Syphilis Treatment: Is High VDRL Really a Concern?

Treatment assessment

Hello, doctor! In April 2022, I experienced balanitis and went with my sexual partner to get tested for HIV and syphilis, both of which were negative.
In May, I had another episode of inflammation and decided to undergo a circumcision.
However, after the wound healed, I continued to experience recurrent inflammation of the glans.
I have visited the same clinic for follow-up more than five times, but the inflammation persists.
I also consulted another clinic once, and both doctors concluded that it was just a case of simple balanitis and not related to any sexually transmitted infections (no symptoms were observed).
During the treatment for balanitis, I took penicillin and doxycycline for two weeks each, which worked quite well.
In September, I was tested for HIV and syphilis again, and this time the syphilis test came back positive with a VDRL titer of 1:32.
The doctor informed me that this indicates a high viral load and that I need to receive three weeks of penicillin treatment.
I received the first injection two days ago, and I would like to ask: 1.
Is a VDRL titer of 1:32 truly considered a high viral load? I have no symptoms at all.
2.
Since I have already taken doxycycline for two weeks and received one dose of penicillin, is it really necessary to complete the remaining two injections? From my perspective, the duration and severity of the infection do not seem high (as I have no symptoms), and since the clinic charges 2200 for each injection, I wanted to inquire whether it is truly necessary.

Xiao Xu, 20~29 year old female. Ask Date: 2022/09/22

Dr. Chen Jiansheng reply Urology

Please seek medical attention elsewhere.

Reply Date: 2022/09/22

More Info

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. The diagnosis and treatment of syphilis can be complex, especially when interpreting serological tests like the VDRL (Venereal Disease Research Laboratory) test. Your situation raises several important points regarding the interpretation of your VDRL results and the necessity of treatment.

1. Understanding VDRL Results: A VDRL result of 1:32 is indeed considered a high titer. The VDRL test is a non-treponemal test, which means it detects antibodies that are not specific to Treponema pallidum but are produced in response to the infection. High titers can indicate active syphilis, and while the absence of symptoms might suggest a less severe infection, it does not negate the need for treatment. In some cases, individuals may be asymptomatic, especially in the early stages of syphilis, but the infection can still progress if left untreated.

2. Treatment Protocol: The standard treatment for syphilis, particularly in cases with a high VDRL titer, is benzathine penicillin G. The typical regimen for early syphilis is a single intramuscular injection, while late latent syphilis or syphilis of unknown duration may require three doses administered at weekly intervals. Given that your doctor has recommended three weeks of treatment, it is likely based on the high titer of your VDRL and the potential for the infection to progress if not adequately treated.

3. Importance of Completing Treatment: Even if you feel asymptomatic, it is crucial to complete the full course of treatment as prescribed by your healthcare provider. Stopping treatment prematurely can lead to complications, including the progression to tertiary syphilis, which can have serious health implications. The cost of treatment is certainly a consideration, but the potential risks of untreated syphilis far outweigh the financial burden.

4. Follow-Up Testing: After completing the treatment, follow-up testing is essential to ensure that the VDRL titer decreases. A fourfold decrease in titer is generally considered a sign of effective treatment. Your healthcare provider will likely schedule follow-up tests to monitor your progress.

5. Communication with Your Healthcare Provider: If you have concerns about the treatment plan or the cost, it is important to communicate these with your healthcare provider. They may be able to provide alternatives or assistance based on your situation. Additionally, they can explain the rationale behind the treatment recommendations, which can help alleviate concerns about the necessity of the prescribed regimen.

In summary, while your VDRL result of 1:32 indicates a significant concern, the absence of symptoms does not eliminate the need for treatment. Completing the prescribed course of benzathine penicillin G is crucial to effectively manage the infection and prevent complications. Always consult with your healthcare provider regarding any concerns or questions about your treatment plan.

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