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Recurring Syphilis Issues and HIV Concern

Back in January I had a one night stand with another man while I was broke up with my girlfriend.  After my girlfriend and I got back together I noticed a rash that started in the groin area and spread to my arms,wrist, legs, ankles, and collarbone area.  I tested positive for syphilis on March 12 and my level was 32:1.  HIV test was negative.  I received treatment on March 17 and they tested me again at that point, level was 64:1.  Girlfriend tested negative for everything, but got preventative treatment.  After the original treatment in March we waited longer than suggested to have sex again. Got re-tested on June 15, syphilis level down to 2:1, HIV Negative.  Started showing symptoms again in late July early August.  Got tested again on August 15th, Syphilis level back up to 16:1, HIV still negative.  Got treatment again on August 21.  My girlfriend still tested negative at the same time but got preventative treatment again.  When the levels were back up I initially thought that maybe we didn't wait long enough to have sex after the March diagnosis, and that I infected her, and she re-infected me.  I haven't been with anyone but her since the beginning of February.  But her test is still negative, so now I'm confused.  Also heard that HIV can make syphilis treatment less successful, so I'm freaking out about that now, but I've tested Negative 3 times now, and it's been over 6 months since the encounter.  Should I be worried?  It's been over a week since my second treatment, and my symptoms aren't getting better, perhaps even a little worse.  I've noticed a similar rash to before developing on my wrist and other areas, and I have had mild stomach issues/diarrhea all week.  
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Your HIV test is NEGATIVE  several times, and that is a very reliable test, nothing influences it's acuracy. Have no worries about that, you are HIV negative.

You gotta make sure you got adequate dosage for the syphilis stadium. Usual dosage is Benzathine Penicillin 2,4 million units, 1,2 in in each buttock. You probably got that.
It's also possible to give 1,2 million units daily for 10 days, so longer, that is a good option.
If it was me, I wouldn't repeat the same regimen of MU 2,4 twice, when it might have failed once.

Penicillin is usually the best and experienced doctors swear by it, but also Doxycycline, Ceftriaxon, Azitromycin can be used.

You need a good specialist which will give you stadium adequate drug and dosing to make sure.
Diarrhea is not a particular symptom of Syphilis, and rash of Secundary syphilis is most often dramatic, obvious rash on body, or palms. Not some rash on wrists.

You'll see the tests next time, these symptoms don't sound like syphilis, but lab will show.
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207091 tn?1337709493
Okay, so how are you being treated? What meds are you being treated with, and what is the dose?

You have secondary syphilis, since you have the rash. You should be getting shots of penicillin, unless you are allergic to that. If you're allergic to penicillin, they'll either try to do desensitization therapy, or treat you with doxycycline or tetracycline for 14 days.

Your levels went back up by more than 4fold - from 1:2 to 1:16, which means treatment failure or a new infection, since they had already dropped by 4fold, from 1:64 to 1:2, which indicated you were cured. I'd have to think you were exposed again, but your girlfriend is being treated AND testing negative, which makes that seemingly not possible.

What kind of testing are you both having done?

There is an incredible doctor who is probably the world's expert on syphilis, Dr. Edward Hook. He answers questions on ASHA - http://www.ashasexualhealth.org/experts/ He literally wrote a textbook on syphilis. You have to pay to ask him a question, but since this is a really tricky case, if you can afford it, I'm suggesting him. You can click on Premium Services on the above link, or get to it here - https://www.askexpertsnow.com/

I'm happy to help however I can, but he's a lot smarter than I am. If you do post there, title it with Syphilis in the title, and I think he answers all the syphilis questions.

Let me know what happens.

What are your doctors saying about this? What kind of doctors are you seeing? If you aren't seeing an infectious disease doctor, you should be.

Helpful - 0
Thank You

In both cases of treatment, on 3-17 and 8-15; I receive two shots of penicillin, one in each buttock. Have no idea what the dosage was.  

The nurse practitioner at planned parenthood I spoke to after getting the 8-15 test results thought it may have something to do different types of tests, but honestly I don't even know the difference.  Due to the 4 fold decrease and then increase as you noted, that doesn't seems likely.  At the time I last spoke to her we also didn't know my Girlfriend's negative result,  so we mostly assumed re-infection from her.  Below is my best accounting of all my test results, not sure if that would lend any clues as to the type of testing.

3/12 - Through my Primary Care Physician, using Labcorp - test reads: T Palladium Screening Cascade:   T Palladium Antibodies - Reactive , RPR Quan - Reactive 1:32

3/17 - Sought treatment at Denver Health Hospital STD Clinic - Received Penicillin Treatment. Testing at Denver Health done through Colorado Dept. of Public Health & Environment Laboratory Services Division.  Test reads Rapid Plasma Reagin Ab (RPR) - Result - Titer 1:64, Syphilis TP - Result - Reactive for treponemal antibodies.

6/15 - Retested through Denver Health, done through Colorado Dept. of Public Health & Environment Laboratory Services Division.  Test reads Rapid Plasma Reagin Ab (RPR) - Result - Titer 1:2, Syphilis TP - Result - Reactive for treponemal antibodies.

8/15 - After having new symptoms, and also having insurance issues with Denver Health, I went to a planned parenthood.  I have no data from them, I was simply told that my levels were 1:16. After this I received the penicillin treatment from planned parenthood on 8/19.  

Not sure if that information says anything about the test types, but I think I can safely assume that at least the tests on 3/17 and 6/15 both done by Denver Health, must have been the same.  

My Girlfriend Received testing from a different planned parenthood, the first test in Mid March, second in Mid August.  All I know is that she tested negative both times.  

My symptoms are still increasing since the second treatment (9 days out), I'm contacting planned parenthood again tomorrow.

Thank you for the recommendation, I will look into it and see if I can afford it!  
If you got two shots, one in each cheek, you're getting the proper dosing.

It also looks like you're getting the same tests each time - the RPR. I'm not sure what that's about.

Let me know what's happening, and if you're able to talk to Dr. Hook.

Thanks.  Due to my levels going back up, and numbness in my hands every night when I sleep for the past 3 weeks, It has been recommended that I get a Lumbar Puncture for evaluation of Neurosyphilis.  The nurse I spoke to at Planned Parenthood thinks I should get this procedure, and I was referred back to Denver Health, which is the only place I know of in the area that can do this procedure on short notice.  However my insurance will not cover anything through Denver Health.  The doctor at Denver Health who I was referred to is trying to help me find someone else in the area who can do the procedure and also be covered by my insurance.   I have no idea when that will be.  The doctor at Denver Health also thinks I should do this procedure based on my history.
Wow, okay. I don't know that I'd agree with that, but that's okay. Before you do that, if you haven't, can you talk to Dr. Hook, who I linked above? I'd hate for you to have to go through such an invasive process unnecessarily.
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