Occupational Syphilis

In true “infectious disease – nerd” fashion, I am overly excited about an article I’m reading. It is très cool, though maybe not for the sufferers. The March 20th, 2012 issue of Annals of Internal Medicine published a letter on Occupational Syphilis following Scalpel Injury. It immediately caught my eye as syphilis is not one of the infections we get concerned with typically when a healthcare worker has a needle-stick or other serious blood or body fluid exposure.

The letter tells the story of a oromaxillofacial surgeon who back in 2009 incised a small painless papular lesion on a patient’s upper lip and found no purulence. When disposing of the scalpel, the surgeon stuck himself in the right middle finger and drew blood. Standard bloodborne pathogen exposure protocol was initiated. The patient was found to be HIV positive and the surgeon did take post-exposure prophylaxis and remained seronegative.

However, 2 weeks after the incident, the surgeon developed a small painless ulcer at the site of the scalpel injury which refused to go away. When the patient returned 6 weeks after the first visit, he had an ulcerating lesion where the papule had been on the upper lip. Biopsy and additional testing proved it to be a syphilitic chancre. The surgeon’s middle finger lesion was later biopsied and tested and proved to be a syphilitic chancre. Both patient and surgeon were then successfully treated for primary syphilis.

I mean, seriously, how cool a case is that? Yes, I’m very well aware that it probably wasn’t cool for the surgeon and not cool for the patient either, but hey, he got diagnosed with HIV and in my book it’s best to know sooner than later so that proper therapy can be initiated and life-style modifications can be made so as not to infect other people.

All excitement aside, this case raises my awareness of the possibility of occupational transmission of syphilis given the right clinical scenario.