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Syphilis relapse?

Hello Doctor,
Here is my case. I got syphilis back in Early Nov.2014, the RPR titer then was 1:32. I received the treatment and in my six-week follow-up test the titer dropped to 1:16. However, in my most recent follow-up test in got the titer back to 1:32. Is that a reinfection or relapse sign? I don't think it's normal to sustain this high titer after six months, but I couldn't think of any occasion that I got reinfected. (Only one sex partner since then, and he got tested when I was diagnosed. Results got back all negatives, and he still had a penicillin shot just in case.)
I am now confused about my result. Can you advise? Thank you so much!
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Avatar universal
Your RPR titer definitely should have declined; by 6 months, yours should be no higher than 1:8, and in most people it would be 1:4 or lower by now. Since reinfection isn't likely, it must be assumed the treatment failed and re-treatment will be required. CDC recommends that people in this situation be evaluated for neurosyphilis, i.e. infection in the brain, spinal cord, etc. That's because the low dose kind of penicillin routinely used doesn't penetrate the central nervous system -- so treatment failure sometimes means silent neurosyphilis.

So you need to see your doctor -- or preferably an infectious disease or STD specialist who understands the details of syphilis management -- and take it from there. Don't delay; untreated neurosyphilis can rapidly cause very bad things, like blindness or stroke. Get on this right away.

Good luck!
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Avatar universal
Hello,
Thanks for reply. The question is when I got treatment I had the early syptoms, meaning that the stage is very early. Is that possible that it becomes neurosyphilis that fast?
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Also is neurosyphilis like my situation totally curable?
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Syphilis bacteria often invade the central nervous system, typically very early; it can be detected in spinal fluid of at least half of people at the earliest stages. The earlier treatment is given, the less likely this results in treatment failure. But still it isn't rare and your situation isn't unsual.

Yes, totally curable -- no worries there. However, if complications develop, they usually cannot be reversed; damage done cannot be undone. So as noted above, don't delay.
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And anyway your syphilis wasn't treated all that early. Your thread last November said you had a skin rash of the hands. Assuming that was secondary syphilis, you probably had been infected for 3 months, possibly as long as a year.
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Hi I had the hand rash as well as a sore around anus at the same time. I don't know why that happened. Seemed that I had the two stages symptoms all together, which is also why I thought my stage was really early.
I went to my doctor today. He sent me to a re-treatment with again 2.4 million units Penicillin G Benzathine, as well as a 10 day's doxycycline.
And this time I did not have any of the so-called "Jarisch-Herxheimer reaction". Does it mean that Penicillin does not work?
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