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How to test for STD?

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Posted on Mon, 23 Jun 2014
Question: Long story short, I dated someone in the recent past and the condom came off without us realizing it (stupid I know!). Needless to say, I got tested for every STD, HIV, herpes, etc. (We are no longer together).

Results came back as non reactive RPR (negative) but Treponemal IgG/IgM reactive (positive) . All other tests were negative ( I will retest for HIV and other stds in a month to be safe until I reach 6 months from exposure). I also have Sjogrens Sydrome, Lupus, and RA, which my Dr said may cause a false positive. My Dr suggested there is no need for further testing but I said I'd like to know the titer levels etc. I am going to get repeat lab work done next week (two week mark after the shot). Is the RPR normally what shows titer levels? If so, why were there no titers on my lab results?

I received the shot last Friday. How will I know when the infection is gone? Are there any further tests you may suggest I get done? I am aware that I need to refrain from any sexual contact for several months and until I know 100% that the infection is gone. Also, I have had no symptoms ( I realize there can be no symptoms or at least a person may not be aware of them). I have
notified those that need to know they may have been exposed to an STD.

Any help would be appreciated. I am horribly upset and disgusted in myself to even allow myself to get in such a situation. Note: under the RPR on my lab results it says: 'blank lab; now offers a specific anti-treponemal antibody test for syphilis, an eia format assay using recombinant treponemal antigens. IGG and IGM antibodies are detected with nearly 100% sensitivity at all stages of the disease, along with 99.9% specificity, greatly reducing false positives. Positive results are confirmed via RPR, and titer if indicated"

do I need to be specific and ask for titer levels while at the lab? Is there a chance this is a false positive (due to my sjogrens etc)? I have spoken to the person, and he swears he has been tested and nothing showed up. Also, I was tested back in January (I get routine std checks even when in a relationship, simply because you never know) and the results were negative for syphilis.

Thank you and I am sorry for the rambling.

-worried
doctor
Answered by Dr. S. Murugan (3 hours later)
Brief Answer:
Descending titres dilutions of RPR indicates cure.

Detailed Answer:
Hi,
Welcome to HCM.

Thanks for posting your query.


RA and Sjograns can give a false positive result for Syphilis in RPR or VDRL and not with Treponemal antibody test as they are very specific only to Syphilis.

The titre of RPR is very important. You have to ask for the same with Laboratory personnel. The response to titre following treatment is the one indicating whether your treatment is adequate and you got cured or not. The RPR may take more than 6 months to an year following a successful treatment to return normal.
Sometimes RPR may likely to show non-reactive at the normal (basal)test, but on further dilutions it will show reactive and this phenomena is called as 'Prozone' or 'Prezone ' phenomena. Treponemal (IgG) antibody test may remain positive for ever even after complete treatment about which you need not bother as it is like serological scar.
Discuss with your physician and nothing to get panicky.
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan (40 hours later)
Thank you very much Dr.

So my next question Is, if my dr never got my titer levels prior to the antibiotic shot, how will he know if I am cured? (As he would have nothing to compare too)
.he said it was primary as i tested negative in mid XXXXXXX i am going to go in for labs 12 days after the shot to get titer levels checked. Is early stage usually cured after one shot ? My dr said 7-14 days a after the shot it's usually gone.

I appreciate your help.
doctor
Answered by Dr. S. Murugan (6 hours later)
Brief Answer:
RPR Titre descends slowly 3 months after treatment

Detailed Answer:
Hi,
Welcome back.
I am sorry to say that your Doctor's statement were not correct. I doubt that his treatment for late syphilis was also might be inappropriate.
Consult somebody who experienced in the management of STD cases or updated himself with latest WHO or CDC guidelines for the management of STDs.

The titre of syphilis may be reversed to normal following treatment after a period of 3- 6 months in early Syphilis and 6- 12 months or more in case of late Syphilis. So if you have the titre of RPR even after treatment, still it could be reliable for further evaluation of prognosis. As far as Syphilis is concerned there is no other type of test available as a test for cure.
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan (15 hours later)
Thank you Dr, I will do that. I wont be able to see the bew dr until next week so my final question is , when will I know I am no longer contagious? I am in a relationship and that is my greatest concern. I am avoiding sexual intercourse until I know what is going on(new relationship we have not had intercourse). Is there a specific titer level that determines if one is no longer contagious? It seems like i couldn't get a straight answer from my research, etc. Most said after the shot one is no longer contagious. Should I avoid sexual activity for six months? I want to be safe and smart about this. Do you think I'd need another shot for my primary infection?
doctor
Answered by Dr. S. Murugan (1 hour later)
Brief Answer:
A month abstinence preferable following treatment.

Detailed Answer:
Hi,
Welcome once again.

There is no specific titre indicates that the disease is no longer contagious. You need not wait to have sex till the titre becomes nonreactive. One month abstinence following the treatment was enough to resume sexual activities.
But I would like to know the exact dose and the type of penicillin you had to make sure whether your treatment is sufficient or not?
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan (20 minutes later)

Hi Dr,

thank you so much for your prompt response. It is greatly appreciated.



I received 2.4 million units benzathine penicillin IM roughly 12 days ago (my mom is a nurse, and initially my Dr wanted to give me oral antibiotics. My mom argued with the pharmacist and demanded the benz. shot from my Dr,which I paid out of pocket for).




doctor
Answered by Dr. S. Murugan (7 hours later)
Brief Answer:
You had an adequate dose of preferable antibiotic

Detailed Answer:
Hi,
Welcome back.

Yes, you had taken the correct choice and correct dose. If you are sure that this infection could have occurred within 2 years, then this dose of Benzathine Penicillin is enough. If you are not sure of the date of infection , and if there is a possibility of more than two years, then it is better to have this same dose of Benzathine penicillin weekly once for another 3 weeks 9 total 4 weeks).

You can resume your sexual activity after an abstinence of 1 month.
Repeat the titre of RPR after three months monthly up to six months and after six months.
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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How to test for STD?

Brief Answer: Descending titres dilutions of RPR indicates cure. Detailed Answer: Hi, Welcome to HCM. Thanks for posting your query. RA and Sjograns can give a false positive result for Syphilis in RPR or VDRL and not with Treponemal antibody test as they are very specific only to Syphilis. The titre of RPR is very important. You have to ask for the same with Laboratory personnel. The response to titre following treatment is the one indicating whether your treatment is adequate and you got cured or not. The RPR may take more than 6 months to an year following a successful treatment to return normal. Sometimes RPR may likely to show non-reactive at the normal (basal)test, but on further dilutions it will show reactive and this phenomena is called as 'Prozone' or 'Prezone ' phenomena. Treponemal (IgG) antibody test may remain positive for ever even after complete treatment about which you need not bother as it is like serological scar. Discuss with your physician and nothing to get panicky. Dr S.Murugan