Syphilis RPR Test

[john197508]

Dear Doctors,

I am a 37 years old guy. I need your advice.

Just two week ago, I had a sexual contact with a sexual worker in Berlin (a  German lady). I massaged her, licked her breasts, and she massaged my penis with her fingers and gave me a protected fellatio, and we had a protected sex.

Because I got very nervous, I went to a doctor for STD tests 14 days after this sexual contact. I had hepatitis B and syphilis blood tests (RPR and TPHA), and tests for gonorrhoea and chlamydia at throat. All clear, except for syphilis RPR test, which was positive. The TPHA was negative. The doctor said that this might be false positive, but it may be real positive.

Actually, I am in panic. What do you think about this result? The doctor advised me to have a syphilis test again in 2-3 weeks. I have no visible symptoms in the mouth and in the genital, and am basically heathy, though I had a bit cold at the day of the tests.

Could you possibly tell me how often the syphilis PRP can be false positive? And, as far as I have no visible symptoms, can I have usual contact with my wife? I may not have unprotected sex for a while, but, in any case, we will kiss.

I am very looking forward to hearing your advice on this.


Best,

John

[Edward W Hook, MD]

Welcome to the Forum. your doctor is being overly conservative and you need not worry.  You may be aware that the commercial sex workers in German brothels are closely regulated and tested regularly for STDs, including syphilis. Further, syphilis is a rare disease and the exposures you describe are extraordinarily low risk for syphilis.  thus, even before we discuss your test results, your risk in infection was miniscule.

Now for your tests.  To diagnose syphilis we typically do two unrelated tests and both tests much be positive to make the diagnosis of syphilis.  Further, because of the nature of the tests, when a person has syphilis and is just developing a reactive blood test, the TPHA and related tests become positive before the RPR.

False positive blood tests for syphilis occur on about 1% of the population for a variety of reasons including chronic infections and the present of rheumatologic illnesses like rheumatoid arthritis or lupus.  Most commonly however it is a chance event.  

I am confident that your future tests will be similar (if the false positive remains- sometimes they go away) or negative.  I would not be concerned about having sex with my partner if I were you.  EWH

[john197508]

Dear Dr Hook,

I thank you very much for your reaction. Just for a confirmation, I had a syphilis test (treponemal antibody test) 3 weeks after the RPR test (i.e. 5 weeks after the sexual contact) in the UK, which was non reactive. With your advice and these results, I will forget all the things concerning syphilis infection.

Very best wishes,

John

[Edward W Hook, MD]

You are clearly having trouble putting this behind you.  You should not think that every new finding/symptom you experience is syphilis.  It just does not work that way.  As I have already told you, there is no reason for you to be worried about syphilis and no need for further testing or concern.  You need to stop worrying and stay off the internet.

Syphilis lesions are not typically painful and do not spontaneous heal in a week or less.  

As for a new doctor, that of course is up to you.  I can tell you however that you do not need STD treatment or further testing related to the exposure you mentioned at the beginning of this thread.

And with that, this thread will end.  Take care. EWH

[john197508]

Dear Dr Hook,

I am writing you today concerning inflammations which I have had at the under lip for one week. These look like usual stomatitides (in comparison to syphilis inflammations as far as I have found on the web), which have pained and are being cured. What do you think about these? I think these are because I have not slept well nor eaten well in the last week. I may also have licked my lips too much because of angst over syphilis. Do syphilis inflammations also pain and can be cured in short days?

I would like to have one more question. After the test in Japan, I moved to the UK for business. I will stay there 6 months or more. That means, I have no more contact with my Japanese doctor. And, to be honest, I want to change doctors because I have been not satisfied with his attitude during this case. If I were your patient, what would you say to future treatments? Do I still have to have a test? If yes, when and what kind of test?

I would like to thank you for your really kind help. I am looking forward to hearing from you.

Best,

John

[john197508]

Dear Dr Hook,

I thank you very much for your kind reply. I try to handle myself...


Best,

John

[Edward W Hook, MD]

Please remember that far less than 0.1% of the population get syphilis each year.  Be confident.  EWH

[john197508]

Dear Dr Hook,

Sorry, I am not still being able to handle myself... You say, my case is not problematic, but, at the same time, the false positive instances in the PRP are only 1 percent of the total population. I cannot just believe that I belong to this 1 percent...

I have not so far have any remarkable symptom, in any case. Can I be confident?


Many thanks and best wishes,

John

[john197508]

Dear Dr Hook,

I thoroughly thank you for your really helpful reactions to my questions!


Best,

John

[Edward W Hook, MD]

Your summary of my answers is correct.  As for your additonal questoins:

1. Do you think there is any risk of other STDs in the exposure I described? I am very concerned especially with Hepatitis B, which the negative result of the test 14 days after the exposure seems to deny. 14 days are enough for this test (HBs antigen)?

While you might theoretically still be incubating hepatitis B, the true risk is so low as to not be a concern.  I would not worry about hepatitis B either

2. That the TPHA test will become positive BEFORE the RPR (when I were actually infected) is a common sense in the USA? Almost all Japanese websites (I am of Japanese origin) and the doctor say that the RPR becomes reactive 1-2 weeks before the TPHA. Are we dealing with different tests? I have been tested in a Japanese clinic.

What you have read is incorrect.  Globally, treponemal tests, including the TPHA become positve before the RPR

3. Do you think I have to have a second test of syphilis, though the risk is very low?

That is between you and your doctor.  If you choose to re-test, I am confident the test will be negative.  EWH

[john197508]

Dear Dr Hook,

I thank you very much for your prompt advice, which has relaxed me very much. Then, the following understanding is right?

1. My risk for syphilis is minimal. I do not have to worry about it.

2. The positive reaction of the RPR is probably false positive.

3. I can have sexual contacts with my wife even BEFORE I have another test.


Can I have a fer more questions?

1. Do you think there is any risk of other STDs in the exposure I described? I am very concerned especially with Hepatitis B, which the negative result of the test 14 days after the exposure seems to deny. 14 days are enough for this test (HBs antigen)?

2. That the TPHA test will become positive BEFORE the RPR (when I were actually infected) is a common sense in the USA? Almost all Japanese websites (I am of Japanese origin) and the doctor say that the RPR becomes reactive 1-2 weeks before the TPHA. Are we dealing with different tests? I have been tested in a Japanese clinic.

3. Do you think I have to have a second test of syphilis, though the risk is very low?


Sorry for asking many things. But, I would like to appreciate your kind help, which is really indispensable.

Best wishes,

John