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Author Topic: treponemal test vs RPR for syphilis  (Read 1083 times)

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Offline bufguy

  • Member
  • Posts: 161
treponemal test vs RPR for syphilis
« on: November 23, 2011, 06:27:44 PM »
I recently was tested for syphilis by the health dept. The results were RPR non reactive, no titer, treponemal AB EIA reactive. The diagnosis was late latent syphilis.
I'm confused. I was never treated before, therefore I would think the RPR would be reactive. I understand once having syphilis and receiving treatment the treponemal test will always be positive but the RPR would be non reactive.
As I said, I was never treated....Any insights?
5/29/08 confirmed HIV+
6/23/08 Vl 47500  CD4 511/29% CD8 .60
start atripla
8/1/08 Vl 130  CD4 667/31% CD8 .70
9/18/08 Vl un  CD4 not tested
12/19/08 Vl un CD4 723/32% CD8 .80
4/3/09 Vl un CD4 615/36% CD8  .98
8/7/09 vl un CD4 689/35% CD8 .9
12/11/09 vl un CD4 712/38% CD8 .89
4/9/10 vl un CD4 796/39% CD8 1.0
8/20/10 vl un CD4 787/38% CD8 1.0
4/6/10 vl un CD4 865/35% CD8 .9
8/16/10 vl un CD4 924/37% CD8 1.0
12/23/10 vl un CD4 1006/35% CD8 .9
5/2/10 vl un CD4 1040/39% CD8 .9
8/7/13 vl un CD4 840/39% CD8 .9

Offline John2038

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Re: treponemal test vs RPR for syphilis
« Reply #1 on: November 23, 2011, 07:11:25 PM »
The diagnosis was late latent syphilis.

RPR tests can be nonreactive in late latent syphilis (and early nfection)

Offline Matty the Damned

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Re: treponemal test vs RPR for syphilis
« Reply #2 on: November 23, 2011, 07:27:46 PM »
RPR (Rapid Plasma Reagin) testing is non-specific. It's used to determine indirectly levels of treponemal activity and to manage treatment.

But as John notes it can be non-reactive at various points in the syphilis disease cycle.

The only definitive ways of diagnosing syphilis are via a specific treponemal serology such as FtsAbs or TPHA and/or isolation and identification by dark-field microscopy of the syphilis organism (treponema pallidum) from a lesion or a body fluid like cerebro-spinal fluid.

Blood testing is preferable.

As your case shows RPR testing alone is simply not good enough. In other cases RPR tests can return false positives as other conditions such as pregnancy can return reactive responses.

The diagnosis and management of syphilis is complex business which requires the attention of suitably experience health care professionals.

I hope this works out for you.

MtD

Offline bufguy

  • Member
  • Posts: 161
Re: treponemal test vs RPR for syphilis
« Reply #3 on: November 23, 2011, 08:02:35 PM »
That's a little scary because I've read where sometimes only an RPR is done for routine STD testing.

Anyway I just finished my 3 weeks of Bicyllin shots...not pleasant, but not as bad as I thought they would be.
5/29/08 confirmed HIV+
6/23/08 Vl 47500  CD4 511/29% CD8 .60
start atripla
8/1/08 Vl 130  CD4 667/31% CD8 .70
9/18/08 Vl un  CD4 not tested
12/19/08 Vl un CD4 723/32% CD8 .80
4/3/09 Vl un CD4 615/36% CD8  .98
8/7/09 vl un CD4 689/35% CD8 .9
12/11/09 vl un CD4 712/38% CD8 .89
4/9/10 vl un CD4 796/39% CD8 1.0
8/20/10 vl un CD4 787/38% CD8 1.0
4/6/10 vl un CD4 865/35% CD8 .9
8/16/10 vl un CD4 924/37% CD8 1.0
12/23/10 vl un CD4 1006/35% CD8 .9
5/2/10 vl un CD4 1040/39% CD8 .9
8/7/13 vl un CD4 840/39% CD8 .9

Offline Matty the Damned

  • Member
  • Posts: 12,228
  • Ninja Please
Re: treponemal test vs RPR for syphilis
« Reply #4 on: November 23, 2011, 09:06:48 PM »
That's a little scary because I've read where sometimes only an RPR is done for routine STD testing.

Anyway I just finished my 3 weeks of Bicyllin shots...not pleasant, but not as bad as I thought they would be.

Don't be too concerned. The syphilis organism is extremely sensitive to antibiotics like Bi-cillin. For reasons we don't really understand why treponema pallidum has never developed resistance to penicillin and related medications in the same way most other bacteria have. It's a strange beast.

So it's reasonable to assume that your syphilis has been treated successfully.

But HIV complicates all these things and you should continue to be monitored. A lumbar puncture would be a wise idea too. Just to make sure.

MtD

Offline bufguy

  • Member
  • Posts: 161
Re: treponemal test vs RPR for syphilis
« Reply #5 on: November 24, 2011, 03:47:26 PM »
thanks for the input...The health dept is confident in the treatment and wants me back in 6 months for retest...In the meantime I see my ID doc in 6 weeks and I'll see what he says.
5/29/08 confirmed HIV+
6/23/08 Vl 47500  CD4 511/29% CD8 .60
start atripla
8/1/08 Vl 130  CD4 667/31% CD8 .70
9/18/08 Vl un  CD4 not tested
12/19/08 Vl un CD4 723/32% CD8 .80
4/3/09 Vl un CD4 615/36% CD8  .98
8/7/09 vl un CD4 689/35% CD8 .9
12/11/09 vl un CD4 712/38% CD8 .89
4/9/10 vl un CD4 796/39% CD8 1.0
8/20/10 vl un CD4 787/38% CD8 1.0
4/6/10 vl un CD4 865/35% CD8 .9
8/16/10 vl un CD4 924/37% CD8 1.0
12/23/10 vl un CD4 1006/35% CD8 .9
5/2/10 vl un CD4 1040/39% CD8 .9
8/7/13 vl un CD4 840/39% CD8 .9

 


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