Syphilis Treatment: How to Confirm Complete Recovery

Syphilis treatment issues?

Hello Doctor: Last November, I was anonymously screened and found to have a syphilis titer of 1:128 and 5120.
I received three injections of Benzathine Penicillin G, and I didn't experience many symptoms.
After the first injection, my blood test showed a titer of 1:32 and 10240 (hospital blood test).
After the third injection, a month later, I had another blood test with results of 1:64 and 5120 (health center blood test).
The titer increased compared to the first test, but after inquiring, it seems to be just a normal variation.
Recently, I had a follow-up screening with a titer of 1:16 and 5120.
I would like to ask you, how can we know if syphilis has been completely treated? Do we need to continue screening until it becomes negative? How can I be sure that I won't transmit it to others? Thank you for your answers, Doctor.

Xiao Bao, 20~29 year old female. Ask Date: 2016/02/26

Dr. Li Xinyi reply Urology

It seems there are no issues.
The treatment has been completed.
However, I am not familiar with your medical history and treatment course.
I recommend that you follow up with your original urologist for further inquiries.

Reply Date: 2016/02/26

More Info

To confirm complete recovery from syphilis, it is essential to understand the treatment process and the significance of follow-up testing. Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum, and it is typically treated with antibiotics, most commonly benzathine penicillin G. In your case, you mentioned receiving three injections of benzathine penicillin, which is the standard treatment for syphilis.

After treatment, the key to confirming recovery lies in monitoring the levels of non-treponemal tests, such as the Rapid Plasma Reagin (RPR) or Venereal Disease Research Laboratory (VDRL) tests. These tests measure the presence of antibodies that the body produces in response to the infection. A significant decline in these titers indicates that the treatment has been effective.
In your situation, you started with a high titer of 1:128 and 5120, which decreased to 1:32 and 10240 after the first injection, and subsequently to 1:64 and 5120 after the third injection. The fluctuations you observed in your test results can be attributed to various factors, including biological variability and the timing of the tests. However, the most recent result of 1:16 and 5120 indicates a positive response to treatment, as the titer has decreased significantly.

To determine whether you have been completely cured, healthcare providers typically look for a fourfold decrease in the titer (for example, from 1:64 to 1:16) within six to twelve months after treatment. Ultimately, a negative result on a non-treponemal test is the most definitive indicator of successful treatment. However, it is important to note that some individuals may continue to test positive for non-treponemal tests even after successful treatment due to the persistence of antibodies, which does not necessarily indicate an active infection.

Regarding the question of transmission, it is generally accepted that once treatment is completed and follow-up tests show a significant decline in titers, the risk of transmitting syphilis to others is greatly reduced. However, it is crucial to ensure that you have completed the full course of treatment and that follow-up testing confirms the effectiveness of the treatment. It is also advisable to inform any sexual partners about your diagnosis and treatment, as they may need to be tested and treated as well.

In summary, to confirm complete recovery from syphilis, you should continue to have follow-up blood tests to monitor your non-treponemal titers. A fourfold decrease in titers or a negative test result is indicative of successful treatment. Additionally, once you have completed treatment and your titers have decreased significantly, the risk of transmission is low, but open communication with partners and regular testing is essential for overall sexual health. Always consult your healthcare provider for personalized advice and follow-up care.

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