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hi

Dear sir i went for master check up on 22/11/2013 and i found vdrl 1:64 positive TPHA is positive ,so immediately i went to doctor he prescribed doxcyilne 200 mg per day up to 21 days .i complete my tablet successfully on 22/12/2013 and that time i went for blood test is same 1:64 .and doctor said dont take blood test now he suggest to take after 3 month now your cured he reply.for my satisfactions i did blood test on 30/01/2014 the report shows 1:16 now .my question is i have to take antibodies or continue when its goes negative ? ....still i have symptoms ringing in ears,headache sometimes.i dont have any contact for sex .i control myself
thank you for your reply
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580755_tn?1357673215
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Avatar_m_tn
Dear sir i went for master check up on 22/11/2013 and i found vdrl 1:64 positive TPHA is positive ,so immediately i went to doctor he prescribed doxcyilne 200 mg per day up to 21 days .i complete my tablet successfully on 22/12/2013 and that time i went for blood test is same 1:64 .and doctor said dont take blood test now he suggest to take after 3 month now your cured he reply.for my satisfactions i did blood test on 30/01/2014 the report shows 1:16 now .after days gone for test again on 26/06/2014 the report shows me TPHA is positive and vdrl range is increase 1:32 from 1:16 .please help me what to do ....iam very confusion
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580755_tn?1357673215
You are going to have to speak to your Dr, I don't know why the tier number has increased.
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Avatar_m_tn
yes i went to doctor he prescribed medicine for 15 days ...after that i recently i checked 2 times in different lab,the report says vdrl is non - reactive and TPHA is positive in 1:200 dilution but still my doctor give medicine for 20 days with dosage low...when it will cure
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580755_tn?1357673215
When the Tier level starts to drop then that shows it is cured. You will often test positive for years but as long as that number drops that is good.
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Avatar_m_tn
Ok, first off, it is usually recommended to wait 3 months after the treatment was first completed to notice a drop in titer numbers.

Also, 26/06/2014?
Its 20/04/2014.
So, unless you are from the future, I think that its likely you inputted incorrect dates (which seem to have been overshot by 1 year).

Rather, more importantly, there was another poster here who took a Doxycycline treatment the same as you.
His titer numbers were 1:32 at the start (not as large as yours), and dropped to 1:16 after doing a repeat test only 1 month after treatment.
At any rate, his ratios went back up to 1:32 approximately 9 months later, and after that was treated with Penicillin and his numbers went back to 1:16 after getting tested 1 month after treatment again.

I suggested to him to wait 3 months after treatment to see what the numbers will be after Penicillin and possibly get a lumbar puncture test done to ascertain the potential presence of a Neurosyphilis infection.

Doxycycline is considered effective for Syphilis treatment, but this is the second time here on Medhelp with a reported Doxycycline treatment failure (treatment failure means the tests do not show a 4 fold decrease in titer counts after 3 months time).

This leads me to suspect 3 possibilities:

1. This particular Syphilis variation is resistant to Doxycycline (it seems relatively unlikely, but still possible).

2. Possible Neurosyphilis infection (in which case, one would need 200mg of Doxycline twice daily for 28 days [resulting in 400 mg per day], or Penicillin treatment).

3. Possible re-infection after the initial treatment was completed.
- Did you have sex with anyone after you completed the initial treatment?
If yes, then its possible you were reinfected.
If you didn't have sex after treatment, then I would definitely ask the doctor to do a lumbar puncture and check for Neurosyphilis infection.
You mentioned ringing in the ears and headaches. I don't mean to scare you, but these might be linked to Nurosyphilis.

4. Your doctor prescribed insufficient duration for Doxycycline. It should have been for 28 to 30 days, not 21.

Btw... which medicine did your doctor prescribe for 15 days on your followup treatment?
First you mentioned 15 days for the second time (I would surmise that this worked in clearing the infection this time because it was weakened by the 21 days of therapy), and then 20 days.
Can you be more precise on what medicine was prescribed, and for exactly how long this second (and third?) time around?

VDRL being non-reactive is excellent.
TPHA being positive is expected (people who had Syphilis for an unknown amount of time and high titer numbers would test positive for some time to come) - the numbers of 1:200 dilution is great (its probably a lot smaller compared to where it was on your previous test - it will take a while longer for those numbers to dwindle to 0).

The important thing is your numbers decreased by 4 times.

I suspect that the initial treatment didn't work because it probably lasted for 21 days and not 28 to 30 days as recommended.
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Avatar_m_tn
he changed the tablet from  doxy to MINOCYCLINE TABLETS 100MG
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Avatar_m_tn
which medicine did your doctor prescribe for 15 days on your followup treatment?

it is Minocycline tablet twice a day 15 days with zemega soft gel capsule

and complete that ,and i go with blood report to consult doctor the report says ,vdrl non reactive....and TPHA  is 1:200 dilution again he prescribed minocyline  capsules 100 mg per day with zemega soft gel capsule for 20 days
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Avatar_m_tn
If the VDRL was non-reactive after the second treatment, then I don't think there was any need for a third course of antibiotics.
Those TPHA numbers would have to come down gradually on their own - but if  your doctor recommended that, then follow through with it.

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Avatar_m_tn
thank you very much sir .....
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