Syphilis symptoms/Erythema Nodosum/Neurosyphilis

[dontundrstnd]

I am writing you to get an expert opinion and clarification about syphilis and it's symptoms  My plan is to get tested when I go to the dr next week but I am having horrific test anxiety about this and it is affecting my daily life.  

I am heterosexual female from Ohio  Can you tell me how common it is for erythema nodosum to be cause by syphilis infection?  9 years ago when I was a freshman in college I had erythema nodosum accompanied by intense itching in my groin area (only on one side, right where my underwear elastic hits, it wasn't down near my vagina but up right where the bone is)  It didn't appear at first to be a rash, just itched bad. From my itching so much it created and appeared to be a large oval maybe an inch and 1/2 in length, not a sore, but like a large oval patch of intensily itchy skin. I never had a rash as is described with syphilis that I am aware of on palms, feet, trunk.  Both the erythema nodosum and the itchy rash went away after about 2 months, if I can recall. During this time in my life, I made out with several guys (maybe 5) during that year.  With probably 2 of them I recieved brief unprotected oral and fingering, kissing, but I never had vaginal or anal sex with them.  After this episode I went on with life, that was 9 years ago, now I am panicked about syphilis because I have heard that erythema nodosum could be a sign of syphilis.

1. What is your opinion that what happened could be due to syphilis?
2. How common is syphilis and erythema nodosum?
3. What are the symptoms and when does neurosyphilis typically occur?  Can it be easily confused with stress?  How would you know you were experiencing it?
4. I read on here on one of the posts where Dr. Handsfield said that most cases of untreated syphilis "die out" or go away on their own. That conflicts with information that I have read.  What does that mean?

Any information that you can provide will be greatly appreciated.  I just want to cry.

[Vance2335]

Dr.Hook first answered your question so he is the one who will answer your follow up question and you have to be patient because he and Dr.HHH have many different things going on and are not dedicated to just answering questions here.

To maybe help you out in 2008 the population in Ohio was 11,500,000 and there were 750 reported cases of syphilis. So that gives you a chance of .0000652% of getting syphilis. And among women the number of cases was 150. So that basically gives you a .000013% chance of having syphilis. And from reading I have done the reported cases in 2000 was lower then it was in 2008. So this again decreases your risk. And to add in what Dr.Hook said about the rare chance of everything else. You are looking at something so rare that the chances might not ba able to be calculated except by NASA,

[Edward W Hook, MD]

You can trust the results of this test.  As predicted, you do not have syphilis and have no reason to worry about this.  I hope this information will let you move forward from this point.  Take care.  EWH

[dontundrstnd]

Hello Dr Hook,

I just wanted to update you and let you know that I got tested and my result was negative.  The kind of test that the clinic/dr performed was the kind where they take your blood and you wait about 20 minutes and they tell you the results right there.  Is my negative result reliable even though I am worried about a chronic (10 years ago) infection?

Just want to make sure I don't need further testing as I have read that sometimes chronic infection can go negative over time.

Thank you!

[Edward W Hook, MD]

I did miss your question yesterday.  Sorry.  At the same time, it is one more anxiety-fueled question that could have been answered definitively well before this is you would just get tested.  It is now time for this thread to end, this will be the last answer provided as part of this thread.

Transmission of syphilis requires contact with a lesion which contains the syphilis bacteria.  TThe lesions which transmit syphilis are typically open, moist sores. In most syphilitic rashes the skin is intact acting as a barrier to transmission of infection.  Thus, while it may be theoretically possible for syphilis to be transmitted from a rash on the hands, as a practical matter it does not happen.  EWH

[dontundrstnd]

Hi Dr., I was wondering if you happened to see my last question above?  I appreciate your response. Thank you so much.

[dontundrstnd]

I am sorry but I have one more question that I would appreciate your expertise on regarding the transmission of syphilis - If a man had a rash on his hands/fingers due to syphilis and he rubbed her labia and then fingered her can this pass syphilis?

I know this is sounding ridiculous, I have just read where one has to some in contact with a sore, but what about fingering/rubbing of genitals when a rash on the hands/fingers?

Basically, is just the sore contagious or is the rash just as contagious?

