Syphilis Testing: Can You Still Transmit It Even If You're Negative?

I went for a sexually transmitted infection screening and tested positive for a slight case of syphilis?

Hello doctor, I have been intimate with my boyfriend a few times using condoms, but we also engaged in unprotected oral sex.
Two weeks later, we went for STD testing.
I tested negative, but the doctor said my boyfriend has a slight case of syphilis and does not need treatment yet.
The doctor mentioned it could be due to some condition during the testing, but the report shows negative, which I don't quite understand.
What does this mean? In this situation where he has a slight case of syphilis, is there still a risk of transmission? Could I be infected? Also, I would like to ask, if person A has syphilis and I have sexual relations with A but test negative, and then I have relations with healthy person B, is it possible that I could still transmit syphilis or another STD to B even though I tested negative, because the infection is present but not yet active in my body?

YCC, 20~29 year old female. Ask Date: 2020/05/31

Dr. Cai Zhuorong reply Urology

I'm not quite sure what this means.
If someone has a mild case of syphilis, is there still a risk of transmission? Could I potentially be infected? A: First, it is essential to distinguish whether the test result is a false positive or if it is indeed syphilis.
If there is uncertainty in the test results, it is advisable to consult an infectious disease specialist to determine if further testing is necessary.
I would also like to ask, if person A has syphilis and I have sexual relations with A but test negative, when I later have relations with healthy person B, is it possible that I could transmit syphilis or another sexually transmitted infection (STI) to B, even though it hasn't manifested in me yet and therefore didn't show up in my test? A: If you were tested during the incubation period, there is indeed a possibility of a false negative result, which could lead to the situation you described.

Reply Date: 2020/05/31

More Info

When it comes to understanding syphilis testing and the potential for transmission, it's essential to grasp the nuances of syphilis infection, testing methods, and the implications of test results.
Firstly, syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. It progresses through several stages: primary, secondary, latent, and tertiary. The testing for syphilis typically involves non-treponemal tests (like RPR or VDRL) and treponemal tests (like FTA-ABS). Non-treponemal tests can yield false positives due to various reasons, including other infections or conditions, while treponemal tests are more specific to syphilis.

In your case, you mentioned that your boyfriend has "a little bit of syphilis," which suggests that he may have a low-level infection or a reactive test result that does not meet the criteria for a definitive diagnosis. If he has not been treated, even a low-level infection can still be infectious. The fact that you tested negative indicates that you do not currently have an active syphilis infection, but it does not entirely eliminate the risk of transmission if your boyfriend is indeed infectious.

Regarding your concern about transmission, it's important to note that syphilis can be transmitted through direct contact with syphilitic sores, which are most commonly found on the genitals, anus, or mouth. If your boyfriend has an active infection, even if it is at a low level, there is still a risk of transmission during unprotected sexual activities, including oral sex. The use of condoms can significantly reduce the risk of transmission, but it does not provide complete protection, especially if sores are present in areas not covered by the condom.

Now, addressing your hypothetical scenario: if you engage in sexual activity with someone who has syphilis (let's call them Person A) and you test negative, you may still be at risk of carrying the infection if you were exposed to it but it has not yet manifested in your body or if it was in a window period where the infection is not detectable. If you then have sexual relations with another person (Person B), there is a potential risk of transmission if you were indeed infected but asymptomatic or undetectable at the time of testing. This is why it is crucial to communicate openly with sexual partners about STI status and to get tested regularly, especially after potential exposure.

In conclusion, while your negative test result is reassuring, it is essential to consider the context of your boyfriend's health status. If he is indeed carrying a syphilis infection, there is a risk of transmission, and it would be prudent for both of you to consult with a healthcare provider for further evaluation and possibly treatment. Regular testing and open communication with partners about STI status are key components of sexual health. If you have any further concerns or symptoms, do not hesitate to seek medical advice.

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