HomeAnswersDermatologysyphilisTPA is high but VDRL is negative. Does it indicate latent syphilis?

TPA is high but VDRL is negative. Please advice.

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Nithila. A

Published At May 15, 2019
Reviewed AtAugust 8, 2023

Patient's Query

Hello doctor,

I have been tested for TPA by CLIA and a high titer of 451 was detected. But VDRL is nonreactive. There is a history of unprotected sex three years back with small erosions in genitalia. At that time broad medicines including antibiotics and antifungals were taken without any specific test. And remaining years were asymptomatic. Does it indicate latent syphilis? My wife also has similar test results now. If its latent form, how do we proceed with treatment?

Hello,

Welcome to icliniq.com.

As you have mentioned the TPA (Treponema pallidum antibody assay) is positive and VDRL (venereal disease research laboratory test) is nonreactive. Next step to confirm if you have latent syphilis, you need to get one of the following two tests first.

  1. TPHA (Treponema pallidum Haemagglutination assay).
  2. TPPA ( Trepenoma pallium particle agglutination assay).

I hope you are satisfied with my answer. For further queries, you can consult me at icliniq.

Thank you.

Investigations to be done

The following investigations need to be conducted: HIV (human immunodeficiency virus), HBsAg (Hepatitis B surface antigen), and Anti HCV (hepatitis C virus antibody test).

Treatment plan

Please revert back with the investigations I have asked for so that I can decide on the specific treatment plan for you.

Patient's Query

Hi doctor,

Thank you for the reply.

TPHA is reactive, indicating a positive result, but HIV is negative. The same result applies to my partner as well.

Hi,

Welcome back to icliniq.com.

In the case of TPHA (Treponema pallidum haemagglutination assay) positivity, both of you need to undergo treatment. Around 30 percent of patients with late latent syphilis may show a negative VDRL result. TPHA remains positive even after treatment.

Hope this helps you. Feel free to ask if you have any further queries.

Thank you.

Treatment plan

The treatment plan involves administering injection Benzathine Penicillin G at a dose of 1.2 million units in each buttock (totaling 2.4 million units in one session) weekly for a duration of three weeks, following sensitivity testing.

Patient's Query

Hello doctor,

Thank you for the reply.

Sir, do we have to test for anti-HCV and hepatitis B? I had completed the vaccination. And anti-HBs titer which was checked last year was adequate.

Hello,

Welcome back to icliniq.com.

Yes, testing for hepatitis C antibodies is recommended whenever there is a case of a sexually transmitted disease. These investigations are routinely conducted because the risk of acquiring other sexually transmitted diseases is higher when one is present. Given that hepatitis C can also be transmitted through sexual contact, it is essential to have it tested as well. Please make sure to get tested for anti HCV (hepatitis C virus).

I hope this has helped you. Please feel free to reach me again, in case of further queries.

Thank you.

Patient's Query

Hi doctor,

Thank you for the reply.

Sir, I also wanted to know how we should proceed after completing the three doses of injection benzathine Penicillin. Should we have another VDRL test after a few months? Currently, the VDRL test is nonreactive. Additionally, is it safe for the injection to be administered during my wife's menstrual bleeding period?

Hello,

Welcome back to icliniq.com.

1. Yes. Although it is already nonreactive, still you need to repeat VDRL (venereal disease research laboratory test) again after four months.

2. Yes, she can take it during her periods.

Patient's Query

Hi doctor,

Thank you again for your time; I greatly appreciate it.

Sir, as discussed before, we have conducted anti HCV and HBsAg tests, which came back non-reactive. We have commenced the treatment. I have the following queries:

  1. We obtained the Penstat LA 24 2.4 million units injection with Benzathine Penicillin composition. Is it the same as the Penidure injection prescribed by many physicians?
  2. During the administration of the first shot, approximately 1 mL (0.035 ounces) of the reconstituted medicine was spilled, leading to the medicine being diluted in 5 mL (0.17 ounces) instead of 4 mL (0.14 ounces) for ease of administration. Is it necessary to repeat this shot due to improper administration?

Both of us experienced very mild fever with no other reactions within 48 hours of taking this shot. Can we assume that the medicine is working?Kindly share your insights, as we are uncertain due to receiving different information from various physicians.

Hello,

Welcome back to icliniq.com.

Yes, both Penidure and Penstat contain the same medicine, which is Benzathine Penicillin G 2.4 million units. I do not think it will make much difference. I hope you have had sensitivity testing done before the injection, as I have advised. While fever is not very common after the injection, mild fever is sometimes observed, and there is no need to worry if it is not accompanied by any other symptoms. There is no visible external indicator to confirm whether the medicine is working or not. However, this is the established drug of choice for syphilis globally, and there is no reason to believe it will not be effective, so please do not worry about it. If the fever persists, you can take a tablet of Paracetamol; it could be unrelated to the injection as well. Just relax and complete all three injections. Just make sure you have undergone sensitivity testing before its administration.

Hope I have solved your query. I will be happy to help you further.

Thank you.

Patient's Query

Hi doctor,

Thank you for your prompt reply.

I am writing with regard to the previous queries posted. I have completed four months of treatment for late syphilis and have undergone serum TPA (Treponema pallidum antibodies) estimation, which showed a positive result. Does this indicate a current infection? Is there any test to determine the success of the treatment?

Hello,

Welcome back to icliniq.com.

TPA (Treponema pallidum antibodies) positivity usually remains positive irrespective of the treatment or infection status. So, if you have completed the treatment, there is no need to worry about it. You can go for a VDRL (Venereal disease research laboratory) test; it should be negative after the treatment. However, you already had a negative result, I suppose, so no active intervention or testing is required at the moment. Just relax and avoid thinking about this for now.

Hope this helps you. Feel free to ask if you have any further queries.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Dilip Kumar Meena
Dr. Dilip Kumar Meena

Dermatology

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