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Syphilis Help!

Please help! I’m waiting to get a cal from an infectious disease expert to make an appointment.

Nov 2018 I was diagnosed with syphilis and treated with 3 rounds of penicillin. My titers were 1:128

December 2019 I became pregnant and was tested again and my titers came back 1:32

April 2020 (28 weeks pregnant) I was retested because my doctor suggested it and my titers were 1:32 again. She said I needed to be treated again and I received another 3 rounds of penicillin injections.

August 2020 I was rested and my values increased to 1:64.

I have been 100% safe (always using a condom) besides with my long term boyfriend who has been testing negative this entire time (since Nov 2018). I did have completely protected sex once with a guy March 7th 2020. And as stated was my titers remained the same BEFORE I was retreated.

My question is why would my titers rise AFTER treatment even though I’ve had no new sexual partners and my baby daddy has consistently tested negative.

Each test was performed by the same doctor and exact same test was done. She’s not referring me to an infectious disease specialist but I may not be able to be seen for a few weeks. What could possibly make my titers rise besides new infection which I’m 100% sure it isn’t.
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Avatar universal
And I’ll add that I have been negative for all other std’s. I did test positive for herpes in 2013 during an initial outbreak (Sores on my vagina were swabbed). I have never had another outbreak since 2013.
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207091 tn?1337709493
Pregnancy can cause false positives. Is this an RPR or VDRL? Are they doing confirmatory testing with another test? What are those tests showing?
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RPR (All positive) with a Treponema Pallidum Antibodies (TB-ABS) conformation. All test were RPR positive with (TB-ABS) Confirmations. The numerical results were.

Nov 2018: 1:128
Dec 2019: 1:32
April 2020 1:32
      Retreated with 3 shots of penicillin
August 2020 1:64

Between April and August I had no new sexual partners and my current sexual partner is negative.
I would say it's a treatment failure, except it seems like you responded to treatment for over a year. If your TB-ABS is positive, it's not a false positive.

Because you are pregnant, and so far along, I don't want to take a chance and give you the wrong information. There is a doctor who is one of the best experts in the world on syphilis. His name is Dr. Edward Hook, and he answers questions on https://www.ashasexualhealth.org/ask-experts-get-answers-questions/ There's a $25 fee, which I hope you can do. He's worth it. You get one question, and 2 follow ups, so make sure in your initial question to put that you had the confirmations. Please let me know what happens.

Thank you. I finally got a call back from the infectious disease specialist and I’m seeing them Thursday so I’m going to hold off on asking Dr. Hook. I was reading through his responses where titers can fluctuate after treatment but the fluctuations he was referring to were low titers (1:2 to 1:4). But I also read that it must be a 4 fold increase to indicate reinfection (1:8 to 1:32 for example) and I’m 100% sure there’s no chance to reinfection so I’m just super confused and hoping my results were just a minor fluctuation and it will continue to go down. I just don’t want my baby to have congenital syphilis. I’ve now had 6 shots of penicillin it’s becoming ridiculous at this point. Do you think I should ask for a lumbar puncture to test for Neurosyphilis. I was originally told it wasn’t necessary because I’m not showing any signs.
I don't know - I'm so hesitant to advise that because of where you are in your pregnancy. I'd think at least, the penicillin would slow the infection enough to not spread to your brain.

There are risks for a lumbar puncture - https://www.mayoclinic.org/tests-procedures/lumbar-puncture/about/pac-20394631 There aren't any extra risks because you are pregnant.

Was your TB-ABS positive in April? It shouldn't have been.

What's your HIV status?

I’m HIV negative and my TB-ABS have remained positive even with the decrease in my Titers. My titers only increased after I was treated for a second time.
You're plowing through all my reasons for why this would be happening lol.

The only thing I can guess is that part of this is a false positive because of pregnancy. That's a risky guess, though. And it's odd that your titer never went below 1:32, which is why your doc suggested being retreated.

If you had late latent syphilis (meaning you had it for a long time), and that's what your doctor was assuming when she treated you with 3 rounds the first time, your TB-ABS may always be positive, but your RPR should have dropped more over time - the 4fold drop is good, but over all this time, I'd have thought it would drop more.

Again, though, Dr. Hook and your ID specialist will know a lot more about this than I will.

Also, I just looked at the calendar and your post again. I thought it said 20 weeks pregnant in April, so you've probably had your baby by now? How is your baby? Has your baby been tested?

No I haven’t had my baby yet. I’m 29 weeks now. (Due Nov 9th) thank you so much for you responses. I’m honestly not sure why my titers havent decreased more and are now increasing but it’s stressing me out! I just want my baby to be born healthy. Hopefully Thursday I can get more answers. I’m not sure why my titers would Increase after being treated with no new partners inbetween. The father of my baby has never tested positive and we have been together 4 years. This definitely makes me this it was latent syphilis When I was originally treated in November 2018. I never had any noticeable symptoms and have never given it to another partner. I was told with the initial 4 fold decrease that I was “cured” but after they remained at 1:32 I was treated as if I was still infected. Ugh please pray for me!
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