RPR Syphilis Confusion

Question

I was recently tested for Syphilis at my local health department.

The nurse who took my blood informed me that my RPR tests were inconclusive and I would have to wait for the results from the "other" test.

Minutes later the "Epidemiology Specialist" told me my RPR tests came back positive.

When I questioned this, she showed me the results and informed me that the titer 1:1 meant that I was positive for syphilis. I was treated with two shots.

As instructed, I called back a week later for the results from the other test and they informed me that I tested negative for syphilis.

I spent a week convinced I had Syphilis. Now, I'm just confused.

Do I need to get a second opinion? If I don't have syphilis, should I be concerned about the 1:1 titer from the RPR?

Answer

The RPR is a screening test. A positive test with a titer of 1:1, without a positive additional confirmational test, is probably a false positive. Most people with syphilis will have RPR titers of at least 1:8 or higher. We use this test to determine a treatment response (seeing the second number go down). Most people would wait for the second test to come back before making the decision to treat, especially if the RPR is 1:1.