Neurosyphilis worried

[rotaryana]

Hi,
I'm 38 heterosexual male with genital herpes, during last 2 months i had few ( 6 ) unprotected oral sex encounters with different persons in SE asia. Before that time i had no sex for 8 months and my vdrl tests were negative. After 2 months from first encounter i noticed a small round, flat ,painless, dark red sore on my penis glans.
At first i thought it was just herpes, but this one lasted for almost a week. 2 days after i noticed this i did a vdrl test in a small dirty lab on an island in asia. This test was positive. I also noticed i have vertigo for 0.5 a second when putting myself to bed, and after switching position in bed.  

I fly out to a bigger city with a proper clinic, they did rpr test , result was non reactiv. I did intramuscular injection of penicling G. Then put myself on 200mg doxycyline taken every 12 hours. I talked with neurologist , he did few tests on me which he said I passed ok, except one which was that my pupils were not shrinking with light test. I will go do the spinal tap, but its not easy to do here.

The question is - was i that unlucky to not only get a syphilis from unprotected oral sex, but a neurosyphilis straight from the start ? Or am I paranoid. The vertigo is what worries me the most.

Thank you for answers.
Grzegorz

[auntiejessi]

When you got the reactive VDRL, did they confirm it with a different test, like a FTA-ABS? Before you continue to dose yourself with meds that include dizziness as a side effect - https://www.rxlist.com/doryx-side-effects-drug-center.htm - you should get your diagnosis confirmed.

Neurosyphilis happens in late term syphilis. We are talking years. LOADS of things cause vertigo and dizziness. You could indeed test positive for syphilis, and indeed have it, and still have something else causing your neuro symptoms.

Who gave you the treatment for syphilis? A syphilis sore lasts at least a few weeks. I understand why you thought you had it - it was different than your normal herpes sores, and you had a reactive VDRL, but I think you need some confirmation before doing invasive and painful testing like a spinal tap.

So see if you can get your VDRL results, and see if that was confirmed by another test - all positive VDRL and RPR tests should be confirmed. What was the actual result on it? There should be a number on it - like 1:16, 1:32 - it can be any number and it may be really high or really low. I'm suspicious of this result because the RPR came back negative, and it should have been positive.

Also, see a neurologist. There are literally 100s of things that I'd suspect for your symptoms before I would neurosyphilis since you had negative testing 8 months ago, and all your exposures were within 2 months.

[rotaryana]

Thanks for the answer. I did the RPR again, and TP-PA, both tested negative. I read however at mayoclinic that: "Patients tested by serology during the primary phase may be negative for antibodies, especially if testing is performed during the first 1 to 2 weeks after symptom onset."
which could mean the neurosyphilis is present, but the body did not have time to respond with antibodies.

Now, should I continue taking antibiotics or stop, wait a week or two, then test again. ?

[auntiejessi]

So the VDRL was first, which was positive? Did they do a TP-PA or FTA-ABS after that? Then the RPR was next?

If the RPR was after the VDRL, then trust that.

It is possible to test too early, but I'm confused about the positive VDRL and negative RPR and the order of those.

Who gave you the antibiotics? Are you self-treating? If you are, stop those. You've already had penicillin, correct? How many shots did you get? If you got 2 shots of that, you don't need the doxy, if you do have syphilis.

Again, neurosyphilis usually occurs later - much later. Most people, if they develop this, don't develop it until 10-20 years after infection. A majority of them also have HIV. Have you tested for HIV?

Worry about whether or not you have syphilis before you worry about neurosyphilis.