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Can Syphilis Be Contracted Through Intercourse?
Question: I am a married man. This summer I stepped out of my relationship this summer - I received oral sex around July 15th August 13th-I visit clinic. I was tested for Gonorrhea, Chlamydia, Syphilis, and HIV all results return negative (even though I was early for the syphilis window). I was also treated with Rocephin 250, 1g Azthromycin, and of course 2.4 MU BPG. On August 15,16th I had sex with my wife where we conceived. I was confident that i was fully covered from STD even though I had not cleared the window. I had read a post from Dr. Handsfield on medhelp saying that you are non infectious 24 hours after the shot of BPG (http://www.medhelp.org/posts/STDs/How-long-are-you-contagious-after-treatment-for-syphilis/show/0000) On 9/17 (4 weeks after last exposure) My wife has all her normal tests done with OB/GYN. To both of our suprise the RPR turns up positive (1:1) and the confirmatory done by chemiluminescence (which I though was weird) was negative. I freak out, tell her about the indsicretion She is tested for syphilis via RPR and EIA again 2 weeks later just over 6 weeks from our last sex(Which I have read on medhelp a number of times is conclusive via Dr. Handsfield). The doctor was satisfied but I had read the Trep-Sure test they used, would not be the best test during Primary syphilis.
Are these test sufficient for my wife?
Could I have passed syphilis to her even being treated about 48 hours before our sex
Are these test sufficient for my wife?
Could I have passed syphilis to her even being treated about 48 hours before our sex
Brief Answer:
Pregnancy is a cause of BFP
Detailed Answer:
Hello. Thanks for writing to us at healthcaremagic
I have taken note of your query.
VDRL can be Biologic falsely positive (BFP), specially if it is in low titres such as in your wife's case. Pregnancy is one of the many causes of BFP.
Moreover, RPR is not a confirmatory test for syphilis.
Many infectious diseases have been reported as causes of transient biologic false positive VDRL/RPR e.g malaria, leprosy, tuberculosis, infectious mononucleosis; pregnancy and immunizations etc are also causes of transient BFP reactivity.
Connective tissue disease may also cause BFP reactivity.
A low titre positive VDRL/RPR should always be followed up with a specific test for syphilis, which has already been concluded as negative for syphilis in your wife's case.
Therefore, I think RPR reactivity in your wife's case is nothing more than a Biologic false positive reactivity, most likely due to pregnancy and requires no further testing.
Regards
Pregnancy is a cause of BFP
Detailed Answer:
Hello. Thanks for writing to us at healthcaremagic
I have taken note of your query.
VDRL can be Biologic falsely positive (BFP), specially if it is in low titres such as in your wife's case. Pregnancy is one of the many causes of BFP.
Moreover, RPR is not a confirmatory test for syphilis.
Many infectious diseases have been reported as causes of transient biologic false positive VDRL/RPR e.g malaria, leprosy, tuberculosis, infectious mononucleosis; pregnancy and immunizations etc are also causes of transient BFP reactivity.
Connective tissue disease may also cause BFP reactivity.
A low titre positive VDRL/RPR should always be followed up with a specific test for syphilis, which has already been concluded as negative for syphilis in your wife's case.
Therefore, I think RPR reactivity in your wife's case is nothing more than a Biologic false positive reactivity, most likely due to pregnancy and requires no further testing.
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
In her follow up test two weeks after the original, the rpr came back as non-reactive. It was done at a another lab than the first....Is this a sure sign of her first test being a false positive or can tests be variable between weakly reactive and non reactive within two weeks. It seems to to me that if she did have syphilis the titre would remain the same or go up after two weeks.
Also please review this link a post by Dr. Handsfield a famous STD doc in the United States, it says people are non contagious 24 hours after being treated by penicillin. Do you agree with the statement? http://www.medhelp.org/posts/STDs/How-long-are-you-contagious-after-treatment-for-syphilis/show/0000
Also please review this link a post by Dr. Handsfield a famous STD doc in the United States, it says people are non contagious 24 hours after being treated by penicillin. Do you agree with the statement? http://www.medhelp.org/posts/STDs/How-long-are-you-contagious-after-treatment-for-syphilis/show/0000
Brief Answer:
You are safe
Detailed Answer:
Hi.
Yes, you mentioned it rightly; If indeed she was infected with syphilis the RPR titre should either go up Or it should remain the same during the intervening 2 weeks.
Moreover, a negative RPR test by another lab justifies the well known fact that transient low titre RPR reactivity can occur in pregnancy. Also the specific test by chemiluminescence came out to be negative.
These are enough evidence to confer that she had a BFP reactivity.
