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What causes decrease in RPR titer levels while treating syphilis?

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Posted on Wed, 20 May 2015
Question: Hello Doctor,
Here is my case. I got syphilis back in Early Nov.2014, the RPR titer then was 1:32. I received the treatment and in my six-week follow-up test the titer dropped to 1:16. However, in my most recent follow-up test in got the titer back to 1:32. Is that a reinfection or relapse sign? I don't think it's normal to sustain this high titer after six months, but I couldn't think of any occasion that I got reinfected. (Only one sex partner since then, and he got tested when I was diagnosed. Results got back all negatives, and he still had a penicillin shot just in case.)
I am now confused about my result. Can you advise? Thank you so much!
doctor
Answered by Dr. Sheetal Verma (1 hour later)
Brief Answer:
Take a VDRL test.

Detailed Answer:
Hi
Thanks for your query at HCM.
I understand your concern and situation.

Firstly I suggest you must not take rapid plasma reagin test RPR for monitoring. I suggest you get tested by VDRL test which is more reliable and sensitivity is higher. Now coming to your query I must tell you before you say you have a treatment failure or persistence if the initial nontreponemal test titer do not decrease fourfold (two dilutions) by 6–12 months for primary, secondary, or early latent syphilis and by 12–24 months for late latent syphilis or syphilis of unknown duration. So it you were having late latent syphilis it will take time. Don't worry. But yes monitor your titers. If you have any clinical symptom then you need to be examined by your treating physician. Follow barrier methods during intercourse. Better get tested by VDRL test for correct diagnosis.

Take care.
I hope I answered your query.
If no clarifications then you can close the discussion and rate the answer.
Dr. Sheetal Verma
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Sheetal Verma (36 minutes later)
Hello Doctor XXXXXXX
Thank you for your answer. If I got a VDRL test what range do you think is possible. Since all of my previous tests are RPR I may not have any benchmark to check whether my VDRL is decreasing or not.
Also I have to tell you I received the treatment when I still got the sore and rash symptoms, meaning that the stage was very early. So I think 6 months should be enough for the titer to drop, if treated successfully.
Given my current situation, do you think I'm already at the neurosyphilis stage. What treatment do you recommend?
doctor
Answered by Dr. Sheetal Verma (12 minutes later)
Brief Answer:
Can guide better after test tesults.

Detailed Answer:
Well come dear.

I request you not to be anxious and jump to conclusions so early that you have neurosyphilis. Firstly RPR is not reliable test so take a VDRL test then only I would be in a situation to guide you better. It has been seen some patients titers may take even 12 months. So first get tested then I can take a follow-up query. There is no worry if you do not have a baseline titre. Let us see what is your titers after test. I have seen several patients who have RPR reactive and VDRL non reactive.


Best of health
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
Answered by
Dr.
Dr. Sheetal Verma

Infectious Diseases Specialist

Practicing since :2001

Answered : 635 Questions

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What causes decrease in RPR titer levels while treating syphilis?

Brief Answer: Take a VDRL test. Detailed Answer: Hi Thanks for your query at HCM. I understand your concern and situation. Firstly I suggest you must not take rapid plasma reagin test RPR for monitoring. I suggest you get tested by VDRL test which is more reliable and sensitivity is higher. Now coming to your query I must tell you before you say you have a treatment failure or persistence if the initial nontreponemal test titer do not decrease fourfold (two dilutions) by 6–12 months for primary, secondary, or early latent syphilis and by 12–24 months for late latent syphilis or syphilis of unknown duration. So it you were having late latent syphilis it will take time. Don't worry. But yes monitor your titers. If you have any clinical symptom then you need to be examined by your treating physician. Follow barrier methods during intercourse. Better get tested by VDRL test for correct diagnosis. Take care. I hope I answered your query. If no clarifications then you can close the discussion and rate the answer. Dr. Sheetal Verma