Negative Syphilis RPR Results: What to Do Next?

Q: Negative Syphilis RPR Results: What to Do Next?

Hello： 1) If you have symptoms, you should get tested. <br>2) If VDRL is positive, you should follow up with a TPHA test. <br>If you prefer not to have another blood draw, you can do both tests at once. <br>3) It is advisable to undergo preliminary sexually transmitted infection

Syphilis RPR negative?

Hello, Doctor! Three months ago, I had unprotected anal intercourse with a male partner.
Last month, I experienced severe pain in the lymph nodes on both sides of my chest, followed by the appearance of rashes on my chest, palms, soles, testicles, and around the anus over the next few days.
The rashes on my testicles and around the anus are very itchy, while the rashes in other areas are neither painful nor itchy.
The rash on my palms has started to break open and form hard lumps.
Upon inquiry, my partner mentioned that he had a history of syphilis but has been treated and regularly undergoes testing.
Therefore, I had blood tests done earlier this month, which showed negative results for syphilis (RPR), Chlamydia, Gonorrhea, and HIV, but positive for HSV-1.
As a result, the doctor did not prescribe any medication, but I have been experiencing significant itching in the rashes on my genitals and scalp over the past few days.

Question 1: Should I immediately get another blood test, or is it still within the window period, and should I wait to test again in three months?
Question 2: Since my RPR is negative and I have never had syphilis before, should I consider getting a TPHA test?
Question 3: Should I give up on testing for syphilis and consult another specialist? Thank you!

Heilun, 20~29 year old female. Ask Date: 2017/12/17

Dr. Du Shixi reply Urology

Hello: 1) If you have symptoms, you should get tested.
2) If VDRL is positive, you should follow up with a TPHA test.
If you prefer not to have another blood draw, you can do both tests at once.
3) It is advisable to undergo preliminary sexually transmitted infection testing and then consult with an infectious disease specialist at the hospital.
Wishing you good health.

Reply Date: 2017/12/17

More Info

Based on the information provided, it seems you are experiencing a complex situation regarding potential syphilis exposure and subsequent testing. Let's break down your questions and provide a comprehensive understanding of your situation.

Question 1: Should I get tested again immediately or wait for three months?
Given that you had a potential exposure three months ago and your initial tests for syphilis (RPR) and other sexually transmitted infections (STIs) returned negative, it is understandable to be concerned about the possibility of a false negative result. The RPR test can sometimes yield false negatives, especially if the infection is in its early stages or if the body has not yet produced enough antibodies to be detected.
In general, the window period for syphilis testing can vary. For RPR, it is typically recommended to wait at least three weeks to three months post-exposure for accurate results. Since you are already at the three-month mark, it would be prudent to consult with your healthcare provider about the possibility of retesting. They may recommend a follow-up test, especially if you continue to experience symptoms or if there is a concern about your exposure history.

Question 2: Should I consider getting a TPHA test?
The TPHA (Treponema pallidum hemagglutination assay) test is a more specific test for syphilis and can confirm the presence of antibodies against the Treponema pallidum bacteria, which causes syphilis. Since your RPR test was negative and you have never had syphilis before, it may be beneficial to get a TPHA test. A positive TPHA would indicate a past or current infection, while a negative result would further support the idea that you are not infected.

Given your symptoms and the history of potential exposure, discussing the TPHA test with your healthcare provider is advisable. They can help interpret the results in the context of your symptoms and exposure history.

Question 3: Should I abandon syphilis testing and consult another specialty?
While your RPR test is negative, your symptoms—such as the painful and itchy rashes—suggest that there may be another underlying issue that needs to be addressed. It is essential to consider that not all rashes or symptoms are related to syphilis or STIs.
If your symptoms persist or worsen, it may be wise to consult a dermatologist or an infectious disease specialist. They can provide a more thorough examination and may suggest additional tests to rule out other conditions, such as herpes (which you tested positive for), allergic reactions, or other dermatological issues.

Additional Considerations
1. Communication with Partners: It’s crucial to maintain open communication with your sexual partners about STI testing and history. If your partner has a history of syphilis, ensure they are following up with their healthcare provider for regular testing.

2. Safe Practices: Given your recent exposure and the current symptoms, practicing safe sex (e.g., using condoms) is essential to prevent potential transmission of STIs.

3. Monitoring Symptoms: Keep track of your symptoms. If they worsen or new symptoms develop, seek medical attention promptly.

4. Mental Health: The anxiety surrounding STIs can be overwhelming. Consider discussing your concerns with a mental health professional if you find it difficult to cope.

In conclusion, while your initial tests are reassuring, it is essential to follow up with your healthcare provider regarding retesting and further evaluation of your symptoms. Staying proactive about your health is the best approach.

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