Sexually Transmitted Diseases/syphilis titer

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Question
syphillis titer was 1-1 for 3 years after treatment im currently pregnant I got retreated about 2 months ago just so it could go to zero I have gotten a blood test 2 weeks ago now my titer is a 1-4 before I got the treatment again it was still a 1-1 how could it have went up and I don't want to pass it to my partner and we have been tested and he was negative in the past I'm really confused and scared how is it possible if I been ok for 3 years then I decided to get the treatment even doe I didn't need it and my titer jump to 1-4 I'm confused and don't want to pass it to my partner

Answer
Hello Krystal,
Relax. No problem. First, it is helpful to know which of these "nontreponemal"  screening tests you had, as they are slightly different in how they measure antibody titers: "RPR" and "VDRL" are used used interchangeably, but are not quite equivalent. I don't recall which one is a tiny bit more sensitive, but exactly the same sample bloods tested with one will have a titer one or two titers different than the other one.  Sort of like the difference between lemons and limes-- both are very similar, sour, citrus, but there are some differences!!

Second, either one of these tests are ANTIBODY tests, designed to measure how your body recognizes past infection.  It is a "marker" antibody, not a "protective" antibody, meaning that it only measures the strength of the immune system's reaction to the past infection.  As it is a "marker" it may eventually go away with time, but it may not. It does not directly measure whether you have a new (or acute) infection of syphilis, unless the same test (RPR OR VDRL) measures a two fold or higher increase in titer. More on that in the paragraph after next.

Technically, these tests measure antibody to a component of cell membranes (cardiolipin) that is modified by the syphilis germ. Other things produce antibody to cardiolipin, including certain autoimmune diseases, lupus, the elderly, and perhaps even pregnancy. In other words, there are other health conditions that can cause a false positive antibody tests. That is why there are confirmatory tests, that may be helpful only if you've never had syphilis before!  Once reactive for the confirmatory test, always and forever positive. It doesn't mean that you have syphilis, just that you've had it and probably had effective treatment.

RPR or VDRL titers are measured as follows:  nonreactive (negative antibody), weakly reactive, 1:1, 1:2,  1:4,...  (the convention is to eliminate the first part of the ratio, "1:x" where x is: 1, 2, 4, 8, 16, 32, 64, 128, 256, 512, etc.).  A change of one dilution would be from 1 to 2, or 16 to 32 (or downward from 16 to 8), etc.  A change of two dilutions would be from 1 to 4, or 16 to 64 (or downward from 256 to 64) for example. But these changes can be compared only by knowing whether the tests were RPR or VDRL.  The confirmatory test is usually interpreted as reactive (positive) or nonreactive (negative). There is also some degree of interpretation involved, so it is important to have someone who knows this stuff before making treatment decisions.

So your titer was 1:1 (or just "1"), and then went up to 1:4. This is a two-fold increase in dilutions, which suggests a reinfection with syphilis. However, if one of the tests done was an RPR and the other a VDRL than they are not entirely equivalent.  One other wrench in the complexity of interpreting these tests, is that you are pregnant.

One thing seems clear. You hopefully received treatment with Bicillin 2.4 million units (a particular type of penicillin; NO OTHER IS RECOMMENDED!) which is injected into buttocks. This is 100% effective if your diagnosis was correct, which depends on how long you may have had the infection during the first go-round. Less than one year's duration of infection is one set of shots; greater than one year's duration requires 3 weekly sets of shots.

You see, the complexity of the diagnosis and treatment really requires the guidance of someone who knows what is going on, preferably an infectious disease expert. Hope this explanation was helpful!

Good luck!
--mark  

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Mark P. Behar

Expertise

Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. 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 “pre-screen” 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 consequences 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; answered 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.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), 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) Q Visions, Quarterly Newsletter of the NABWMT

Education/Credentials
Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

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

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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