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Q. TPA is high but VDRL is negative. Please advice.

Answered by
Dr. Dilip Meena
and medically reviewed by Dr.Nithila A
This is a premium question & answer published on Apr 04, 2019

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?

Dr. Dilip Meena

Dermatology Venereology
#

Hello,

Welcome to icliniq.com.

1. As you have mentioned the TPA (Treponema pallidum antibody assay) is positive. 2. VDRL is nonreactive.3. Next step to confirm if you have latent syphilis, you need to get one of the following two tests first.

A.TPHA (Treponema pallidum Haemagglutination assay).

Or

B. TPPA ( Trepenoma pallium particle agglutination assay).


Investigations to be done:

A. TPPA/TPHA
B. HIV
C. HBsAg
D. Anti HCV

Treatment plan:

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


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Thank you doctor,

TPHA is reactive, HIV negative. same result for partner also

Dr. Dilip Meena

Dermatology Venereology
#

Hi,

Welcome back to icliniq.com.

1. In the Case of TPHA positivity, you both need to take treatment.

2. About 30 percent of patients with late latent syphilis might have negative VDRL.

3. TPHA remains positive even after the treatment.

4. Injection Benzathine penicillin G 1.2 MU in each buttock (total 2.4 MU in one sitting) weekly for three weeks after sensitivity testing.


Treatment plan:

1. Injection Benzathin penicillin G 1.2 MU in each buttock (Total 2.4 MU in one sitting) every week for 3 weeks after sensitivity testing.


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Thank you doctor,

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.

Dr. Dilip Meena

Dermatology Venereology
#

Hello,

welcome back to icliniq.com.

1. Yes, hepatitis C antibodies should be tested once in any case of a sexually transmitted disease.

2. All these investigations are routinely done as chances of acquiring other sexually transmitted diseases increase in the presence of one. So as HCV can also be acquired by sexual route. It is mandatory to have it tested.

I hope this clears it. Please get anti HCV tested.


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Thank you doctor,

Sir, I also wanted to know how do we follow up after completion of three doses of injection Benzathine Penicillin. Do we go for VDRL again after a few months? Currently, VDRL is nonreactive. Also, can the injection be taken during the menstrual bleeding period(for my wife)?

Dr. Dilip Meena

Dermatology Venereology
#

Hello,

Welcome back to icliniq.com.

1. Yes. Although it is already nonreactive, still you need to repeat VDRL again after 4 Months.

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


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