Aa
Nervous About GF's Results
Doctors,
My girlfriend just went for an STD screening, and she came up negative for everything except antibodies for syphilis were detected. She went to have another blood test to determine if this was a false positive. I am not bisexua (never been with a man), but have been somewhat permiscuous, which she knows about. I am going to get tested myself asap, however as of right now I am nervous and would like your opinion. I am not sure which test she was given to determine that antibodies were present, but I would like to know the chances of this being a false positive. I realize that syphilis is entirely rare among heterosexuals, and I just don't understand how we could have it. Furthermore, we have had a long talk and I am almost 100% confident she has not cheated on me with another guy, so the only way she could have gotten it would be through me (she tested negative for it a few years ago, at which point we were together). Neither one of us has ever had a syphilis chancre. I would greatly appreciate your advice/opinion on whether this is likely a flase positive. Thanks a lot
My girlfriend just went for an STD screening, and she came up negative for everything except antibodies for syphilis were detected. She went to have another blood test to determine if this was a false positive. I am not bisexua (never been with a man), but have been somewhat permiscuous, which she knows about. I am going to get tested myself asap, however as of right now I am nervous and would like your opinion. I am not sure which test she was given to determine that antibodies were present, but I would like to know the chances of this being a false positive. I realize that syphilis is entirely rare among heterosexuals, and I just don't understand how we could have it. Furthermore, we have had a long talk and I am almost 100% confident she has not cheated on me with another guy, so the only way she could have gotten it would be through me (she tested negative for it a few years ago, at which point we were together). Neither one of us has ever had a syphilis chancre. I would greatly appreciate your advice/opinion on whether this is likely a flase positive. Thanks a lot
A related discussion, Frustrated was started.
MEDICAL PROFESSIONAL
Here are the only possibilities, all three of which assume your certainty about yoru partner's sexual fidelity is correct:
1) Your partner has false positive test results, i.e. no syphilis at all. This is the best bet. More information below.
2) She has chronic, longstanding syphilis (or previously treated syphilis) that predates your relationship and was missed when she was tested 2 1/2 year ago. As I said before, this would be consistent with her weakly reactive RPR at this time. By treatment, I don't imply that her syphilis was actually treated intentionally. If she received antibiotics for other reasons over the years, an unknown syphilis infection might have been treated without knowing she had it.
3) You were infected somewhere along the line, infected her, and your syphilis then resolved. Syphilis can clear up on its own, without treatment, and the standard blood test can revert to negative. Or, as above, treatment via antibiotics for another infection within the past couple of years.
You might never know the answer for sure. If you want to pursue the first and most likely possibility, your partner could be re-tested with one or more additional confirmatory blood tests. This is something to be addressed with her health care provider. As suggested earlier, an infectious diseases specialist would know how to go about it.
Sorry that we cannot resolve all uncertainty for you. But the good news is that you don't have syphilis, probably your partner doesn't either (but to be maximally safe, she should complete the treatment her doctor has recommended), and neither of you is at risk for any serious health consequences. When all is said and done, this episode should fade into an inconvenience, nothing more.
That will have to end this thread. Take care.
1) Your partner has false positive test results, i.e. no syphilis at all. This is the best bet. More information below.
2) She has chronic, longstanding syphilis (or previously treated syphilis) that predates your relationship and was missed when she was tested 2 1/2 year ago. As I said before, this would be consistent with her weakly reactive RPR at this time. By treatment, I don't imply that her syphilis was actually treated intentionally. If she received antibiotics for other reasons over the years, an unknown syphilis infection might have been treated without knowing she had it.
3) You were infected somewhere along the line, infected her, and your syphilis then resolved. Syphilis can clear up on its own, without treatment, and the standard blood test can revert to negative. Or, as above, treatment via antibiotics for another infection within the past couple of years.
You might never know the answer for sure. If you want to pursue the first and most likely possibility, your partner could be re-tested with one or more additional confirmatory blood tests. This is something to be addressed with her health care provider. As suggested earlier, an infectious diseases specialist would know how to go about it.
Sorry that we cannot resolve all uncertainty for you. But the good news is that you don't have syphilis, probably your partner doesn't either (but to be maximally safe, she should complete the treatment her doctor has recommended), and neither of you is at risk for any serious health consequences. When all is said and done, this episode should fade into an inconvenience, nothing more.
That will have to end this thread. Take care.
Docs,
I got my results back today and they were negative. I had an RPR. Can either of you please help me draw some conclusions here? The nurse practitioner I saw has no clue about any of this, and I actually found myself educating him about false positives, etc.
