[Question #9603] syphilis transmission question

31 months ago

Dear all, I was diagnosed with syphilis in November 2022.

It all started in June 2022. Then the proctologist diagnosed me with an anal fissure, which, according to my infectious disease specialist after my positive test in November was apparently a primary chancre. At the end of July, I developed a rash on my palms that quickly became scaly and looked like a wart, so I treated them with a chiro therapy kit bought at a pharmacy. Of course, the rash did not go away. I went for an HIV/syphilis test in November and it turned out positive for syphilis. The rash on the palms was not critical. Several lesions on both palms. I got rid of syphilis, but my fear that I could have transmitted syphilis to my friends' children or any person in my life by holding hands did not. First of all, it is written on various medical websites that a person can become infected if he touches the primary sore or rash of an infected person with any part of his body. Before I wanted to bother you with this question, I read a lot of answers from doctors on other pages, including from Dr. Handsfield, who writes on other pages that the infection cannot be transmitted to another person through lesions (rashes) on the palm by touch. Yesterday, on these pages, I read Dr. Handsfield's response to another patient, where he mentions sore and rashes as an infectious lesions.(old question)

So my question is whether I am exaggerating about the transmission of syphilis through lesions on the palms. When I think with common sense, if an infection had occurred, the primary sore would have been on the palms or in a visible place and would not have gone unnoticed for several weeks.

H. Hunter Handsfield, MD

31 months ago

Welcome to the forum. Thank you for your confidence in our services, and for reviewing other discussions with questions similar to your own.

I'm glad your syphilis eventually was correctly diagnosed and, presumably, treated. (You don't mention what treatment you were given. Probably a single injection of benzathine (long acting) penicillin, right?)

It would seem you have misunderstood what you found in your web searching, including some things on this forum. It is true that some skin sores and lesions caused by syphilis and other STDs are infectious, i.e. potential sources of transmission. But this does not mean that all syphilis skin rashes and lesions are sources of transmission or that any and all skin contact is risky. The large majority of skin lesions are not infectious by any kind of contact, and skin contact other than sexual is zero risk. Someone with some types of genital or anal area skin lesions of syphilis -- only open sores or other moist lesions -- can transmit the infection when they have sex. Hand shaking, non-sexual kissing (e.g. with family members), and other personal contact is never risky. Contaminated toilets, kitchen utensil, towels, and clothing also do not transmit syphilis. No household members or family members of persons with syphilis ever become infected unless they have sex with the infected person. (The statement you quote from me -- that sores and rashes are infectious -- must have been related only to sexual exposure, not otherwise.) All this applies equally to other STDs that involve the skin, such as HPV and herpes.

Also, assuming you were properly treated, you were non-infectious for partners -- even through sex -- within 24 hours of your penicillin injection.

Those comments pretty well answer your main question, but to be explicit: Yes, you are seriously exaggerating the risk of transmission. The rash on your palms was never a risk to anyone, no matter what sort of contact you had with them. Your anal fissure was the only possible source of infecting another person (assuming you had no other open sores). And that would have required sexual contact with the fissure.

So all is well; no worries at all. At this point, all you need do is follow the instructions you received about follow-up. Normally that would include blood tests 6 months and a year after treatment (and sometimes around 3 months as well). I would be happy to address these aspects if you have any questions about it. In the meantime, I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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31 months ago

Dear doctor, thank you for your quick and very comprehensive answer. I appreciate such answers. I went too far with searching the internet and reading various studies (for example, about Chinese patients - children’s who got syphilis from their family members through non-sexual contact).

As for me, I was treated with a single dose of long-acting penicillin. I also did not mention that during the test for HIV/SYPHILIS and hepatitis, a swab of my anus/rectum was also done and after 2 weeks it came back positive for chlamydia, so I took antibiotics for it for 8 days. In 2 weeks, it will be 2 months since the penicillin injection, so I'm going to visit a doctor for a follow-up for syphilis and chlamydia.

I'm interested in something else. The young man I had sex with without a condom ejaculated in me. Was his sperm possibly the medium of transmission of the infection? because I don't think I saw any open lesions on the penis.

H. Hunter Handsfield, MD

31 months ago

Thanks for the additional details. Your syphilis has been managed by the book, i.e. consistent with almost all authoritative guidelines.

You raise an interesting issue, i.e. exceptions to sexual transmission of STD. For example, some culture-specific nonsexual intimate behaviors and contacts can transmit syphilis and other STDs. I can't speak to particular populations in China, but there are cultures where intimately shared food can transmit STDs, like a parent partly chewing food before feeding it to an infant or an infirm elderly parent. Many years ago there was a report of gonorrhea in several family members' eyes because urine was used as eyewash. Gonorrhea has been acquired by laboratory accidents that exposed the eyes or mouth to gonorrhea bacteria. Nursing mothers with syphilis can transmit it to their babies. Sometimes very young children in intimately crowded settings have transmitted STDs, like several toddlers or infants sharing the same bed. The rare STD chancroid can be transmitted as a non-STD skin condition in children in tropical climates. You will understand that all these are unusual situations; they do not change my advice in my initial reply.

Your partner's semen likely is the source of your chlamydia, but not syphilis. Many persons with syphilis have moist genital lesions that are not easily visible to the untrained eye. Except for you natural curiosity, the exact lesion or source of your syphilis doesn't really matter.

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31 months ago

Dear doctor, thank you.

You certainly put my mind at ease. In addition to everything I read, the fact that I treated those lesions on my palms with a nipple freezer (a temperature of -50 ° is reached) made me even more worried, although of course no wounds were created from this procedure.

Now, out of curiosity, I am again interested in the case of toddlers sharing a bed. Did they also get infected through the syphilitic chancre? This was my last question.

Thank you very much, doctor

H. Hunter Handsfield, MD

31 months ago

My comment about toddlers sharing beds does not specify syphilis. I'm aware of a case for which this was a possible explanation for gonorrhea. In the distant past (100 years or more) there were beliefs that young kids in orphanages might be infected with gonorrhea or syphilis in this manner, but of course today we better understand the potential (and perhaps higher likelihood) of sexual abuse by infected adults. The exact mechanisms by which such infections might be transmitted, if at all, are not known.

That concludes this thread. Thanks for the thanks; I'm glad to have been of help. Best wishes and stay safe.

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