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3rd tryPlease Help! RPR test reliabilty with Uveitis

Mar 13, 2006

Dr Bob, im desperate for a straight answer(no pun intended) I know that immunology is your specialty, and hope you can/will help. I have had a second bout of Uveitis (Anterior) and am terrified of the many diseases that have been linked to this eye inflammation. I have had recently been tested for Syphilis and Hiv, both negative. The syphilis test was the RPR, which I am now hearing may not be accurate. My opthamologist wants to also now order a confirmatory test in addition to the RPR. My question, how reliable is the RPR? Why would it be used for screening if it is not accurate? P.S I have not had any sexual encounters in over a year, so I am hoping waiting periods are not an issue.

Response from Dr. Frascino


Syphilis testing is very confusing and the interpretation of the tests can at times be complicated. Basically there are several types of syphilis tests and several different stages of syphilis (primary, secondary and tertiary). Not all tests are positive for all stages. Generally speaking, RPR (or VDRL) tests are run for routine syphilis screening. A high value (called "titer") would indicate recent infection; however, various things can affect these tests. Consequently, they need to be confirmed with a secondary test (usually FTA or MHA). I don't know what tests your ophthalmologist has ordered for you and suggest you discuss this with him/her.

Regarding the interval since your last sexual encounter, my, you've really had a dry spell, haven't you?!? However, you don't worry about test accuracy. The FTA will usually remain positive for life, once you've had syphilis (even if it's been treated and the RPR and VDRL decrease very dramatically). Try not to worry too much, OK? You're doing the correct thing by having your problem properly evaluated. Your HIV test is negative, which is great news. If your syphilis test does turn up positive, curative treatment is available.

Good luck.

Dr. Bob

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