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Syphilis test showed positive for VDRL, TPHA, no improvement after taking benzine penicillin injections, calamox. What should be done?

hi sir/madam. i recently went through syphilis test,and report was positive for both VDRL and TPHA. both were above 50. my docter suggested me to have benzine penciline injections for 1 week,and then i got mr report again. my report was again positive with out any less but increased volume. then docter sugested to have benzine penciline 10 lac units twice a day for 2 weeks. even then my report was same.even a bit increased. then i change my lab,and report come 33 from above 50. i also had calamox 600mg for 1 week. no symtoms are vissible. and it was 33 15 dyas ago,yesterday i get another blood test and my report was 36. i went throgh both VDRL and TPHA and both are positive. what more i can do to avoide it?
Asked On : Sat, 8 Sep 2012
Answers:  2 Views:  472
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Dermatologist 's  Response
Jul 2012
Hi there. At the outset, serological tests for syphilis are a touch tricky to interpret. This will require the help of a qualified dermatologist on the ground togehter with assesment of the sexual history & clinical features.There are a lot of false positives & false negatives & each test has to be interpreted in that given clinical scenario taking into account the clinical history of sexual exposure, time since exposure & clinical features manifested. Once ascertained if the syphilis is primary, secondary or tertiary, the treatment will vary accordingly. There are different schools of thought as regards treatment with injection benzathine penicillin, or the newer derivatives eg, Azithromycin . CDC has certain guidelines for the treatment of syphilis that can be easily accessed over the internet. However, after treatment more often than not, the VDRL et al does not become negative for months altogether...usually anywhere from 3-6 months but i have come across cases that remain positive for longer sans any clinical manifestations.This does not mean one needs to continue treatment. I do hope i have cleared this doubt you have. The TPHA test is another matter & may never become negative. Again, like i mentioned earlier, the STS tests have to be interpreted in conjunction with the clinical features of that particular case. Cheers & Good Luck!
Answered: Mon, 10 Sep 2012
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HIV AIDS Specialist Dr. S. Murugan's  Response
Hai, Welcome to HCM.

TPHA ONCE POSITIVE MEANS, IT WILL SHOW POSITIVE FOR EVER. It is called as serological scar. That doesn't mean you are having still Syphilis.

VDRL will be reactive only as 2,4,8,16,32,64,128,256 dilutions not as 33, 36 or 50.
The treatment for early syphilis (within 2 years) is a single injection of Inj. Benzathine penicilline 24 LA deep IM. If it is late syphilis (more than 2 years) then the treatment is The same injection weekly once for 4 weeks.

The titre of VDRL may become nonreactive after 3-6 months or more following treatment and in case of late syphilis it may delay up to two years to become nonreactive.

You have wait till this time to reach a nonreactive titre after correct dose.
Dr S.murugan
Answered: Sun, 9 Sep 2012
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