To sum it up, my girlfirend has absolutely not cheated in the last few years and I would have been the only way she could have gotten it. She tested negative 2 1/2 years ago and her test had a titer of 1:1 in her recent test. Is this likely a false positive?
Thanks
I got my results back today and they were negative. I had an RPR. Can either of you please help me draw some conclusions here? The nurse practitioner I saw has no clue about any of this, and I actually found myself educating him about false positives, etc.
To sum it up, my girlfirend has absolutely not cheated in the last few years and I would have been the only way she could have gotten it. She tested negative 2 1/2 years ago and her test had a titer of 1:1 in her recent test. Is this likely a false positive?
Thanks
MEDICAL PROFESSIONAL
When the VDRL or RPR is so weakly positive, it is easy for the test to miss it entirely one time and pick it up the next. There is no way to know from these results whether your gf was infected recently or in the distant past; i.e., her test 2-3 years ago might have just missed it. That's inherent in the syphilis blood tests and at this point it is not possible to know.
Yes, it is possible that someone infected 2 or more years earlier could have a titer of only 1:1.
Auto-immune diseases can cause false-positive syphilis tests. The confirmatory test is designed to sort this out, and most likely she in fact has a chronic (probably inactive) syphilis infection. However, there is no way for any distant, online expert to come to a definitive decision about this. As I said above, it would be best if an infectious diseases specialist were involved in your partner's care.
It is not the purpose of a forum like this to come to final diagnoses or to direct somene's healthc are. That's up to your health care provider(s). When your own test results are available, I will be happy to help draw whatever conclusions are warranted at that time. Other than that, Dr. Hook and I won't have any further comments.
Yes, it is possible that someone infected 2 or more years earlier could have a titer of only 1:1.
Auto-immune diseases can cause false-positive syphilis tests. The confirmatory test is designed to sort this out, and most likely she in fact has a chronic (probably inactive) syphilis infection. However, there is no way for any distant, online expert to come to a definitive decision about this. As I said above, it would be best if an infectious diseases specialist were involved in your partner's care.
It is not the purpose of a forum like this to come to final diagnoses or to direct somene's healthc are. That's up to your health care provider(s). When your own test results are available, I will be happy to help draw whatever conclusions are warranted at that time. Other than that, Dr. Hook and I won't have any further comments.
Doctors,
Was that information not specific enough? I realized I didn't include the types of tests she had. Unfortunately, she has been in panic mode and forgot to ask them which tests were performed.
Thanks again
Was that information not specific enough? I realized I didn't include the types of tests she had. Unfortunately, she has been in panic mode and forgot to ask them which tests were performed.
Thanks again
My gf had an appointment today for her first round of shots. As per my request, she asked them to see the results. They seem to be suspicious from what I have researched in medical publications. She had a titer of 1:1 and the test was a non-reactionary positive. However, as I said, she was tested about 2 1/2 years ago and the result of that screen was negative! A titer of 1:1 would indicate a far-distant infection, correct? Is it possible to have such a low titer if the infection was acquired within the last 2 1/2 years??
She does has a family history of auto-immune disorders. Again, neither one of us have ever noticed a chancre and/or rash. Given the above information (remember, I am entirely heterosexual), does it appear likely that this was a false positive? And if so, is there any reason why she wouldn't have had a false positive 2 1/2 years ago?
Thanks!!
She does has a family history of auto-immune disorders. Again, neither one of us have ever noticed a chancre and/or rash. Given the above information (remember, I am entirely heterosexual), does it appear likely that this was a false positive? And if so, is there any reason why she wouldn't have had a false positive 2 1/2 years ago?
Thanks!!
MEDICAL PROFESSIONAL
I've read the thread and will start by saying that throughout the entire thread Dr, Handsfield has answered just as I would have. I think that there is a need to gather further information here. Assuming that, indeed you and your GF are low risk, it remains as likely as not that her test is a false positve result. In recent years laboratories have shifted to a new type of test, termed an EIA for syphilis screening. In doing so, we have had new probvlems with false positve tests to wrestle with. As Dr. Handsfield has suggested, I would start by:
1. Find out what sort of test your GF had and how the result was reported. This should be done for both the inital test and the confirmatory tests.
2. You should be tested yourself.
Regarding whether syphilis is markedly underdiagnosed, the answer is no. Please remember that every blood donation in the country is tested for syphilis, as are the vast majority of pregnant women. when you all all of this testing, as well as all of the testing done in the contect of STD testing, if there were more syphilis out there, we'd know it.
