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Syphilis count was low with negative HIV test

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I recently did some blood work and my doc says my syphillis count was low. A four. She said she wanted to repeat the test and this time gave me a HIV test as well. She said the syphillis count is now an 8 but all my test is coming up negative. She now has to refer me to a infectious disease doc and now I'm worried. She keeps asking me if I have rashes and all these HIV questions. She also asked if I was exposed to malaria. I'm worried because I don't know what's going on. She gave me doxycycline to take in the mean time. But y would my test all show negative including the syphillis but still rise to an 8?????

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
 18 Doctors Online


Thank you for asking the query.

The syphilis test you have mentioned here is probably a Non Treponemal test which measures a rise in antibody titre for Syphilis diagnosis. That means two measurements of the titres are needed. In your case the first value is probably 1:4 and second is 1:8. (In an ideal scenario it should be same when repeated.-That is 1:4) . This is called a raise in titre which may indicate syphilis. BUT, this can be falsely positive too under certain conditions. Also ideally a fourfold rise is needed. (Not two fold as in your case).
This is the reason why your Doctor is suspecting Syphilis and asking you related questions.

In short there is possibility that you might have Syphilis, but there is no definitive evidence clinically or lab wise. You will need other Syphillis related test to confirm. Your sexual history becomes relevant here. If you had a high risk sexual behaviour or un protected sex the chance / risk increases. But do not worry, diagnosis and treatment (in case you test positive) is simple and straightforward.
I would like to know whether you have any genital rashes or symptoms. Also whether you were exposed to unprotected sex (only if you wish to comment)

Thank you
Please feel free to ask any queries you may have.

Patient replied :

I don't have any rashes. But I do have genital itching. I am in a relationship but did have a sexual unfortunate encounter otherwise. I know I was risky. My doc also keeps asking if I have Lyme disease or malaria but I wouldn't know. I answered no to all questions she asks

The reason your Doctor is asking for history of Malaria or Lymes is because these can cause a falsely elevated (positive) Syphilis Test. This does not imply that you are at risk for Malaria or Lymes.

As I said earlier, there is a small rise in titre, which needs to be evaluated. There is no need for any worry now, just followup with your Doctor. This is general affair. Gential itching is not suggestive of Syphillis.

Hope this helps
Please feel free to ask followup questions.

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
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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