Regarding the statement made by Dr. Handsfield, I don't agree with it. The reason being that syphilis bacterium has a generation time of approx 33 hours, so for the drug to be effective it must be present in the serum for a sufficiently long period of time to inhibit the generation of new bacteria. Moreover not all bacteria reproduce synchronously in the infected person.
That is the basis of using Benzathine penicillin G, which stays above the required levels for killing treponemes for as long as 10-14 days. This period is usually considered to be safe to kill all the treponemes.
Regards
You are safe
Detailed Answer:
Hi.
Yes, you mentioned it rightly; If indeed she was infected with syphilis the RPR titre should either go up Or it should remain the same during the intervening 2 weeks.
Moreover, a negative RPR test by another lab justifies the well known fact that transient low titre RPR reactivity can occur in pregnancy. Also the specific test by chemiluminescence came out to be negative.
These are enough evidence to confer that she had a BFP reactivity.
Regarding the statement made by Dr. Handsfield, I don't agree with it. The reason being that syphilis bacterium has a generation time of approx 33 hours, so for the drug to be effective it must be present in the serum for a sufficiently long period of time to inhibit the generation of new bacteria. Moreover not all bacteria reproduce synchronously in the infected person.
That is the basis of using Benzathine penicillin G, which stays above the required levels for killing treponemes for as long as 10-14 days. This period is usually considered to be safe to kill all the treponemes.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My understanding of the concept of BPG is that it killed the bacterium rather quickly (with in 24hours) and because it is long lasting serum levels prevents regeneration of the bacteria after its death for up to 3 weeks....Is'nt the the quick death of all TP the cause of jarisch-herxheimer reaction? I guess that may be beside the point. I am still a bit worried because the confirmation test on her original test was not FTA-ABS or TPPA which seems to be the norm in the States as opposed to chemiluminescence. Would the chemiluminescence test be as sensitive as those other confirmation tests?
Brief Answer:
You are safe
Detailed Answer:
Hi
Jarish Herxheimer Reaction (JHR) is is thought to be the result of an inflammatory response to the destruction of treponemes. It begins soon after treatment and usually subsides within 24 hours but this time duration cannot be concluded that all the bacteria are dead within 24 hours because not all bacteria would be dividing at the same time.
The purpose of giving longer acting Benzathine penicillin G (BPG) rather than shorter acting Crystalline penicillin (CP) is to allow multiple cycles of generation covered during that time till the drug is effective (above tissue levels needed to kill treponemes) so that all the treponemes are killed and that is because not all treponemes are dividing synchronously. Once killed the bacteria won't regenerate.
The person is considered infectious until all sores and lesions heal after treatment. This view is in absolute contrast to Dr. Hansfield in which he says that an individual becomes non-infectious within 24 hours of treatment even in the presence of clinical lesions (sores and moist lesions of syphilis).
The JHR is most intense shortly after treatment because most but not all bacteria are being killed following BPG administration and therefore the intensity during the first 24 hours.
The chemiluminescence method is very sensitive as well as specific for syphilis.
Regards
You are safe
Detailed Answer:
Hi
Jarish Herxheimer Reaction (JHR) is is thought to be the result of an inflammatory response to the destruction of treponemes. It begins soon after treatment and usually subsides within 24 hours but this time duration cannot be concluded that all the bacteria are dead within 24 hours because not all bacteria would be dividing at the same time.
The purpose of giving longer acting Benzathine penicillin G (BPG) rather than shorter acting Crystalline penicillin (CP) is to allow multiple cycles of generation covered during that time till the drug is effective (above tissue levels needed to kill treponemes) so that all the treponemes are killed and that is because not all treponemes are dividing synchronously. Once killed the bacteria won't regenerate.
The person is considered infectious until all sores and lesions heal after treatment. This view is in absolute contrast to Dr. Hansfield in which he says that an individual becomes non-infectious within 24 hours of treatment even in the presence of clinical lesions (sores and moist lesions of syphilis).
The JHR is most intense shortly after treatment because most but not all bacteria are being killed following BPG administration and therefore the intensity during the first 24 hours.
The chemiluminescence method is very sensitive as well as specific for syphilis.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
ok, that makes sense....is the chemiluminescence method as specific and sensitive as the others? Just to reiterate, there is no need for further testing my wife is syphilis free?
Brief Answer:
No further testing needed
Detailed Answer:
Hi.
I think there is no requirement for any further testing, neither in you nor in your wife. Your wife never contracted syphilis neither did you.
The chemiluminescence method is as sensitive as well as specific for syphilis as other specific tests.
Regards
No further testing needed
Detailed Answer:
Hi.
I think there is no requirement for any further testing, neither in you nor in your wife. Your wife never contracted syphilis neither did you.
The chemiluminescence method is as sensitive as well as specific for syphilis as other specific tests.
Regards
Note: Consult a Sexual Diseases Specialist online for further follow up- Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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