to dr hook, A few questions

[revo33]

hello dr hook, thank you for the last reply, i appreciate your opinion . i have one last question and i hope that you would be kind enough to answer. ill recap on my situation. i had sexual contact in 02, had a chancre sore right after, RPR neg FTA abs minimally reactive. I got one pennecillin shot. i did my second test in 09  , RPR neg FTA-ABS neg. i guess im the few whose fta abs turned non reactive. but,

My worry lies in neurosyphilis, and i need to get this off my mind because the what if's are getting to me. Dr Hook, say if i had neurosyphilis when i was treated with that one penecillin shot. After killing the syphilis in my blood system (but not in the spinal system) would the syphilis germ reappear in my bloodstream again from the lingering neurosyphilis. and thus on the FTA ABS and RPR from the neurosyphilis if it was present, Making the tests completely reliable that i dont have neurosyphilis or for that matter any syphilis?  

or does neurosyphilis stay in the spine, and is unable to reach the blood system again after a penecillin shot killed the blood germs of syphilis, rendering the blood test useless for a neurosyphilis diagnoses?

should i get a spinal test?

my last question is, can syphilis be transmitted through blood contact? such as if i was bleeding, and someone was trying to help me with my injury, and they had a cut too and my blood touched there cut, could they get it too? or does the syphilis virus die when the blood is outside the body?

THANK YOU so much for your time.

[Edward W Hook, MD]

Yes, the same is true if you had secondary syphilis, which was not the case since virtually everyone who has secondary syphilis has a reactive RPR test at the time of diagnosis.

This line of questioning seems to go on and on, suggesting that my answers are only fueling your unwarranted anxiety.  As a result, this will be the last answer to this thread.
Your concerns really are now at a place where there have been far to many "but what if"s and "but could..."s to be realistic..  You really need to get by the idea that you have persistent syphilis at this time.  If you cannot, my suggestion would be that you should seek counseling to help you work through this.  EWH

[Edward W Hook, MD]

Your questions suggest to me that you are having a very hard time dealing with the idea that your syphilis, if that is what you had, has been successfully treated.  I am really not sure where this sort of concern comes from.   You have negative syphilis blood tests and non-specific symptoms.

The clinical presentations of syphilis are highly variable.  For that reason and because the tests are so reliable, when a person has findings which might be due to syphilis, they should be tested for syphilis.  If the test is negative, they do not have syphilis.  On the other hand, to not believe the test and to be concerned that every rash or other symptoms which might possibly be caused by syphilis simply has no basis is scientific/medical fact.  You really need to believe your tests.

Finally, yes I did say that if you had nervous system involvement with your primary syphilis, the benzathine penicillin sots would have cure it.  

I repeat, nothing you have said above raises any concern for me that you might have syphilis.  You do not need further testing, nor is there any for concern.  EWH

[revo33]

symptoms i forgot to add,  

lymph node hurts in the groin last week but now gone, diarhea for a while, and once had a full body dotted, non itchy rash 2 years ago (few years after the injection), and the skin irritation on face looks like very dry and flaky skin if touched or scratched , dry  peices of skin chafe off, ring shaped,,or half or a quarter of a circle, non itchy, on both cheeks, covering the whole of cheeks, had it for 10 months, tried lamisil,ketoderm,lotriderm,cetaphil with 1% something in it, and a psoriasis and excema ointment. the steroidal creams seem to totally clear it up, but when i go off, it comes back, very irritated looking at first when i come off the meds, then settles down 50% and back to the way it normally looked. my family dr referred me to dermatologis, and dermatolgist is confused, he said he did not know what it is. so im searching for a new derm now


thank you and if you can please answer questions in last post. thanks

[revo33]

thank u , my symptoms

rashes on body and irritation (6 or 7 circles of dry skin, not ringworm but shaped like it) on face, insomnia, deppression/aanxiety, weight loss (20 pounds in few months) , slight hearing loss, muscle twitches - only rarely, black gums, hair loss , what do you think doctor, would this be the other consideration to the RPR. Or do my symptoms not have anything to do with the illness. are you still in the opinion of no other testing needed (blood or csf tests) after these symptoms. thank you



thank you DR Hook.