Once you have these data we can begin to sort out whether or not infection(s) are present and what to do about them. I will follow with interst. EWH
1. Find out what sort of test your GF had and how the result was reported. This should be done for both the inital test and the confirmatory tests.
2. You should be tested yourself.
Regarding whether syphilis is markedly underdiagnosed, the answer is no. Please remember that every blood donation in the country is tested for syphilis, as are the vast majority of pregnant women. when you all all of this testing, as well as all of the testing done in the contect of STD testing, if there were more syphilis out there, we'd know it.
Once you have these data we can begin to sort out whether or not infection(s) are present and what to do about them. I will follow with interst. EWH
MEDICAL PROFESSIONAL
You don't yet know that you have syphilis. It seems probable, based on your sexual history compared with your partner's. But please wait until you know your test results.
But if you are infected, your "dumfounded" state and "I don't see how" comment reflect fallaceous reasoning. The fact that someone has a rare outcome doesn't mean it didn't happen. If someone is struck by lightning, you don't say "lightning strikes are rare, so it must have been something else". This applies both to syphilis in general in cases like yours, and to having syphilis without a visible lesion. It isn't common but it happens. There is no point in trying to figure out a specific explanation. Probably you're never going to know.
Don't expect specific replies from Dr. Hook. We agree in our assessment and advice about 99% of the time, having worked together very closely for 3 decades.
But if you are infected, your "dumfounded" state and "I don't see how" comment reflect fallaceous reasoning. The fact that someone has a rare outcome doesn't mean it didn't happen. If someone is struck by lightning, you don't say "lightning strikes are rare, so it must have been something else". This applies both to syphilis in general in cases like yours, and to having syphilis without a visible lesion. It isn't common but it happens. There is no point in trying to figure out a specific explanation. Probably you're never going to know.
Don't expect specific replies from Dr. Hook. We agree in our assessment and advice about 99% of the time, having worked together very closely for 3 decades.
Thank you for all the useful input. I will be sure to keep you updated. If Dr. Hook wouldn't mind, the last questions I will ask is in regards to me never having a symptom and some statistics. I have always been certain to inspect my penis on a regular basis, and I absolutely never noticed anything even remotely related to a chancre. For that matter, neither did she. The health officials don't seem to be explaining much to her, rather they are heavily alluding to the belief that I am more than likely bisexual.
Furthemore, I have looked at the statistics and I just don't see how we could be one of literally a few dozen people in the whole state who have tested positive for syphilis. Is it possible that the sample size used to estimate syphilis infections is not significant? Could the fact that most people are not tested for syphilis mean that actual infections are substantially higher than the estimates? Sorry for being bothersome, but I am rather dumbfounded...
Furthemore, I have looked at the statistics and I just don't see how we could be one of literally a few dozen people in the whole state who have tested positive for syphilis. Is it possible that the sample size used to estimate syphilis infections is not significant? Could the fact that most people are not tested for syphilis mean that actual infections are substantially higher than the estimates? Sorry for being bothersome, but I am rather dumbfounded...
MEDICAL PROFESSIONAL
Dr. Hook is perhaps the single most respected expert in the country on clinical aspects of syphilis. I have asked him to review this thread and make any comments he finds appropriate. (If he doesn't add anything, it means he agrees with my perspectives.)
MEDICAL PROFESSIONAL
I cannot explain it and will not try. Your test results and hers now are of prime importance Her initial test undoubtedly was either a VDRL or RPR test, with the positive result undoubtedly expressed as a "titer", in the form of a ratio like 1:4, 1:16, etc. The higher the number, usually the more recent and/or more active the infection is. If the result was weakly positive or in a titer of say 1:2 or 1:4, it might be a distant past infection, perhaps one missed when she was tested 3 years ago. If 1:8 or higher, most likely her syphilis was acquired in the past 12 months.
It is crucial that you both be managed by a provider experienced in syphilis care, such as your local health department STD clinic (which for obvious reasons has much more experience than most private providers) or an infectious diseases specialist. Depending on your RPR/VDRL titers and other factors, either or both of you might need a lumbar puncture (spinal tap) to make sure you don't have syphilis of the central nervous system, which requires more intensive treatment and carries the greatest risk of bad outcomes if not properly managed.
To answer your specific question, whether syphilis is "that rare" among heterosexuals, it depends on your definition of rare. There are around 20,000 new cases of syphilis per year in the United States and probably 70-75% of cases occur in men who have sex with men. That leaves 5,000-6,000 cases per year in heterosexuals. That's obviously rare by most standards, but it happens.
