[Question #5919] Syphilis Transmission

18 months ago
Hi Dr Handsfield, thank you so much for taking the time to read my question. So I’m very confused, there seems to be a lot of conflicting info with Syphilis and how it’s transmitted. My Dr always said you get it from sex and that if you didn’t have any symptoms you didn’t require testing. Unfortunately I had to go google searching, and I see scary information, like chancres can appear anywhere on the body, and contact can transmit it, so can a chancre appear anywhere? Can I get syphilis from a handshake, a hug, a massage? A chancre can appear on the hand? This is giving me a lot of anxiety, I’ve seen pics of supposed chancres on the face, the stomach. A CDC brochure shows that syphilis can be transmitted in non penetrative foreplay? Any clarification would be much appreciated. Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
18 months ago
Welcome to our Forum and thanks for your question.  On this occasion I will be answering your question.  FYI, Dr. Handsfield and I share the forum and have worked together for over 35 years and while our verbal styles differ, we always agree on the facts and recommendations provided.  By chance I happened to pick up your question to day.

Syphilis is a bacterial infection that is transmitted through DIRECT contact with an infectious syphilis lesion (often an ulcerative lesion called a chancre).  Contact with a chancre leads to a new lesion, the first sign of infection, at the site of contact.  Since sex can involve contact with lots of different body parts, syphilis lesions can occur lots of different places however about 98% of initial syphilis lesions occur at the genital tract or rectum which are the most common sites of sexual contact and have skin that is particularly vulnerable to infection (not all skin is equally vulnerable to infection- for instance, it is very, very unusual to get a primary syphilis lesion on the skin of the hands).  

The infection typically starts with the sort of sore (the chancre mentioned above) that I suspect you have seen pictures of.  These sores are often noticed but if unnoticed they can resolve without treatment.  Thus while your doctor is correct that most people with syphilis will have signs or symptoms, the infection can be missed and then would only be detected with a blood test.

Syphilis is a relatively uncommon disease.  This year only about 30,000 new cases of syphilis will occur in the U.S. population of well over 300,000,000 people.  At the present time 60-70% of all syphilis is occurring among men who have sex with other men.

I hope this information is helpful to you.  You would not be at risk for syphilis from the contacts that occur during your activities of daily living, i.e. through touching, shaking hands, hugging etc.  I would be cautious about seeking information on the internet- much of what is there is overstated, taken out of context, out of date or just plain wrong.  EWH  
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18 months ago
Thank you Dr. Hook, that does offer some comfort. I guess what had me most worried was all the conflicting info and that it may be easier to get than I had thought. It makes sense that a lot of it was overstated but it still worried me. Like that online brochure from the CDC, I figured they had credible info, I wish I had never looked that stuff up. Also I had always thought chancres could only appear on just genitals or anus or mouth, never thought they could be anywhere else. As a follow up, you said it’s very unusual for a chancre to appear on the hand, I saw a picture of what appeared to be chancres on the face, and one on the chest, so while rare I guess it happens. My question is would the initial chancre still appear on the genitals, mouth, anus, and then others appear on the chest, face hypothetically? Or could the penis come in contact with a sore and then the chancre appears on the chest face, or I saw one on the back of the neck? That seems weird. I know I’m being technical but it just freaked me out so I wanna ask. Or transmission by deep kissing is a possibility? Thank you so much! 
Edward W. Hook M.D.
Edward W. Hook M.D.
18 months ago
Syphilis is really not all that easy to transmit- the contact must be direct and even then most contact does not lead to transmission.  The reason that the genitals are rather easily infected is that the skin is thin and through sexual activity, there is gentle abrasion which helps to "work the bacteria into the skin".  Pictures of that sort are certainly scary but they are a rarity.  Chancres are also typically solitary (there are later, secondary stages of syphilis in which persons may have multiple lesions) and do not spread from place to place on the body.

My sense is that you are worrying more than you need to.  If you truly have good reason to worry about syphilis, a blood test will tell if you are infected.  personally, from the little you have mentioned, I doubt it.  EWH
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18 months ago
Thank you Dr. Hook, you have eased some of my tension. I do realize those pics are a rarity, but they still kinda bother me, I don’t know why they just do. I guess as my final follow up I’m just curious as to how a chancre would pop up on the neck or face? I assume the first one would be on genitalia or mouth, you said they’re typically solitary but in cases with more than one? Also contracting it from deep kissing or cunnilingus? Is kissing even possible, and for cunnilingus, I assume that’s rare but it must be possible. Thank you for your time. 
Edward W. Hook M.D.
Edward W. Hook M.D.
18 months ago
It is a shame that people choose to put particularly gruesome or misleading photos on line.  Please try not to be mislead.

A chance would occur on the face or neck after direct contact with a partner's infectious lesion (i.e. chancre).  Remember, during sexual activity one partner's genitals (and hence if they have a chancre, their chancre) can touch any of those sites.   

When they occur on the genitals about 15% of chancres present as two lesions -typically they occur close to one another, not spread distantly on the body.

Contraction of syphilis from kissing or cunnilingus is virtually unheard of- your partner would have to have a chancre that you then contacted during oral sex.  

Hope these final replies are helpful. As you know, with this third reply, there will be no further replies and the thread will be closed shortly.  Take care, please don't worry. EWH
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