Infectious Disease Specialist | Infectious Disease Questions Infectious Disease Specialist

Still infected with Syphilis?

I found out I had syphilis in October 2020. I had a Trep value of 21.07 and an RPR Quantitative of 1:512. I don't know how long I had had it for, but I had been feeling fatigued and losing my hair since July. I was treated with the standard penicillin treatment.

I got retested 6 weeks later and had a Trep value of 18.42 and an RPR of 1:64. My doctor was satisfied with this decrease and sent me on my way and told me to get retested 6 months later.

I got retested a week ago and had a Trep value of 20.22 and an RPR of 1:32. I thought that my numbers would've decreased more after 6 months. I asked my doctor about it, and all she did was refer me to an infectious disease specialist.

Now I'm worried and I can't go to the doctor right now because I'm out of the country. What do these test results suggest? Am I still infected/contagious or just in a serofast state? Any information would be greatly appreciated because I'm finding it difficult to find sufficient help on Google about syphilis.

Overall, I feel healthy, my hair has grown back, and I've tested negative for all other STDs.

Male | 22 years old
Complaint duration: Months
Conditions: Syphilis

2 Answers

Thanks for your question. A fourfold drop in RPR or VDRL is an indication of successful treatment. The one dilution rise later does not indicate failure, but should be repeated in four weeks. If the trend is upward, it is possible that it indicates reinfection, and should be repeated. Positive tests remain positive for life, even after successful treatment. Sorry for your illness. If you have not been tested for other STDs and HIV, you should be tested. Protection is always suggested for encounters, with rare exceptions you can discuss with your doctor.
You do not specify what treatment you received. For early latent syphilis (no signs of syphilis, but the laboratory test), that is, syphilis acquired in the prior 12 months or less, the treatment would be 2.4 million units of syphilis one time. If the latent syphilis is more than one year's duration - or you do not know the duration - the treatment is the same, but given three times once a week apart. Your serology is improving appropriately as expected for successful treatment.

G. Dickinson
Have a question aboutInfectious Disease Specialist?Ask a doctor now