[dontundrstnd]

Thank you.  You don't know how much I appreciate your time in this matter and in calming my fears.

[Edward W Hook, MD]

It is time for you to stop worrying about whether past occurrences could have been due to syphilis.  As i sadim if you have nay concern about that at all, get tested so you can get over it.

The itchy patch you describe on your groin does not at all sound like STD of any sort.  Rather it is likely some other dermatologic process
EWH

[dontundrstnd]

Thank you.  Your reassurance definately helps.  I feel that if I had had syphilis 9 years ago I would have displayed symptoms such as rash, etc. more specific to syphilis during that time that I had the EN.  I just got concerned when I looked back on the fact that the EN appeared one day out of nowhere and lasted for about two months without an apparent cause (to my knowledge at the time).  And when I saw that syphilis may cause EN to appear I started relating all my symptoms I had at that time (itch/unwell feeling) to syphilis.  And now, 9 years later, fearing that I "may" have this awful disease and not been aware of it because I didn't display "typical" symptoms at the time has got the best of me.  And now I am walking around trying to remember any weird occurance that has happened with my body over the last few years and attributing it to late/tertiary syphilis.

Do you agree?
Is this kind of anxiety normal?  I am not just going crazy?
Does the odd itchy patch in the groin sound like an STD to you?  It lasted for a while as well as I just itched and itched until it finally went away at the time chalking it up to just extremely dry/itchy skin (even though it was only in one spot).

Thank you so much for your help.  I am going to try to move on from this now.

[Edward W Hook, MD]

It should not be scary.  Your fears are unrealistic and fueled by misinformatation or misinterpretation of infomation you saw on the internet.  Erythema nodosum has little in common with syphilis and the two should not be mistaken one for another.  Feeling unwell is totally non-specific and thus should not realistically raise concerns about syphilis.  If your anxieties don't allow you to accept what I am saying get tested.  the test will be negative.  then you can (hopefully) move on from your misperceptions.

I hope this helps.  EWH

[dontundrstnd]

Can either doctor please read my last comment above and tell me what the chances are of having syphilis but not displaying typical, overt symptoms? And my question regarding the timing or commonality of neurosyphilis or symptoms of tertiary syphilis to set in?  I know I am freaking out way too much, it's just scary.

Thank you.

[dontundrstnd]

So the EN, itching and unwell feeling does not sound indicative of syphilis?  The reason for the neurosyphilis concern is that the only time I would have been exposed to syphilis was in 1999-2000 (that school year), that was 9 years ago and it freaks me out that I could have had something that syphilis caused, not known it, and then 9 years later I am just realizing it.  That has been a long time and everything I've read says that neurosyphilis usually starts around 10 years after infection.  My concern is that maybe at that time, since I didn't know what caused the EN, maybe it was syphilis in the absence of the other typical symptoms like rash and the condylamata lata, and mucous patches.

Thank you for your help.  It is greatly appreciated.

[Edward W Hook, MD]

You have little to worry about.  In 2007 (the last year there were date , less than 2 out of every 100,000 persons in Ohio acquired syphilis It is a very, very rare disease.  Among those who get it the infection is most common among men who have sex with men.  Thus your risk of syphilis overall is very low.  In addition, as I will explain in answering your questions, your history does not suggest syphilis either.

On to your questions:

1.  No, this really does not sound at all like syphilis.  Your exposures were not high risk and your symptoms are not suggestive.
2.  Erythema nodosum is a relatively common, non-specific allergic reaction.  It is very, very rarely caused by syphilis.  In most people who get E. nodosum we never learn what caused it.
3.  Neurosyphilis can present with a wide variety of neurologic symptoms including meningitis and stroke but it is even more rare than syphilis itself.  Why would you think you might have neurosyphilis.
4.  Your information is incorrect.  Most persons with untreated syphilis do not suffer long term consequences, even if the disease is not discovered until it has been present for years.

BTW, if you have given blood or been pregnant since the time of your E. nodosum, you have been tested for syphilis.

Bottom line, yo are more likely to be hit by lightening while reading this than to have syphilis. There is nothing that you have said that raises any concern whatsoever about syphilis.  If you are getting your information off of the internet, please stop.  there is more misinformation out there than not.

Hope t his helps.  EWH