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I also have some confusion about HIV and syphilis.  The local health dept. called me and informed me that we (my partner and I) had been listed as sexual contacts by an individual who tested poz for HIV and syphilis.  I had the health dept draw blood and test for syphilis (I used one of the send-in HIV tests though).  They confirmed that I had syphilis and wanted to start treatment immediately.  When they found out that I was also HIV+, the treatment became a bit more rigorous - three sets of bicillin shots (one in each hip).  The first set was the most painful thing I've dealt with; the 2nd and 3rd sets weren't as bad.

What was strange was that my ID Dr. (not related to the health dept) also had me tested for syphilis.  According to him, I didn't have it.  He thinks that I never did.  I'm not sure what the relationship to being HIV+ and testing poz for syphilis is.  Isn't the rash on the hands stage of syphilis pretty early on?  I didn't realize that part would recur.  BTW, I never had any symptoms of syphilis.


Tar Heel:
I swore I'd take this to my grave with me but I need to spill it.....

In May 05, I played Russian Roulette with a guy and was very unsafe.  The next week, I began running a fever and I know I was starting the conversion syndrome.

In June 05, I still tested HIV- on an antibody test but they found it when they did a viral load test.  So I'm HIV+.

In July 05, I began running the fever again, swollen nodes, whacked out CBC and was so sore I could not move.

They did a whole screen of blood work and my RPR (VDRL) was positive.  I had no rash or cankers.  One shot of Bicillin in each hip followed by 3 hours of shaking and freezing to death from the Bicillin and it was over.

In Jan 06, my RPR was back to negative.

I got HIV and syphillis from the same guy.  Wanna talk about a double-whammy?

Matty the Damned:
Sorry guys, I meant to reply to this earlier. Syphilis is a little bit of an interest of mine. It was my first STD back when I was 15. I guess I'm just a nostalgic old thing. None of the information I'm providing here should replace any medical advice you may receive.

Syphilis (the pox) is a sexually transmitted infection caused by the bacterial organism Treponema Pallidum. It can also be transmitted from mother to child in utero. Congenital syphilis is quite complicated and I won't go into details about it here.

Syphilis has three distinct phases.

Primary syphilis - this phase is characterised by a distinctive lesion called a chancre which appears 7 - 10 days or sometimes a couple of weeks after exposure. It's quite an ugly thing but is notable because it's painless. It appears on the site of infection so, if it's inside your body - you may not notice it. It heals without leaving a scar. The chancre is highly infectious.

Secondary syphilis - occurs some months to a couple of years after the primary phase. It's characterised by fever and a flu like illness and distinctive rash  on the palms of the hands and the soles of the feet. Other lesions which typically weep fluid can appear on the body as well. Like the primary phase, secondary syphilis resolves spontaneously.

Tertiary syphilis - generally occurs anywhere 15 to 30 years after the primary phase. This is the most serious stage of the disease. Symptoms include large open lesions called gummas which can appear on the skin or the internal organs. Tertiary syphilis can also cause serious damage to the cardio vascular system.

Perhaps the most well known and feared form of tertiary syphilis is neuro-syphilis. Tabes dorsalis (damage to the spinal cord), peripheral neuropathy and most notably General Paresis of the Insane (GPI) are common manifestations of this stage.  The damage done in this phase is usually permanent. GPI is a psychotic condition with symptoms similar to both dementia and mental illnesses like schizophrenia and/or bi-polar affective disorder.

Untreated tertiary syphilis is ultimately fatal.

It's important to understand that not everybody who gets syphilis will progress through all three phases. We don't understand why this is. People with HIV however seem to be more likely to develop secondary and tertiary syphilitic disease and often progress much more quickly. Similarly there are no symptoms or outward signs of illness between the phases. Hence the importance of testing. Speaking of which . . .

Testing for syphilis can be a bit complex. In Australia (where I am) there are two blood tests used to diagnose the condition.

Treponema Pallidum Haemagglutination Assay (TPHA): which indicates whether or not you've been exposed to the organism. It takes around 3 months to seroconvert. TPHA tests are specific to syphilis and once you've seroconverted you remain TPHA positive for life, regardless of treatment.

Rapid Plasma Reagin (RPR) and Venereal Diseases Research Laboratory (VDRL) tests are used to determine whether or not you have active disease, how advanced it might be and to monitor the efficacy of treatment. These results are returned as numbers called titres. They're expressed as 1/1, 1/2, 1/4, 1/8, 1/16 and so on. The higher the second number the more active the disease.

Positive (or reactive) RPR testing is not specific to syphilis. Other infections and conditions (such as pregancy) can produce reactive RPR and VDRL results. For this reason RPR tests should be performed in conjunction with a specific test like TPHA to give a definitive diagnosis. RPR tests are useful for determining how syphilis treatment is working. In most cases we expect to see a four fold reduction in RPR titres three months after successful treatment. Most people return a non reactive RPR or VDRL after being treated properly, but some people may return a 1/1 result for a long while afterwards. Such people are still considered cured.

The treatment for syphiltic infection normally is gluteal (ie in your tushie) injections of procaine penicillin or preferrably benzyl penicillin (BI-Cillin). Syphilis is very sensitive to penicillin so proper treatment will cure the infection. Even in the tertiary stage. Nevertheless any damage done in the latter stages of the disease is generally permanent. People who are sensitive to penicillin can be treated with other anti-biotics such as erythromycin, but these are less effective and take much longer to complete. It's important to understand that oral courses of penicillin and related anti-biotics can suppress the disease but not cure it.

As you guys would know, syphilis is a very serious condition that requires competent medical attention. Many doctors don't understand the intricacies of diagnosing and treating the disease. HIV specialists and sexual health clinics are your best bet for ensuring that you're accurately diagnosed and treated.


Which test should you have 16 years after you've tested pos for Syphilis and already received the initial painful injections of Bicillan?


Matty the Damned:
Which test should you have 16 years after you've tested pos for Syphilis and already received the initial painful injections of Bicillan?



I'd have both TPHA and RPR performed. That way you'll be sure to get it right. If you've got concerns about syphilis especially 16 years after you were treated you should speak to your HIV specialist or sexual health clinic.




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