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    Had intercourse with sex worker, tested positive for syphilis, now VDRL negative but TPHA positive. Am I fully cured?

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Posted on Sun, 26 Aug 2012 in Sexually Transmitted Diseases
Question: Dear Doctor,

In the year 1990, I had an intercourse with a female sex worker in India, I fell sick after 3 weeks, but I just ignored it assuming as a common fever.

In 1992 I got married and we had to see a doctor

In 1994 for infertility, doctor tested my blood for VDRL, it was weak positive, without any further investigations he treated me and my wife with PENIDURE inj. 6 lacs intra muscular Weekly one inj. For six weeks.
In 1997 again I consulted another doctor, as sperm analysis was found azoospermia, then I had to undergo all blood tests where it was diagnosed (VDRL weak Positive and TPHA 1:320) that I have syphilis, doctor prescribed PENIDURE inj. 24 lac, intra muscular, after a month again the same injection was repeated.
After treatment when I got my blood tested. VDRL became negative but TPHA showed 1:80 ( I doubt these titre values as the labs what we have here are not so perfect)
When consulted the doc he said, the parasite is totally dead but the antibodies are still present in the blood, now almost it is 13 years after my treatment.
In 2012 , Very recently again I got my blood tested, TPHA is positive 1:320, but VDRL is negative.

Now my concern is

1.How do I know that I am fully cured of the disease? Was the treatment I had sufficient?
(Usually doctors recommend after 2yrs of infection PENIDURE 24 lac IM weekly one for three weeks on day 1, day 8 and 15, my treatment different)

2. Can TPHA Titres increase while VDRL values remain same?

3. Do I need any CSF examination? (I am enjoying a very good perfect health)


Thanks in advance
doctor
Answered by Dr. Sudarshan 6 hours later
Hi XXXXXXX

Syphilis is STD caused by a bacteria Treponema pallidum.

Bacteria is very much sensitive to penicillin(penidura) antibiotic.

VDRL is a test used for diagnosis, follow up and response to treatment of syphilis .

To answer your questions

1.As VDRL has become negative you are cured of disease.
Treatment you had is sufficient. Normal treatment is 1 dose of penidura 24 lac units intramascular single dose.

2.TPHA test is used only for diagnosis .It can remain positive even after cured off disease. Titre may change. It may be due to laboratory techniques.
Negative VDRL is more important.

3.CSF examination is not required . If you had nervous system involved initially then CSF examination is needed.

If you need any further explanation feel free to ask.

Regards


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudarshan 2 days later
Dear Doctor,
As you said :
XXXXXXX As VDRL has become negative you are cured of disease. Treatment you had is sufficient. Normal treatment is 1 dose of penidura 24 lac units intramascular single dose. XXXXXXX

I was going through lots of information that is available on internet most often
CDC and WHO recommend if the infection is 2 yrs past the patient should be given PENIDURE 24 lac inj IM / once a week for three weeks on day 1, 8, and 15.. my infection was more than 2 years past, and I had PENIDURE 24 lac as one single dose on day 1 and after 30 days the same inj was given as single dose.
How do I understand this, which doesn't match with CDC / WHO guidelines.

Thanks in advance.
doctor
Answered by Dr. Sudarshan 25 hours later
HI again,

You said you have been treated with "PENIDURE inj. 6 lacs intra muscular Weekly one inj. For six weeks XXXXXXX

This is also a regimen for treating syphilis. On top of that you have received "PENIDURE 24 lac as one single dose on day 1 and after 30 days"
This is significantly sufficient dosage of penicillin to kill syphilis causing organism.

Ultimately your VDRL has become negative after treatment which is more important than CDC/WHO guidelines.

Hope Ive made myself clear.

Regards
Dr Sudarshan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudarshan 16 hours later
Dear Sir,
Your answers are so clear and concise, very supportive and explanatory.

Thank you so much
doctor
Answered by Dr. Sudarshan 18 hours later
Hi again,

If you have liked my answer please accept it and rate it at the end.

Dr Sudarshan.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Sudarshan

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Practicing since :2005

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