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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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Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.


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 info@doctorspring.com

Thank you

Patient replied :

I sent pictures in email

Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.


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.

Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.


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. Deepu Sebin Sebastian
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MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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