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9 week syphilis test conclusive in face of symptoms?

Following up on my last question. I had a suspected syphilis chancre appear 5 weeks after an oral exposure. It cleared up in about ten days. I tested nonreactive on RPR and TPPA at 5 weeks (just when it appeared). Also got a nonreactive RPR and syphilis health check at 6.5 weeks at the public health clinic (the sore was gone by this point). I feel like I've been getting a lot of lymph node pain in my groin area for the 3 weeks or so after the sore. I tested non-reactive again on RPR and TPPA at 9 weeks (65 days). Think I can put it to bed yet or further testing necessary?
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207091 tn?1337709493
COMMUNITY LEADER
Yes, I think you can put it to rest.

Did a doctor ever see the sore? A syphilis chancre clearing in 10 days is possible, but that's pretty fast for it to clear.
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6 Comments
Thanks for your reply!
A physician assistant saw it and said it didn't look like the chancres he'd ever seen before but that he couldn't rule it out (he also said he had only seen about four of them before). It had cleared up by the time the nurse at the STD clinic saw me.

I've asked Dr. Hook about it over at ASHA and he seems to think the 9 week tests are conclusive. I'm still really concerned because the first time I ever have an exposure like this this (with a csw) I get a sore on my penis and lymph node pains in my groin. Seems like such a coincidence. I'm wondering about testing again at 12 weeks. Have you ever seen or heard of someone testing positive at 12  weeks after being negative at 9 weeks? Thanks again.
Seriously, trust Dr. Hook. He literally wrote a book about syphilis, and is among the best there is. He used to be an expert here before we stopped having experts.

I haven't heard of anyone developing antibodies after 9 weeks.

Seriously, trust Dr. Hook. :) He is the best. Here's his profile from our site - https://www.medhelp.org/doctor_profiles/show/300980

Thank you for replying again. I really want to trust Dr. Hook's advice!

I'm just having a really hard time with it to be honest. I feel like a positive blood test is just a matter of time. I suffered a penile sore and inflamed lymph nodes for the first time EVER, after first EVER encounter with a csw. The chances of this being coincidental seem remote, to put it mildly. The guilt and uncertainty are tearing me up.
I get it - if I had a sore, I'd want definitive answers, too.

However, make sure you remember that guilt doesn't equal risk, and that science is backing us up here.

According to the CDC: "The chancre lasts 3 to 6 weeks and heals regardless of whether a person is treated or not." (https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm)

"Seroconversion occurs around 3 weeks, but can take up to 6 weeks." - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999316/ (That's in the "Nontreponemal tests" section about 1/4 down the page.

So your sore healed too fast to be a chancre, and your negative 9 week tests (and you had 2 different types to confirm, which is all kinds of awesome) mean you don't have it.

I wish the PA had cultured it to see what it was, but unfortunately, that ship has sailed. The best you can do now is know that it isn't syphilis, and if you get another one, get in and make someone culture it. Loads of things cause sores, and a lot of them look quite similar.

Thank you! I really appreciate you commenting again. I've actually read that line about 3-6 week seroconversion dozens of times to try to calm myself down. It's so freaking weird to get the symptoms (including the lymph nodes) so aligned with syphilis and the negative tests. It messes with your head so badly. I'm going to test again next week (which will be 90 days). I'll let you know the outcome of that. If negative, hopefully I can put it to bed finally (both mentally and for real).

Btw- check out slides 23 and 24 here: https://slideplayer.com/slide/3814158/  
Slide 23 makes it look like RPR is 98% accurate at 9 weeks, while slide 24 makes it look 65% accurate at that time. It's things like that that help drive me crazy!

Thanks again for the reassuring word. Sincerely appreciated.
Not knowing why those two slides were included, what she intended to point out, it's hard for me to comment on them. I do see that slide 24 is combining the RPR and VDRL in one line, since those are both nontreponemal tests. The RPR and VDRL have different accuracy rates, so slide 24 is probably averaging the two tests.

You had an RPR, so go with slide 23.

I will point out that your sore healed way too fast to be syphilis.

Stop researching this. I get it - I'd likely be researching it, too, but now you are digging so deep (I have no idea how you found this lol) that it's just going to drive you crazy.

Avatar universal
Thanks for your reply!
A physician assistant saw it and said it didn't look like the chancres he'd ever seen before but that he couldn't rule it out (he also said he had only seen about four of them before). It had cleared up by the time the nurse at the STD clinic saw me.

I've asked Dr. Hook about it over at ASHA and he seems to think the 9 week tests are conclusive. I'm still really concerned because the first time I ever have an exposure like this this (with a csw) I get a sore on my penis and lymph node pains in my groin. Seems like such a coincidence. I'm wondering about testing again at 12 weeks. Have you ever seen or heard of someone testing positive at 12  weeks after being negative at 9 weeks? Thanks again.
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