Syphilis Titer Not Falling

[igimakit]

I had a syphilis diagnosis Feb 14...wasn't really sure what stage it was in, but the titer came back at 1:16. Before I actually knew I had syphilis I thought it was a sore throat, so I took a Z-pak and when I was retested a week later the result was 1:1 nonreactive. The nurse was saying that was odd. I had two rounds of Pen G injections for two weeks. Abstained from sex...same partner, he was tested and came back negative of all stds. I decided to get tested again in March because I saw a little bump show up on my hand. Went back in and that test said 1:8 went back to be treated this time with Doxycycline 100mg because I travel for work and couldn't keep up with the 1/week penicillin injections. Needless to say I've been taking the Doxycycline on schedule, twice a day and was tested in April...the titer was still at 1:8. This is my first time ever having any STD btw.

My questions are...

Am I not responding to treatment? Do I need to wait to be tested again because the titer is staying the same not moving. Should I not be having sex right now? I have about 2 more days left on Doxycycline, when should I go back to retest to see if the titers are falling?

Any help would be appreciated. Thanks everyone.

[igimakit]

After all of this...I have to admit I got my last test results back and everything is clear and good to go 1:1 nonreactive!!!

[igimakit]

I went back to the doctor and told him what I was experiencing. He decided to give me a 1.5g of Rocephin and I had a 5 day round of Amox 875mg after all of this. I will probably retest within the next few weeks. I cannot wait for this to be over.

[deksman2]

Well, if you are still concerned, I would suggest you go back to the doctor and explain the situation to him/her just in case.
Have then re-examine you and see what's happening.

[igimakit]

deksman2

Thank you so much for your response! I just got so nervous when I saw some of the symptoms return which I saw initially. That's what started to make me think the treatments were failing/failed.

Again thank you for your response.

[deksman2]

First off... way too much testing and not enough time has passed.

It takes time for RPR numbers to drop by about 4 fold... approximately 3 months after Penicillin treatment, and even then, a 4 fold drop is not guaranteed even after the first 3 or 4 months... it was stated in peer-reviewed studies that if the RPR numbers do not decrease 4 fold about 400 days after treatment, THEN its considered for the treatment to be a failure.

Also... I was on Doxycycline treatment (2 weeks, 2x 100 mg daily - each pill 12 hours apart - followed to the letter) for secondary Syphilis (RPR was 1:32 before treatment) and my RPR dropped to 1:16 when I went for a re-test 4 months later.
TPHA reduced by about 8 times however and my FTA-ABS IgM was non-reactive (indicating that the bacteria was effectively 'dead').

When I addressed my concern to the dermatologist that my RPR failed to drop by 4x (4 months after treatment), she said that this isn't worrying and that it was also because I was on Doxycycline instead of Penicilin - plus that the total time until a treatment can be considered a 'failure' would be about 12 months (or at most, 400 days).

She simply advised me to retest in 6 months time.
I asked if it would be prudent to do one more round of Doxycycline, and she said that it shouldn't be necessary.
I also asked if I could retest in 5 weeks time (before moving to UK), but she stated the RPR numbers wouldn't really 'budge' in that time frame (because it can take months for those numbers to change), so it would be pointless to do the test so soon.

If your Syphilis infection was under 1 year of duration (first and secondary stage), only 1 IM Benzathine Penicillin G (24 million units) injection would suffice - or Doxycycline 100 mg, twice per day, for 2 weeks.
If the infection lasted longer than 1 year, the recommended treatment is 3 IM Penicillin injections, with each injection being administered once per week (3 weeks in total)... or Doxycycline 100 mg 2x daily for 4 weeks.

Simply speaking, you never allowed enough time for your RPR numbers to drop 4 fold.
At best, they dropped by half (although that 1:1 test  in between was odd to say the least - could have been an error, or a possible interaction with the drug).

Finish your Doxycycline treatment and then wait 3 months until you get retested.

You can start having (safe) sex again roughly 2 weeks after you finished with Doxycycline.

Also keep in mind that each body reacts differently.
Just because numbers seem to drop slower in one person and faster in another is not necessarily an indication the treatment failed in the slower case.