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    Suggest treatment for syphilis

Posted on Mon, 10 Jul 2017 in Sexually Transmitted Diseases
Question: I am a 30 year old male.I am married for 10 years and have two kids.I have been in a mongamous relationship with my wife and never had sexual relations outside my marraige. I was sexually abused when i was 14 years old. I never got tested for that incident but it always stayed in the back of my mind. An year ago i got tested for std's and syphilis rpr came back as positive with titer 1:4. The follow up test
FTA-ABS came back as negative. I got tested 6 times after that in a period of 9 months and the titer is still 1:4 and FTA-ABS negative. I know that it could be biological false positive but i recently read an article from ncbi which says that in late(teritiary) syphilis the RPR and Treponema specific antibodies will be negative in some patients. Below is the link and paragraph which talks about late syphilis.

As in up to 30% patients nontreponemal tests may not be reactive, treponemal tests should be performed. However, 2–4% of patients with late syphilis will show negative results with treponemal tests also. As the number of organisms are too low in late stages, polymerase chain reaction (PCR) technique may be a very useful test in establishing a diagnosis.

My question is, its been more than 15 years since the sexual abuse took place, i must be in late syphilis , that is why the rpr titer is too low (1:4) and FTA-ABS is coming back negative. Do you recommend a PCR test for me. Please advise. I just want to make sure that i did not pass anything to my wife and kids.
Answered by Dr. Noble Zachariah 32 minutes later
Brief Answer:
I don't think you require a PCR. Discussion follows

Detailed Answer:

Welcome and thanks for your query.
Relax, I do not think you have syphilis.
I presume that by sexually abused , you mean that you were subjected to an anal intercourse. If you had syphilis you would have developed primary lesion ( chancre ) or a condyloma latum ( secondary syphilis) or rash or lymphadenopathy. But you had nothing to suggest an infection.
RPR is a screening test which uncommonly gives false positive at very low titers and 1:4 which is a very low titer. FTA-ABS is the specific test and since it is negative, it is most likely that you don't have syphilis. If you had Syphilis, you would have infected your wife during unprotected sex. She has not had any symptoms or signs of syphilis either.
I don't think there is a need for PCR.
Do get back to me if you have further queries.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Noble Zachariah 24 minutes later
Thank you for the reply doctor. Yes it was anal. Since it happened 15 years ago i do not remember developing a lesion or warts and rashes. The ncbi link i mentioned in the main question says that in late teritiary syphilis it might be possible that even for 2-4% people treponema specific anitbodies test will come as negative. Should i be concerned or just disregard it. I have been married to my wife for 10 years. She got tested with rpr and it came back negative twice.

Answered by Dr. Noble Zachariah 53 minutes later
Brief Answer:

Detailed Answer:
Thanks for your feedback.
Your wife would have been RPR positive if you had syphilis. So I think you should just take your RPR as false positive under the present circumstances.
I expect the PCR to be negative if you were to do it for peace of mind.
Have a good day.
Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. Noble Zachariah 42 hours later
Thank you doctor.Last question. I took amoxicillin for 10 days last year. Would this have affected the outcome of the fta-abs. Just a hypothetical question. Is it possible that i might have syphilis but fta-abs comes back negative. I just want to put an end to this nightmare and go on with my life.
Answered by Dr. Noble Zachariah 4 hours later
Brief Answer:

Detailed Answer:
A 10 day course of Amoxicillin will not affect the FTA-abs test.
So relax and get on with your life.

I am available if you have any queries in the future.
Have a good day and good health.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Noble Zachariah

Internal Medicine Specialist

Practicing since :1974

Answered : 2276 Questions


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