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Am I negative for syphilis if my RPR test result was non-reactive?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

I have Hashimoto’s thyroiditis and recently had an RPR test for syphilis that showed positive results. But the confirmation RPR shows non-reactive. My only symptom was a white tongue and a chronic sore throat that I still have even after ten days of oral Penicillin 500 mg.

If my RPR confirmation antibody test came out non-reactive, does that mean I do not have syphilis?

Kindly help.

Hi,

Welcome to icliniq.com.

Thank you for the query. According to your statement, you have been suffering from a sore throat and white tongue for two months. I can understand your concern.

A false-positive RPR (rapid plasma reagin) test indicates that you are suffering from syphilis, although you do not have one. It may happen when another type of disease other than syphilis creates a similar kind of antibody. Some diseases that may cause false-positive RPR are HIV, pneumonia in immunocompromised patients, SLE (systemic lupus erythematosus), and other autoimmune conditions like Hashimoto's thyroiditis, tuberculosis, malaria, pregnancy, etc.

So, your RPR test may become reactive due to the presence of Hashimoto's thyroiditis. RPR is a screening test, not a confirmatory test. If confirmatory tests like TPA (Treponema pallidum antibody) become non-reactive, that may indicate that your previous RPR test was falsely positive.

Take care.

Patient's Query

Hello doctor,

In my laboratory report, they have mentioned that RPR confirms Treponema pallidum as non-reactive. Is that a confirmatory test?

Thanks.

Hi,

Welcome back to icliniq.com.

Screening tests for syphilis are RPR and VDRL (venereal disease research laboratory). When any of these tests become reactive, the other tests used to confirm a syphilis infection are enzyme immunoassay test, fluorescent Treponema antibody absorption test, Treponema pallidum particle agglutination assay, darkfield microscopy, microhemagglutination assay, etc.

TPA or Treponema pallidum antibodies test is used to detect the presence of syphilis in a person. It is used as both an initial screening and a confirmatory test as this test is more specific and sensitive. Syphilis testing should be started with a TPA test according to the CDC's current guidelines for syphilis as it has a very low incidence of false positives.

RPR becomes false positive or false reactive as you are suffering from autoimmune disorders like Hashimoto's thyroiditis. Due to the presence of Hashimoto's thyroiditis, your RPR becomes false positive in laboratory results, and it may happen.

If you still have doubts, you can undergo some other confirmatory tests that have already been mentioned to confirm the presence or absence of syphilis infection.

Take care.

Medically reviewed byiCliniq medical review team
Published At January 11, 2022
Reviewed AtOctober 5, 2022

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Syphilis Test Result Decision Helper

Confused by your syphilis test results?

This quick check helps you understand what your RPR and confirmatory test results might mean, especially if you have a reactive RPR but a non-reactive Treponemal test.

This tool provides guidance only and is not a diagnosis. Always consult a healthcare professional for medical advice.

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