www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf

This Workbook mentions syphilis only once (isn't the "Find on this page" function great?) and it says syphilis is transmitted in lab or autopsy exposures but not in patient care. It cites only one possibly relevant article (Collins CH, Kennedy DA. Microbiological hazards of occupational needlestick and other sharps’ injuries. J Appl Bacteriol 1987;62:385-402) but there's no abstract on PubMed and the article itself is NA online.

Proving a negative is difficult, but has anyone tried to find health care worker occupational bloodborne syphilis exposure/conversions? For HIV, the conversion rate is <1%; if it's similar for syphilis, and no one has looked, it would be easy to miss.

One person "did a literature search on this subject about two years ago. Going back 50 years there are no reported transmissions even in blood transfusions. It may be worth repeating the search."

I couldn't find anything, but Dave W did (thanks, Dave):

Infez Med. 2007 Sep;15(3):187-90.

Clinical case of seroconversion for syphilis following a needlestick injury: why not take a prophylaxis?

Franco A, Aprea L, Dell'Isola C, Faella FS, Felaco FM, Manzillo E, Martucci F, Pizzella T, Sansone M, Simioli F, Simioli S, Izzo CM.

Infectious Diseases Hospital D. Cotugno, Naples, Italy.

A 47-year-old woman was pricked accidentally with a needle previously used for a neurosyphilitic man. At day 0 she had no positive laboratory results for the infection, while the source, at day 1, had TPHA positive, but no post-exposure prophylaxis (PEP) against syphilis was prescribed. The subject missed the day 30 follow-up, and underwent our visit at day 90, when she showed no clinical signs, but she seroconverted (VDRL = positive 1/2; TPHA = positive 1/320; FTA-Abs IgG and IgM = present). She started antibiotic therapy, and currently her serological status is VDRL = positive 1/2, TPHA = positive 1/160, FTA-Abs IgM = negative.

So it seems that syphilis CAN be transmitted by needlestick, but the population prevalence is low enough that it's not included in published protocols.

A lot of you who responded are doing RPRs as part of post-exposure monitoring anyway. Until/unless someone does a risk/benefit analysis I think you can go either way, and it would be easy to justify monitoring in some healthcare settings.

Thanks to all who responded.

Daniel J. Brustein, MD, FACOEM

US Dept of Veterans Affairs

Louis Stokes Cleveland

10701 East Blvd

Cleveland, OH 44106

(216) 791-3800 X4445