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Positive RPR and negative treponemal test in syphilis

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Hi. During regular check up last year, had a positive RPR 128 and negative confirmatory treponemal test, so RPR was read as false positive, a month later developed fever, upper respiratory symptoms and rash suspicious for syphilis, diffuse and on soles and hands, RPR was rechecked 256, treponemal test still was read negative, after calling lab and explained symptoms they rechecked treponemal test again per lab director it may be inconclusive but they would read as positive. Treated with 3 bicillin LA injections every week. In 2 month rechecked RPR is negative, in 6 month Rpr is negative. Yesterday noticed few same rashes on both knees and elbows,one year later.. No sexual exposure since treatment. HIV test was negative, last done 1 month ago. Can RPR drop from 256 to negative within 2 month last year?
Should I go and start retreatment ?

Category: Infectious Disease Specialist

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Category: HIV- AIDS Specialist
 30 Doctors Online

Hello,


Thank you for choosing DoctorSpring.

I have discussed your concern with our Dermatologist.
Will it be possible for you to upload a picture of the lesion ? You can upload it here or email it to [email protected]

Thank you


Patient replied :

I sent pictures in email


Hello,

The emailed pictures were not available, please check your email again. I am really sorry and I am trying to get this issue sorted out asap. But please bear with me and send them in email by uploading/attaching rather than copy paste in the body.


In-house Physician


Patient replied :

I just rechecked RPR again,done last night, its read negative.


Hello,

Thanks for posting your query at DoctorSpring.com. I can understand your concern.

RPR test shows dropping levels of antibodies after treatment.

The picture shows a macular localized rash which can be seen in secondary syphilis. However, this rash is not specific for syphilis. You could send me a few more pictures of the rash? even a few zoomed out ones.

RPR test rises in presence of infection, however in early stages it may not be positive.

Its not wise to recommend retreatment, just on the basis of the rash. There should be confirmation of reinfection with blood tests, e g. RPR levels should rise indicating infection.

I would recommend that you need to visit your doctor for further evaluation.

Hope this helps, please feel free to discuss further.
Take care


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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