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Dear Doctor, I Got Syphilis In 2017, I Was Given
Question: Dear Doctor,
I got syphilis in 2017, I was given 3 injections weekly for 1.2 lakhs units in each butt, After the treatment my VDRL was non reactive but my TPHA is 1:1280. Its been 2 years my TPHA is still the same.1:1280. I am HIV + and under proper medications. My Viral load is undetectable. but my CD 4 count is declining from 570 to 400 in last three years. This could be because of the presence of TPHA. I also get involved in sex few times with random persons and then sometimes i got reinfection of spyhilis which i treat my taking doxycycline. Everytime i took doxycycline and after that my VDRL test get Non Reactive but my TPHA never chnages. It is still the same 1:1280 from last 3 years. Could you please tell me how can i get non reactive TPHA.
I got syphilis in 2017, I was given 3 injections weekly for 1.2 lakhs units in each butt, After the treatment my VDRL was non reactive but my TPHA is 1:1280. Its been 2 years my TPHA is still the same.1:1280. I am HIV + and under proper medications. My Viral load is undetectable. but my CD 4 count is declining from 570 to 400 in last three years. This could be because of the presence of TPHA. I also get involved in sex few times with random persons and then sometimes i got reinfection of spyhilis which i treat my taking doxycycline. Everytime i took doxycycline and after that my VDRL test get Non Reactive but my TPHA never chnages. It is still the same 1:1280 from last 3 years. Could you please tell me how can i get non reactive TPHA.
Brief Answer:
Stick to safe sex strictly.
Detailed Answer:
Hi,
Welcome to "Ask a Doctor"
Thanks for posting your query.
TPHA test is a Treponemal antigen test. If once it becomes reactive, it remains reactive for ever. That does not mean that you are still having infection. Only nontreponemal tests like VDRL and RPR will be back to non reactive and never with TPHA. So you need not worry about its reactivity and about its titre values.
Are you married?
If so, your wife got treated? or Your sex partners got treated?
Regarding your treatment,
It seems you are having HIV infection also? How long? How long are you on ART? In the presence of HIV infection I used to give 4 injections of Benzathine penicillin 24 lakhs at weekly intervals.
Moreover I am worrying about your statement with regards to reinfection of syphilis as you are having sex with multiple partners. Try to stick to safe sex. Doxycyclin at what dose you had? How long? Doxycyclin would not be as effective as Penicillin. I will not encourage self medication.
Have it under supervision of an expert. If there was a possibility of reinfection repeat the RPR test a month after the last exposure (it could be delayed if you took Doxycyclin) before assuring a total cure.
DR S.Murugan
Stick to safe sex strictly.
Detailed Answer:
Hi,
Welcome to "Ask a Doctor"
Thanks for posting your query.
TPHA test is a Treponemal antigen test. If once it becomes reactive, it remains reactive for ever. That does not mean that you are still having infection. Only nontreponemal tests like VDRL and RPR will be back to non reactive and never with TPHA. So you need not worry about its reactivity and about its titre values.
Are you married?
If so, your wife got treated? or Your sex partners got treated?
Regarding your treatment,
It seems you are having HIV infection also? How long? How long are you on ART? In the presence of HIV infection I used to give 4 injections of Benzathine penicillin 24 lakhs at weekly intervals.
Moreover I am worrying about your statement with regards to reinfection of syphilis as you are having sex with multiple partners. Try to stick to safe sex. Doxycyclin at what dose you had? How long? Doxycyclin would not be as effective as Penicillin. I will not encourage self medication.
Have it under supervision of an expert. If there was a possibility of reinfection repeat the RPR test a month after the last exposure (it could be delayed if you took Doxycyclin) before assuring a total cure.
DR S.Murugan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I am having HIV from XXXXXXX 2016 and i am on ART since then. I am very punctual in mt medications and never miss it.
I took doxycycline 100 mg twice daily for 3 weeks.
Should i take penicillin injections again if that could lower my TPHA titre.
And why is the CD4 count decreasing in these 3 years. Is there any thing i could do to increase my CD4? OR Do I need to change my HIV medicines ?
I took doxycycline 100 mg twice daily for 3 weeks.
Should i take penicillin injections again if that could lower my TPHA titre.
And why is the CD4 count decreasing in these 3 years. Is there any thing i could do to increase my CD4? OR Do I need to change my HIV medicines ?
Brief Answer:
Treated syphilis won't affect CD4 count.
Detailed Answer:
Hi,
Welcome back.
TPHA test will never become non reactive. Don't bother about titre value.
Doxycyclin in case of late syphilis (more than two years) have to be taken for a month.
As your viral load is undetectable level, wait for another 3 months and repeat the CD4 count... If further decrease noted change of ART is preferred.
CD4 decrease has no relevance to your TPHA titre.
If there is active infection it could affect the CD4 count. Treated syphilis has no effect on CD4 count.
Dr S.Murugan
Treated syphilis won't affect CD4 count.
Detailed Answer:
Hi,
Welcome back.
TPHA test will never become non reactive. Don't bother about titre value.
Doxycyclin in case of late syphilis (more than two years) have to be taken for a month.
As your viral load is undetectable level, wait for another 3 months and repeat the CD4 count... If further decrease noted change of ART is preferred.
CD4 decrease has no relevance to your TPHA titre.
If there is active infection it could affect the CD4 count. Treated syphilis has no effect on CD4 count.
Dr S.Murugan
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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