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How long am I contagious? Syphilis (SYPHILIS, 2011)
Aug 3, 2011

I was diagnosed with Syphilis last march, I was given two penicillin injectios in the course of two weeks (April the 7th and 14th). I had unprotected sex with my partner on June the 16th (for the first time), and did it four times between that date and July the 1st, since the doctor had told me I was no longer contagious/infectious.

VDRL test revealed my initial serology was 1:32 I got tested on August 1st and it had dropped to 1:8, so I assume the treatment has worked. However FTA-ABS test came out positive again and my doctor said that in that case there could have been a chance of infection. My partner left a couple of days ago on a long business trip for a few months and I'm not sure if I should worry him yet...

(Note: I was diagnosed with syphilis and went through treatment before dating him. He hadn't been sexually active ever, I was his first time, that's why I don't want him to go through such a bad experience specially when he's so busy in a foreign land.

My doctor suggested I took a couple of hematology tests (leukogram and eritrosedimentation) to check if there was any infectious agent in my body related to syphilis, in which case he'd have to get tested.)

My questions are:

1. Was I still infectious by the time I had unprotected sex? Conseidering it had been almost 2 moths after being treated

2. Does having a positive FTA test after the VDRL showed a significant drop in serology (1:32 - 1:8) mean I could still have the syphilis agent active in my body?

and 3. Is taking the reccommended hematology tests completely necessary or should I stop worrying?

Response from Dr. Frascino

Hi.

Your doctor said that since your post-treatment FTA-ABS (fluorescent treponemal antibody absorbed) was positive that you might still be infectious? WHAT?!? Your doctor is woefully uninformed on this matter! The majority of patients who have reactive treponemal tests will have reactive tests for the remainder of their lives, regardless of treatment or disease activity. However, 15%25% of patients treated during the primary stage revert to being serologically nonreactive after 23 years. Treponemal test antibody titers do not correlate with disease activity and should not be used to assess treatment response!

Folks with syphilis are rendered non-infectious shortly after receiving penicillin. It's extremely effective. See link below.

Responding to your specific questions:

1. No, assuming your syphilis was treated appropriately.

2. Nope!

3. You should have routine follow-up titers. (See link below.)

Dr. Bob

Syphilis From U.S. National Institute of Allergy and Infectious Diseases March 19, 2009



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