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What is the reason for a long term positive VDRL?

Q: I am a physician (MD) doing private practice. One of my patients' VDRL is positive for the past 8 years. He is 35 years old. He has been treated with almost every medicine but his VDRL is still positive. His current TPHA is 1:320, earlier it was 1:640. He wants to go abroad and is rejected due to this every time. Is there any medicine available to make it negative? He had sexual contact 8 years ago. He is totally asymptomatic. How can he be treated? He has already been treated by inj. Penidure and inj. Ceftriaxone. Please advise.

A:Usually VDRL titre gradually falls over a 2 year period and is generally negative at the end of it. In about 5% patients it may remain positive in a low titre and such patients are referred to as serofast. A strong positive titre is most unusual. Rather than reflecting treatment failure, it most likely indicates another cause for VDRL positivity apart from syphilis.

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