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Can Vdrl can remain positive even after having been treated successfully for Syphilis?

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Practicing since : 2009
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When I was 30 I contracted syphilis. I was treated twice by oral antibiotics because I'm allergic to penicillin. I understood I was "cured." However, last week, I was hospitalized and a VDRL test was run, which showed up positive for syphilis. How concerned do I need to be? Could this just be showing that I once had syphilis but it's still "cured"? Or better put, what are the odds it's a false positive after almost 20 years on a VDRL test? The hospital confirmed with me that is the test that would have been used.
Posted Thu, 26 Dec 2013 in General Health
Answered by Dr. Rakesh Madhyastha 43 minutes later
Brief Answer: Need more info Detailed Answer: Hello Thanks for the query I understand that you were treated for syphillis and several decades later your vdrl is positive, to give you a better answer I need to know a few more details 1. Have you engaged in unprotected sex with someone who either had or was at high risk for syphillis after you were treated? 2. Do you have any symptoms like easy fatgueability, ulcer over the penis, tremors, fever ? 3. why was the test done this time ? was there any clinical suspicion ? Please get back to me, I am awaiting your reply regards
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Follow-up: Can Vdrl can remain positive even after having been treated successfully for Syphilis? 17 minutes later
1. No, I was treated after any high risk sex 2. I do have a small abrasion on the right side of my penis that occasionally "opens" and hurts, but it is nothing like the chancre as in my bout with syphillis. It didn't develop until a few years ago and is almost certainly the result of extremely excessive masturbation and often near impossibility of ejaculation due to SSRI's I've been on at high doses. That's embarassing but I mean at times hour or more long sessions, alone or with a partner, in which I never finished. This I believe is the cause of that. When I do not engage in any activity for a while, it disappears. The skin is simply very thin there. I do not think it's related to syphilis and it bears no relation to any other photos of those types of sours I've seen. It's hardly visible usually. I don't see myself as excessively fatigued -- in fact, quite the opposite....I never get nearly enough sleep and work constantly. I do not have a fever or any other feelings of illness, except I do have back pain occasionally and, like I said, some foot numbness, which I believe and was told was the result of the surgery I had in my late thirties for a severely herniated disk, which I was told left residual sciatica. The back pain improved after surgery and so did the sciatica, but the foot numbness followed. 3. I was on the psych ward and was told by the nurse today that the VDRL and other tests are run there on a standard basis under the assumption that patients there are at higher risk of STD's. Oddly, I believe I have had negative results on at least one other VDRL, which was a screening at a mental health facility a couple of years after that first infection. I'm almost sure the same thing happened on another VDRL.
Answered by Dr. Rakesh Madhyastha 2 hours later
Brief Answer: False positive Detailed Answer: Hello Thanks for the reply in detail. Here are my suggestions to you 1. Vdrl can remain positive in low titres after you have been treated successfully so there are chances that it is a false positive report 2. Since vdrl is positive I highly recommend you to go for a more specific test known as FTA-ABS test. It is highly accurate in knowing if you have still infected with syphillis. If I were your physician I would have repeated the vdrl again to rule out lab errors as well. 3. Cross reactions can happen and lead to false positive results when you are infected with other organisms like in case of tuberculosis, filaria, etx but this is ruled out since you do not have fever 4. Try using a lubricant during masturbation as you are getting bruised easily I hope I was of help, please get back to me if you have any further queries I wish you good health and speedy recovery Regards
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Follow-up: Can Vdrl can remain positive even after having been treated successfully for Syphilis? 35 minutes later
Just one last question. I know you can't give me a number, but just so I keep my fears realistic, for better or worse, what are the chance of a VDRL showing up "false positive" with low tiers so many years -- 19 years -- after treatment? I mean, are we talking a near impossible scenario? Or does that happen sometimes? And is it possible -- as I believe happened -- that I could get a negative on a VDRL and then a positive later without having been reinfected? Because if I am infected, I'm almost positive it's from the original infection 19 years ago. That was the end of my high risk sex activity. As you can imagine, it was a bit of an incentive to settle down! I will get the other test but probably can't get in until Monday and obviously I'm a bit freaked out. I thought I read the VDRL over times drops down to practically zero levels, much less after 19 years, if you;'re successfully treated. I suppose I'm mainly asking this: Should I just pretty much face the fact that I'm going to turn up positive? Or do I have a decent cause for hope that it's a false positive: And what am I facing medication wise if it's positive? Is it going to be some massively painful and extended cure after all this time? I know you can't give me specifics or any kind of promises, but hit me as straight as you can. I'd rather be prepared. Thank you. No more follow-ups after thus one.
Answered by Dr. Rakesh Madhyastha 3 hours later
Brief Answer: Hello Detailed Answer: I understand your concern I would like to point out to you that the tests performed now are much more accurate now than it was 20 years earlier so the chances of flase positive is about 2% however in your case it will be higher because you were already infected but the positivity is not important but the titres at which it is positive. Low titre positivity is of no concern and requires no treatment however higher titres will be treated with antibiotics which are not painful. I hope I was of help , please get yourself re tested like I have asked you to. I would like to add here that it is a treatable illness with good outcome. I wish you good health regards
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