syphilis titer question

[lydgate]

I was treated for syph last year (six horribly painful injections in the glutes over three weeks). The titer wasn't that high to begin with 1:4. Came down to 1:2 after treatment.

Just had it checked again: it's 1:2 still. I'm told that's "normal," that it'll likely stay that way for life, and that I'm no longer -- gasp! -- syphilitic. (Is this what is called a "serofast reaction"?) But having this low titer for life doesn't mean I'm still infectious/contagious, does it? Or does it?

Second question: can you get reinfected with syphilis, or does one bout confer immunity through antibody generation/protection?

Jay

[Matty the Damned]

Yes, you can be reinfected with syphilis and one bout does not confer immunity.

Three months after treatment for syphilis one expects to see a 4 four fold reduction in the titre. So ideally your titre should have gone from 1/4 to 1/1. Whilst it's quite common for people who have been treated successfully to return a reactive RPR with a titre of 1/1 for life, 1/2 is less common but if your doctor is happy with it then that's cool.

MtD

[lydgate]

Thanks Matty.

I don't think a lumbar puncture and CSF examination is necessary at this point. (Though that's the CDC recommendation for HIV-infected people treated for latent syphilis of unknown duration or of a duration longer than one year.)

Jay

[Matty the Damned]

Yairs.

Normally CSF examination is performed in those who've had syphilis for a long time (10 years +) or those presenting with symptoms of tabes dorsalis, general paresis of the insane and other conditions associated with neurosyphilis, which is possibly the most ghastly manifestation of the disease.

HIV positive people tend to progress to tertiary syphilis much more quickly than negative people. Also HIV positive people with syphilis may suffer quite serious damage before any symptoms appear, so CSF examination is important in that sense.

Given your response to treatment (and I would expect that your titre will eventually drop to 1/1) and the view of your doctor, I would think that a lumbar puncture and CSF examination isn't warranted in your case.

MtD