[Edward W Hook, MD]

Your first question presumes that the penicillin would not eliminate sy0philis from your nervous system. That is incorrect. In situations such as yours, if you had neurosyphilis, your blood tests would be positive.  

No risk related to blod contact.

The RPR is the right test for evaluating your old contact.  No other testing is needed.The prozone would only be a consideration if other evidence of syphilis were present.  

EWH

[revo33]

thank you doctor for the reply, ur are right i need counselling, i guess it makes me feel better knowing a Dr that knows about the disease can give me correct answers compared to the dr that i have seen recently. i just trust what u have to say, and it does make me push like 90% of my fear away. its anxiety , and i am using relaxation techniques which seem to help.


still not to clear on the questions though directly, any more insight?
""""After killing the syphilis in my blood system with one shot, (but not in the spinal system) would the syphilis germ reappear in my bloodstream again from the lingering neurosyphilis. and thus on the FTA ABS and RPR from the neurosyphilis IF neurosyphilis was present, Making the tests completely reliable that i dont have neurosyphilis or for that matter any syphilis?'''''  previous quote,
would u know the answer to this?  
does the treponema pallidum re-appear from the spine/brian barrier back to the bloodstream. (does that make sense)
does it happen pretty quickly (detectable by a blood test say within a year of the shot)?


So risk is very low for blood/cut to blood/cut contact i take it? or non existant?

One more question please Dr hook, i want to get someone tested because i might have had contact with them 7 years ago (during my chancre sore very possibly), i was very very young at the time, so i never thought about transmission, And they are only allowing an RPR  and no ftaabs tppa(the clinic says RPR is good enough and is accurate) is this ok? i know of the prozone effect. How often does that effect occur? can the RPR be reliable for my friend, how reliable? or should fight for the confirmatorie tests too. (no serious visual skin issues with friend that i can see)

thanks again DOC!

i just want to cover all bases, and know that these tests are reliable, in the very unlikely chance, that this WAS the situation.... thank u for your response Dr, i greatly appreciate it, and i am going to be talking to a counselor regarding my anxiety issue as well. because they seem to effect my life alot.

[Edward W Hook, MD]

Your prior interchanges were with DR. Handsfield and this time you got me.  I agree with all of the information that Dr. Handsfield gave you.  I will briefly answer your continuing questions but the most direct summary statement that I can say is that it appears to me that for some reason you are very concerned that your syphilis may have not been adequately treated with the penicillin you received when you were initially treated.  The fact is that syphilis, even in its earliest stages is widespread throughout the body.  Despite that, penicillin treatment is highly reliable and that your blood test are now entirely negative proves that if you had syphilis to start with, you no longer do.  Sadly, I am sure you can find statements on the internet that syphilis is difficult to treat or that a single shot of penicillin is insufficient therapy.  Those statements however are not supported by any scientific studies conducted using good methods.  Those studies which have been carried out support Dr. Handsfield’s and my assessments/recommendations, i.e. that there is simply no reasonable chance that you have neurosyphilis.  I would not recommend a spinal tap for you.  

Syphilis can be transmitted by injection but there is no evidence that syphilis is or has ever been transmitted through contamination of a cut in the way that you describe.

Dr. Handsfield suggested you may wish to seek counseling to help you deal with this unwarranted fear that you have syphilis.  I endorse that.  Your concerns are not founded in fact or in science and I fear that they are causing you unnecessary worry.  Take care.  EWH  

[revo33]

ok Dr and i thank you for giving me your input to this as well, i appreciate it, and you are a great DR , very knowledeable, thank you

[revo33]

oh ok , i understand , so 1 injection would have killed neurosyphilis in primary , does that go for secondary etc as well. thank u for the clarification. i didnt understand that was the case.

[revo33]

"Your first question presumes that the penicillin would not eliminate sy0philis from your nervous system. That is incorrect"

so you are saying bicillin (one shot) would have cured neurosyphilis as well?

"do my symptoms not have anything to do with the illness. are you still in the opinion of no other testing needed (blood or csf tests) after these symptoms. thank you "

[revo33]

sorry, i just thought of more symptom cus im feeling it right now, i feel tired and fatigued alot, and also , if i eat anything with spice, even the smallest amount, i have excruciating abdominal pain, worst pain i probably felt (scared something internally is messed up). and i never use to be sensitive to it in the past. thanks doctor, bye bye