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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: HIV and AIDS
Satisfied Customers: 18536
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have tested positive for the RPR test for 20 years but

Customer Question

I have tested positive for the RPR test for 20 years but the follow up test came out as non-reactive/negative with the TPPA test. I went to a clinic recently and they said I tested positive for the RPR and the FTA-ABS, should I get a second opinion?
Submitted: 10 months ago.
Category: HIV and AIDS
Expert:  Dr. D. Love replied 10 months ago.

Hello from JustAnswer. This is Dr. Love and I will be assisting you today.

It would be appropriate to recheck a TPPA test. The FTA-ABS is a very good test, but it does have a low rate of false positives. Since you have a long history of negative TPPA tests, it would be appropriate to recheck the TPPA test. If your current doctor is not willing to consider doing the test, then seeking a second opinion would be reasonable.

It also would be appropriate to no longer check an RPR for any future testing. There has been some controversy in the testing process for diagnosing syphilis. The traditional approach has been to use an RPR as the initial test and then perform a more specific test as a confirmatory test whenever the RPR is positive. The FTA-ABS has been used for a while and the TPPA test is a newer confirmatory test. A new approach is to perform an EIA test as the initial test, which is an automated test for antibodies, and only perform an RPR or other tests if the EIA test is positive. This has been an approach that has been recommended for everyone, but it also has a distinct advantage in someone with a history of false positive RPR tests.

If someone is having specific symptoms that are worrisome for syphilis, then there also may be other tests that can be done to clarify the situation. Are you having any symptoms that has prompted this testing?

Customer: replied 10 months ago.
No symptoms. I am starting a new relationship and we both agreed to getting STI test so that is what prompted me to be tested again. I was tested last year months after I was intimate and I was told I was negative. I haven't been sexual with anyone since, so that is why I am confused and upset.
Expert:  Dr. D. Love replied 10 months ago.

If you have not had any opportunity for infection since the last negative test, then it would be more likely that the FTA-ABS is a false positive.

It is reasonable to be tested again in the situation that you describe with a new relationship, but if a similar situation ever arises again in the future, it would be appropriate to request testing initially with the EIA, rather than with the RPR.

For the current situation, though, it would be appropriate for you to request a TPPA test, and if he current doctor/clinic is unwilling to do so, to seek a second opinion.

Expert:  Dr. D. Love replied 10 months ago.

Please let me know if I can provide any further assistance.