) how long does it take for a treponemal EIA to become positive?
2) how about an FTA-ABS?
3) they both will remain positive for life and therefore no false-negative whether it be four weeks four months or four years Of last exposure?
4) after that last exposure I treated myself with doxycycline 100 mg twice daily for 10 to 14 days that I had in the house. Could that alter reliability of any of these tests?
I'm asking because he was unsure. He says he hasn't had alot of experience with syphilis and would have to ask his peers.
Thank you very much. I will not return unless you want to know the final diagnosis.
Take care
MEDICAL PROFESSIONAL
1) Prozone only applies to RPR and VDRL. It is irrelevant to your situation.
2) TPPA and EIA are equivalent, for practical purposes. Neither is "better" than the other.
3) The only treponemal tests recommended for screening are the newer EIAs. Otherwise, screening is only with RPR or equivalent "nontreponemal" tests.
4) Tests turning negative over time is only an issue for RPR and other nontreponemal tests. It does not happen with TPPA, EIA, or FTA-ABS.
5) Yes, if your penile lesion had been a chancre, most if not all your many tests over the years would have been positive.
It is obvious you are obsessed with this, and it is in the nature of obsession that there always is another "yes but" question that come to mind. Responding to repeated questions like that often simply prolongs the problem, perhaps delaying proper evaluation (i.e. mental health care). I will not play that game. This thread is now closed to any further comments, and you may not start a new thread with the same questions.
Accept the evidence and advice you have had and do your best to move on.
2) TPPA and EIA are equivalent, for practical purposes. Neither is "better" than the other.
3) The only treponemal tests recommended for screening are the newer EIAs. Otherwise, screening is only with RPR or equivalent "nontreponemal" tests.
4) Tests turning negative over time is only an issue for RPR and other nontreponemal tests. It does not happen with TPPA, EIA, or FTA-ABS.
5) Yes, if your penile lesion had been a chancre, most if not all your many tests over the years would have been positive.
It is obvious you are obsessed with this, and it is in the nature of obsession that there always is another "yes but" question that come to mind. Responding to repeated questions like that often simply prolongs the problem, perhaps delaying proper evaluation (i.e. mental health care). I will not play that game. This thread is now closed to any further comments, and you may not start a new thread with the same questions.
Accept the evidence and advice you have had and do your best to move on.
Thank you for your time and thoughts. Only a couple other things if you could please.
1)after some more reading, I was worried about the prozone effect. Is that possible?
2)is the tp-pa any better than the EIA?
3)which is best treponemal test for screening/diagnosis?
4)I've heard that after years that tests can turn negative. Could i have tested too late and now unable to diagnose even though rpr was done repeatedly?
5)last, if it fact was a chancre i had would I have known versus abrasion and would my results have shown such?
I just want to resolve these issues. I am
Seeing my doctor this afternoon again. If you would please answer and give me your thoughts on these questions I would really value it, but I will take these concerns up with him.
Thank you
1)after some more reading, I was worried about the prozone effect. Is that possible?
2)is the tp-pa any better than the EIA?
3)which is best treponemal test for screening/diagnosis?
4)I've heard that after years that tests can turn negative. Could i have tested too late and now unable to diagnose even though rpr was done repeatedly?
5)last, if it fact was a chancre i had would I have known versus abrasion and would my results have shown such?
I just want to resolve these issues. I am
Seeing my doctor this afternoon again. If you would please answer and give me your thoughts on these questions I would really value it, but I will take these concerns up with him.
Thank you
MEDICAL PROFESSIONAL
Welcome to the forum and thanks for your question. The quick answer to the question literally posed in the title is somewhere around 6 weeks. After that, a negative result is proof that syphilis never was present; or, in certain situations, that the disease has been cured (by antibiotics or the immune system) and not likely to ever be transmitted to to cause important health problems.
In your case: You describe exposures exceedingly unlikely to result in syphilis, which is rare in female sex workers in most industrialized countries; a symptom (penile "abrasion") that was not typical for syphilis; and a number of negative blood tests thereafter. To be honest, I don't understand why syphilis remains on your mind. The "neurological" symptoms you describe cannot be syphilis in the presence of negative blood tests. Moreover, you not only had classical "nontreponemal" testing with repeated RPR tests, but also negative results by FTA-ABS and enzyme immunoassay (EIA).
So your test results are absolute, rock-solid proof you do not have syphilis and never did, and that something else explains your symptoms. (From your description, I'm not sure anything is wrong at all, except perhaps anxiety magnifying normal body sensations.) There are no "limitations" to the tests that could explain negative results in presence of syphilis. And no ethical physician would perform or condone a spinal tap in order to test CSF for syphilis in this circumstance. Anyway, it isn't possible to have neurosyphilis, or a positive CSF VDRL result, with the negative blood test results you describe.
So my advice is to stop testing for syphilis and put it out of your mind. I'm sure this isn't the first time you have heard this advice. If you cannot despite such overwhelming evidence and repeated reassurance (which undoubtedly you have had from multiple doctors over the years), it suggests you continue to be abnormally obsessed with guilt over sexual choices you regret. Professional mental health counseling may be in order; I suggest it from compassion, not criticism -- but stronly recommend you discuss this possibility with your primary care provider.
Regards-- HHH, MD
In your case: You describe exposures exceedingly unlikely to result in syphilis, which is rare in female sex workers in most industrialized countries; a symptom (penile "abrasion") that was not typical for syphilis; and a number of negative blood tests thereafter. To be honest, I don't understand why syphilis remains on your mind. The "neurological" symptoms you describe cannot be syphilis in the presence of negative blood tests. Moreover, you not only had classical "nontreponemal" testing with repeated RPR tests, but also negative results by FTA-ABS and enzyme immunoassay (EIA).
So your test results are absolute, rock-solid proof you do not have syphilis and never did, and that something else explains your symptoms. (From your description, I'm not sure anything is wrong at all, except perhaps anxiety magnifying normal body sensations.) There are no "limitations" to the tests that could explain negative results in presence of syphilis. And no ethical physician would perform or condone a spinal tap in order to test CSF for syphilis in this circumstance. Anyway, it isn't possible to have neurosyphilis, or a positive CSF VDRL result, with the negative blood test results you describe.
So my advice is to stop testing for syphilis and put it out of your mind. I'm sure this isn't the first time you have heard this advice. If you cannot despite such overwhelming evidence and repeated reassurance (which undoubtedly you have had from multiple doctors over the years), it suggests you continue to be abnormally obsessed with guilt over sexual choices you regret. Professional mental health counseling may be in order; I suggest it from compassion, not criticism -- but stronly recommend you discuss this possibility with your primary care provider.
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.
