Syphilis: Concerns, Transmission, and Treatment Explained

Q: Syphilis: Concerns, Transmission, and Treatment Explained

Anonymous： Hello. 1. Body fluids may be infectious, especially blood. Oral mucosal lesions may occur. 2. Two weeks of treatment? Generally, penicillin is recommended for three weeks for better efficacy. You can look for other hospitals that have applied fo

Questions about syphilis?

I previously had symptoms that resembled primary syphilis (chancre) on my nipple, which caused me concern.
I went to the hospital for a confidential check-up, and I have never engaged in any high-risk sexual behavior (always used condoms and never had unprotected sex).
Since I always use condoms, I thought I wouldn't contract any disease.
However, I was tested and found to have an RPR of 1:8 and a TPPA of 1:640.
The hospital staff insisted that only blood, semen, and prostatic fluid could transmit the infection and claimed that saliva would not transmit it at all.
They also mentioned that even after successful treatment, blood tests would still show past syphilis infection! I am puzzled as to how I contracted syphilis.
The hospital required me to show identification to report to the health department (they said they wouldn’t notify my family).
They informed me that there is a shortage of penicillin in the country and prescribed Doxycycline HCL 100 mg capsules to be taken for two weeks.
Since I will be traveling abroad for two years next month, I have several questions that I am unclear about:
1.
Did the syphilis infection start with the chancre on my nipple because it was kissed (perhaps there was a break in the skin)? Can syphilis be transmitted through saliva? Saliva can transmit it, right? Otherwise, how did I contract syphilis?

2.
After taking the medication for two weeks, will I be completely cured? How can I know if the treatment was successful?
3.
After taking the medication, why do I still see syphilitic roseola (when will it go away)? Does the medication actually have an effect?
4.
What do the RPR 1:8 and TPPA 1:640 represent? Is a lower number better?
5.
After completing the two weeks of medication, if I am abroad and the health department tries to contact me but cannot reach me, will they come to my house to find me? Wouldn’t my family then find out about my illness?
6.
If I undergo a work-related health examination, will I still test positive for syphilis? Wouldn’t that mean I would lose my job? Even if I change jobs, testing positive for syphilis would likely prevent me from being hired.
Is having syphilis like receiving a death sentence? After being treated for syphilis, can I still have children?

Wuming Shi, 20~29 year old female. Ask Date: 2015/07/26

Dr. Xu Weikai reply Urology

Anonymous: Hello.
1.
Body fluids may be infectious, especially blood.
Oral mucosal lesions may occur.
2.
Two weeks of treatment? Generally, penicillin is recommended for three weeks for better efficacy.
You can look for other hospitals that have applied for special permission to import penicillin.
Many hospitals have already done so.
Personally, I prescribe a four-week treatment course, followed by a blood test three months later to assess changes in laboratory data to determine the effectiveness of the treatment.
3.
I'm not sure.
4.
The lower the better; the levels indicate serum reactivity.
5.
I'm unclear about this.
Usually, the local health department will notify you, or you can proactively inquire at the local health department.
6.
Syphilis can be completely cured.
It is not easily transmitted, so companies typically do not terminate employees for this reason.
Note: If a syphilis reaction is detected in the blood, it is important to determine the type of reaction: some indicate an active infection, while others indicate a past infection that is no longer active, along with other non-syphilis pathogens causing serum reactivity.
If the test results show values indicating that the infection has been cured, it should not affect employment rights.
Only active infections or those that can still be transmitted to others would impact employment.
Some companies may send infected employees for treatment at a hospital, and once cured, the hospital will issue a certificate of recovery, allowing them to return to work.
If there are any unclear points, feel free to ask again for further discussion and research.
Online responses can only serve as a reference; it is still necessary to seek medical care at healthcare facilities.
The Ministry of Health and Welfare, Taitung Hospital, cares about you.

Reply Date: 2015/07/26

More Info

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. Understanding syphilis involves recognizing its transmission, symptoms, and treatment options. Your concerns about contracting syphilis, especially given your history of safe sexual practices, are valid and warrant a thorough explanation.

1. Transmission of Syphilis: Syphilis is primarily transmitted through direct contact with a syphilis sore, which can occur during vaginal, anal, or oral sex. While the most common mode of transmission is through sexual contact, it is theoretically possible to contract syphilis through non-sexual means, such as kissing if there are active sores in the mouth or on the lips. However, this is quite rare. The presence of a sore (hard chancre) on your nipple could suggest that there was direct contact with an infected area, possibly through intimate contact or kissing, especially if there was any break in the skin.

2. Diagnosis and Testing: The RPR (Rapid Plasma Reagin) and TPPA (Treponema pallidum particle agglutination) tests are used to diagnose syphilis. The RPR test is a non-treponemal test that detects antibodies, while the TPPA is a treponemal test that confirms the presence of antibodies specific to the syphilis bacterium. Your results (RPR 1:8 and TPPA 1:640) indicate that you have been exposed to the syphilis bacterium. The numbers represent the dilution of the blood sample; a higher number in the RPR test suggests a more active infection, while the TPPA indicates past or current infection.

3. Treatment: Doxycycline is an alternative treatment for syphilis, especially for those allergic to penicillin. The standard treatment for early syphilis is a single dose of benzathine penicillin G, but since you mentioned a shortage, doxycycline for two weeks is a reasonable alternative. After completing the treatment, follow-up testing is essential to ensure that the infection has been cleared. Typically, a follow-up RPR test is done at 6 and 12 months after treatment to check for a decrease in titers, indicating successful treatment.

4. Symptoms and Follow-Up: After starting treatment, you may still experience symptoms like the rash associated with secondary syphilis. This rash can take time to resolve, and it does not necessarily indicate treatment failure. Monitoring your symptoms and following up with your healthcare provider is crucial.

5. Privacy and Reporting: Regarding the reporting to health authorities, it is standard practice for STIs to be reported to public health departments to help control outbreaks. However, they typically do not disclose personal information to family members. If you are concerned about privacy, discuss this with your healthcare provider.

6. Employment Concerns: It is understandable to worry about how a syphilis diagnosis might affect your job prospects. Many employers conduct routine health screenings, but having a history of syphilis, especially after successful treatment, should not prevent you from obtaining employment. Under the Americans with Disabilities Act (ADA), employers cannot discriminate against you based on a past medical condition, especially if you are no longer contagious.

7. Future Family Planning: If treated successfully, syphilis should not affect your ability to have children. However, it is essential to ensure that any partners are also tested and treated to prevent reinfection.

In summary, while your diagnosis may feel overwhelming, syphilis is treatable, and with proper medical care, you can manage your health effectively. It is crucial to maintain open communication with your healthcare provider, follow their recommendations, and seek support from trusted friends or mental health professionals as needed.

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