Finally, if either you or your partner is suspected to have recently acquired syphilis (within a year), the local health department probably will be in touch with both of you. Please cooperate when they interview you about your sexual history. The information will be cruicial in protecting others and in helping prevent continued spread, and there never has been a significant breach of confidentiality in such information.
Obviously, based on my initial response, I am somewhat surprised by this outcome. Please keep the forum posted as your work-up and treatment progress. And don't worry about the ultimate outcome. With both of you presumably asymptomatic at this point, there is little risk of a dangerous outcome as long as you comply with recommended diagnostic tests and treatment.
HHH, MD
It is crucial that you both be managed by a provider experienced in syphilis care, such as your local health department STD clinic (which for obvious reasons has much more experience than most private providers) or an infectious diseases specialist. Depending on your RPR/VDRL titers and other factors, either or both of you might need a lumbar puncture (spinal tap) to make sure you don't have syphilis of the central nervous system, which requires more intensive treatment and carries the greatest risk of bad outcomes if not properly managed.
To answer your specific question, whether syphilis is "that rare" among heterosexuals, it depends on your definition of rare. There are around 20,000 new cases of syphilis per year in the United States and probably 70-75% of cases occur in men who have sex with men. That leaves 5,000-6,000 cases per year in heterosexuals. That's obviously rare by most standards, but it happens.
Finally, if either you or your partner is suspected to have recently acquired syphilis (within a year), the local health department probably will be in touch with both of you. Please cooperate when they interview you about your sexual history. The information will be cruicial in protecting others and in helping prevent continued spread, and there never has been a significant breach of confidentiality in such information.
Obviously, based on my initial response, I am somewhat surprised by this outcome. Please keep the forum posted as your work-up and treatment progress. And don't worry about the ultimate outcome. With both of you presumably asymptomatic at this point, there is little risk of a dangerous outcome as long as you comply with recommended diagnostic tests and treatment.
HHH, MD
Dr,,
My gf's confirmatory test came back positive. How can this be? Neither one of us ever noticed symptoms and she wass tested 3 years ago...Like I said I have been permiscuous, but have never been with a guy...Is it really that rare among heterosexuals?
My gf's confirmatory test came back positive. How can this be? Neither one of us ever noticed symptoms and she wass tested 3 years ago...Like I said I have been permiscuous, but have never been with a guy...Is it really that rare among heterosexuals?
MEDICAL PROFESSIONAL
The proportion of people who don't notice chancres varies with sex and sexual practices. Most asymptomatic chancres probably are internal, i.e. inside the vagina or rectum. Probably 80-90% of straight men would notice a penile chancre.
In your situation, the lack of recognized chancre is doesn't make much difference.
Please try to relax about this. Do not get tested for syphilis yourself unless your gf's cosnfirmatory test is positive. Feel free to return to describe that result and/or your own test results -- but please not until then.
In your situation, the lack of recognized chancre is doesn't make much difference.
Please try to relax about this. Do not get tested for syphilis yourself unless your gf's cosnfirmatory test is positive. Feel free to return to describe that result and/or your own test results -- but please not until then.
Would the fact that neither of us have ever had a chancre be reassuring?? Could you just tell me what % of people that have syphilis never shows signs? Thanks a lot again
MEDICAL PROFESSIONAL
You describe a virtually zero risk situation for syphilis with respect to both your and your partner's sexual history. Therefore, it is unlikely she has syphilis. False positive tests for syphilis (the standard medical term is biological false positive, or BFP) are common, and that is the most likely explanation. Your gf's confirmatory test probably will be negative. If that is the case, you can completely forget syphilis; negative confirmatory tests are 100% reliable.
I suggest you wait for your partner's repeat test result before you get tested for syphilis yourself. If that test is negative, there is no point in you being tested. (In fact, had you asked, I would have recommended against having "the talk" about other partners until the confirmatory test result was available.)
In the unlikely event your partner's confirmatory test is positive, come back and let me know. We can then discuss the implications, whether or not you need to be tested, and so on. In the meantime, relax. Most likely there is no syphilis or any other health problem of importance.
Best wishes-- HHH, MD
I suggest you wait for your partner's repeat test result before you get tested for syphilis yourself. If that test is negative, there is no point in you being tested. (In fact, had you asked, I would have recommended against having "the talk" about other partners until the confirmatory test result was available.)
In the unlikely event your partner's confirmatory test is positive, come back and let me know. We can then discuss the implications, whether or not you need to be tested, and so on. In the meantime, relax. Most likely there is no syphilis or any other health problem of importance.
Best wishes-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
