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Ask Dr. Roach: It’s not uncommon for titers not to drop undetectably | Lifestyle

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Dear Dr. Cockroach: In October 2018, I was treated for syphilis and had a VDRL titer of 1: 128. A few months later, the titer was 1: 8, but has remained 1: 8 ever since. Why didn’t you fall?

-YY

Dear reader: VDRL and RPR are antibody tests for syphilis. They are non-specific and can lead to false positive results. That is, a person can be tested positive, but has never been exposed to syphilis. However, decades of experience with these tests have made them an important part of monitoring therapy.

In your case, the titer has dropped dramatically: 16x. This is consistent with the cure for syphilis in 2018. However, the titer did not drop undetectably as usual. This is called the “cellofast state”. It is not uncommon for more than 20% of people who have successfully treated syphilis to have antibodies that can be detected by the RPR or VDRL test.

If you haven’t been tested for HIV recently, you should do so because syphilis and HIV can be transmitted in the same way, sometimes at the same time, and HIV-positive people are more likely to have a prolonged seropositive status.

Dear Dr. Cockroach: The last time I went to the dentist was in March 2020, when the pandemic began. The secretariat asked us to sign a form that we are aware that the virus may be contained in water droplets due to the large amount of water used for treatment. Since then, I haven’t returned to the dentist. I was excited to get vaccinated and return to the dentist, but I thought it was not a good idea because my daughter still lives in a place with many new cases. Do you think it’s safe to clean my teeth and get an implant? They clean with water.

-JC

Dear reader: At the beginning of the pandemic, we didn’t really understand how the virus spread, but now most of the spread is due to person-to-person transmission through respiratory secretions. It’s clear. Initially inconsistent enough to recommend wearing a mask, but now both people (those who are infected with COVID-19 and those who are susceptible to it without knowing it) wear effective masks. Therefore, the possibility of infection is low. A 6-month study showed zero COVID-19 infections if the dental office adhered to best practices.

The water droplets used by dentists and hygienists to clean their teeth do not spread COVID-19. If your dental office follows the recommendations, it is very safe to go to the dentist. Of course, you have to be safe while traveling.

Dear Dr. Cockroach: I am a 58 year old woman with lupus and have been taking 10 mg of prednisone for 40 weeks. I’m gradually reducing this drug. My bone mass was okay before the medication. After taking this drug for almost a year, am I at high risk of bone loss?

— MW

Dear reader: Women’s bone mass tends to decrease after menopause, and 58 years is in that age range. Prednisone absolutely increases the rate of bone loss, even at relatively low doses of 10 mg. It is advisable to test bone density on a regular basis. The best time to get follow-up measurements is not clear and depends on the exact result of the test, but it is a common rule to double-check after two years and personalize it. need to do it.

Contact Dr. Roach [email protected]

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