[Question #7992] syphilis questions

50 months ago

Hi, Dr. Handsfield and Hook, long term fan and you have both done a tremendous job to help evaluate the risk and alleviate the anxiety.

have a few questions I don’t seem to find a definitive answer by reading the forum:

If direct contact of syphilitic chancre from primary stage is how syphilis is transmitted, when chancre/open sore is healed in secondary stage, why a person could still be contagious in second stage? How syphilis is still transmitted in secondary stage?
Would skin rash occur in 100% of syphilis cases? How contagious these rash from secondary stage be? What is the risk by touch these rashes? Can you get syphilis through body-to-body contact or sleeping next to someone with a rash? How about wresting, playing team sports or give a massage to a person with syphilis rash? Could syphilis transmit through sharing bed sheets, towels or clothes?
Is it fair to say the risk of syphilis transmission through syphilis is primarily when primary chancre presents in mouth and/or lips? If a person gets syphilis through anus, would kissing still pose the same risk? Kissing on the lips should have much lower risk than French kiss, right?

Thank you so much for taking the time to address my concerns. Your answers are always based on science and decades of experience. I am really looking forward to it!

Thanks,

Edward W. Hook M.D.

50 months ago

Welcome to our forum. Thanks for your questions. I’ll do my best to answer them. As you know, Syphilis evolves through a series of clinical stages. In primary syphilis there is typically a lesion called a chancre present at the site of inoculation of the infection. Chancres may occur on the genitalia, within the vagina in women, and within the rectum in persons participating in receptive rectal intercourse. Syphilitic chancres are painless and, as a result, chancres in the rectum or deep within the vagina are particularly likely to be missed. The chancre is highly infectious and the majority of Syphilis transmission occurs as a result of direct contact with the syphilitic chancre.

Secondary syphilis occurs in untreated persons when the syphilis bacteria spread throughout the body in the blood to cause a wide variety of clinical signs and symptoms. The classical lesions of secondary Syphilis are a skin rash but there are many other sorts of secondary Syphilis lesions. Further, some lesions of a secondary syphilis presentation/rash are dry and less transmissible while others are moist and readily transmissible if direct contact occurs. By and large however there is less transmission of Syphilis in the secondary stage than in person with the primary stage.

With Syphilis. Therefore, Syphilis cannot be contracted through contact with contaminated bedsheets or other inanimate objects. Despite the widespread nature of the infection, if lesions are not present and directly contacted Syphilis is not transmissible. It is for this reason that kissing of any sort in the absence of a syphilitic lesion does not result in Syphilis transmission. While the dry skin rash lesions of syphilis are theoretically transmissible, the fact is that they are far less transmissible than wet, moist lesions.

While not presented in precisely the order of your questions, I believe the explanation above addresses your questions. If any part of this is unclear please feel free to use your up to two follow-up questions for clarification. If you do this please make your follow-up questions as specific as possible. EWH

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