Hi Jakub, no we do not routinely test source patients for syphilis. While tertiary syphilis could be transmissible through a BBF exposure, not all stages would be considered a blood borne infection. Testing asymptomatic patients would then require clinical evaluation of each positive result to determine if this was an old, resolve or treated infection, primary syphilis, etc. So not as simple as an HIV, HBV or HCV antigen test for communicability as a BBP.

I’ve given PEP for a needle stick from a patient with tertiary syphilis, but the diagnosis was already made clinically by the source patient’s care team.

Melanie

From: MCOH-EH <mcoh-eh-bounces@mylist.net> on behalf of Jakub Furmaga via MCOH-EH <mcoh-eh@mylist.net>
Sent: Tuesday, October 24, 2023 10:24:27 AM
To: mcoh-eh@mylist.net <mcoh-eh@mylist.net>
Cc: Jakub Furmaga <jfurmaga@me.com>
Subject: [EXTERNAL] [MCOH-EH] Syphilis testing for BBF

I work in a hospital system, and recently, I started getting asked for syphilis testing for blood and body fluid (BBF) exposures. Our current panel consists of HIV, Hepatitis B, and Hepatitis C testing, which is in line with the CDC recommendations: https://www.cdc.gov/nhsn/pdfs/hps-manual/exposure/3-hps-exposure-options.pdf

CDC (https://www.cdc.gov/sharpssafety/resources.html) acknowledges that there are over 20 pathogens that have been reported as being transmitted via BBF, but we obviously can’t test for all of them every time there is an exposure. I know the news is reporting that syphilis is on the rise, which is likely why we are now getting these requests. There are cases in the literature of healthcare providers getting syphilis seroconversion from a sharps injury, but it is unclear how often this happens. I wanted to ask the group if anyone is routinely testing for syphilis as part of their BBF protocol.

Jakub Furmaga, MD

Medical Director of Occupational Health

UT Southwestern