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About Mark Behar
Expertise
Almost any question or concern about sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), gay men's health issues. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “prescreen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and conseqences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!

Experience
Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answer STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Organizations
Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; Wisconsin Academy of Physician Assistants; American Society of Colposcopy and Cervical Pathology (ASCCP); Board of Directors, National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Publications
Journal of the American Academy of Physician Assistants (JAPA)

Education/Credentials
Physician Assistant Certified, since 1982; Masters in Physician Assistant Studies; Colposcopy Recognition Award, American Society of Colposcopy and Cervical Pathology (ASCCP);

Awards and Honors
Colposcopy Recognition Award (CRA), from the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI

You are here: Experts > Teens > Health for Teens > Sexually Transmitted Diseases > syphilis

Sexually Transmitted Diseases - syphilis

Expert: Mark Behar - 11/3/2009

Question
Hello, I was diagnosed with syphillis back in 1996 and treated for it during it's primary stage. If I'm not mistaken I think I understand that the antibodies create a reactive ratio in my blood (when tested) but that doesn't mean that the disease has come back. Recently I did my annual std screening and was told that my ratio had risen from 1:4 to 1:8. I was asked to come back within a month to be retested. Does that suggest I've been reinfected? Or is this a common occurrence for someone with the antibodies in her system who has not been reinfected? Why do I have to wait an entire month? If I've somehow been infected again shouldn't I go back immediately to see if the ratio has increased?

Answer
Hello Naomi,
There are two common screening tests for syphilis, that are almost identical, but not quite!! The VDRL and the RPR. (Public health departments usually perform the more sensitive VDRL; private doctor's offices and hospital/clinical labs usually perform the RPR. They are essentially synonymous, but they really aren't!) Although they test for antibody, running both tests on exactly the same blood sample may cause the titer to differ by one to two dilutions. So it is important to know whether the same tests were done at both times. It would also be interesting to me what your inital pre and post treatment titers were back in 1996. It seems unusual that it is still at a 4 or 8 dilution after 13 years, rather than reverting back to nonreactive, weekly reactive, or 1:1.

You didn't mention what stage of infection you were actually diagnosed with, and what exactly your treatment was. Also, you didn't mention whether you have any other medical conditions, such as lupus, or rheumatoid arthritis, etc., that might cause biologic false positives.

Indeed, return for a repeat blood test in 1 month as instructed. It make take as much as 1-3 months to determine if antibody is stable (unchanging, or oscillating between 4 and 8), or whether it goes up by more than 2 dilutions (4 to 8 is one dilution; 8 to 16 is one dilution, 16 to 32 is one dilution; 4 to 16 is two dilutions, etc.). Is there any reason to believe that you may have been truly reinfected through sexual contact or blood exposure?

The only way to determine if there is a new infection in the absence of obvious signs and symptoms of primary or secondary syphilis is through this blood work (RPR or VDRL). Signs and symptomes include: painless sore at the sign the bacteria first enters the body (chancre; if inside the mouth, vagina, or rectum, it will be totally unnoticeable); rashes, hair loss, warty like growths, etc.

So, if I were you, I'd gently reflect with your sex partner(s) whether there could be any possibility of a reinfection.

Good luck! Hope I provided you with a few answers, as well as many more questions for you to ask your healthcare provider.

--mark

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