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HIV, Hep C, Syphilis, High Red Blood Count and Lumbar Puncture
Apr 8, 2013

I'm HIV undetectable on atripla, and Hep C undetectable so far thanks to a new HC trial treatment.

Four months ago I tested negative for Syphilis and three weeks ago I tested positive, was told the syphilis RPR was 256, and was also told my red blood count was high, perhaps due to testosterone shots which I stopped doing three weeks before my most recent syphilis test. My doctor wants me to get a phlebotomy to bring my red blood count down. I'm not sure if the high red blood count is due to the syphilis or not.

I will be going in this week to get my third and final shot for syphilis. The last two days my head has felt like it has pressure, similar to the same pressure sensation I get when I take my atripla at night. I'm not sure if this is from the syphilis and not sure if I really need the Lumbar Puncture, only because there has only been a 4 month window of time from the negative test to positive test for syphilis. Here are some questions I have regarding the Lumbar Puncture.

1. Is it necessary to get a Lumbar Puncture if the time frame from my last negative test for syphilis has only been 4 months, even if my RPR is 256?

2. What are the chances that infection or permanent spinal nerve damage could occur as a result of the Lumbar Puncture?

3.a. If I were to proceed with a Lumbar Puncture and they find any sign of Syphilis in the spinal fluid or brain, what is the procedure for a remedy?

3.b. Would I have to be hospitalized ASAP for a month or more in bed hooked to a drip IV?

3.c. Is there any other way to administer treatment without having to be in a hospital hooked to an IV?

3.d. I heard there is some sort of patch to administer the medication, allowing the person to move around and do daily activities. Is this true?

Response from Dr. Taylor

My recommendation would be to have the lumbar puncture. This is a safe procedure. The risks are none to small when done under sterile conditions by knowledgeable doctors, and the benefits potentially enormous; untreated neurosyphilis (syphilis involving the brain) can cause severe and sometimes permanent damage. With an RPR of 256, HIV infection and head pressure, I would err on the side of caution and get checked for neurosyphilis.

The treatment for syphilis involving the spinal fluid/brain is intravenous penicillin for 2 weeks. This is the first choice treatment. Many people can go home after a few days in the hospital, with the intravenous line in place, once it is clear someone is doing well on the antibiotic and you can get home care. You can move around with the intravenous line in place. Atripla is safe with treatment for neurosyphilis.

I am glad you are doing well regarding your hep C. Remember after cure of hep C and syphilis, you can catch them again and be right back at the start, having to get re-treated. Hep C, HIV and syphilis seem to be travelling close together particularly among gay men and men who have sex with men. So talk with your doctors about how you may have gotten infected and work to develop a plan to prevent getting infected again after treatment.

If possible it is kind to track down any sexual partners, drug-using partners, people you may have shared testosterone injections with if this is part of your past, and see if you or someone else can tell them even anonymously, to get checked. I wish you all the very best.

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