What precautions should be taken when examining a patient with syphilis?

Precautions for Healthcare Providers When Examining Patients with Syphilis

Standard precautions are sufficient when examining patients with syphilis, as the disease is primarily transmitted through direct contact with infectious lesions during sexual activity or transplacentally during pregnancy, not through casual contact in healthcare settings. 1, 2

Understanding Transmission Risk

• Syphilis is caused by the spirochete bacterium Treponema pallidum, which is primarily transmitted through direct contact with infectious lesions during sexual activity 1
• The primary and secondary stages are the most infectious periods, characterized by the presence of mucocutaneous lesions 2
• Transmission occurs through contact with infectious lesions during vaginal, anal, or oral sex, or via the placenta during pregnancy 1

Recommended Precautions

Standard Precautions

• Use gloves when examining any patient with suspected or confirmed syphilis, especially when examining lesions or handling potentially infectious materials 3
• Perform thorough hand hygiene before and after patient contact, even when gloves are worn 3
• Use personal protective equipment (PPE) appropriate to the examination being performed:
  • Gloves for touching potentially infectious materials
  • Gowns if clothing might be contaminated
  • Face protection (mask and eye protection) if there is risk of splash or spray 3

Specific Examination Considerations

• When examining primary or secondary syphilis lesions, always wear gloves as these lesions are highly infectious 3, 4
• Take particular care when examining oral, genital, or perianal lesions, which may contain high concentrations of treponemes 3
• For darkfield microscopy of lesion material, handle specimens carefully to avoid self-inoculation 3

Special Situations

Pregnant Patients

• Exercise additional caution when examining pregnant patients with syphilis due to the risk of congenital transmission 3
• Ensure proper documentation of maternal treatment to guide management of the newborn 3

HIV Co-infection

• Be aware that patients with HIV co-infection may present with more severe or atypical manifestations of syphilis 5
• Consider the possibility of neurosyphilis in HIV-infected patients, which may require additional precautions during lumbar puncture if performed 3

Common Pitfalls to Avoid

• Failing to recognize that primary and secondary syphilis lesions are highly infectious and require appropriate barrier precautions 4
• Neglecting to test sexual partners of patients diagnosed with syphilis, who should be treated presumptively if exposed within 90 days prior to diagnosis 4
• Overlooking the need for HIV testing in all patients diagnosed with syphilis due to the high rate of co-infection 6
• Underestimating the importance of follow-up serological testing to ensure adequate treatment response 6

Post-Exposure Management

• In case of accidental exposure to potentially infectious material, wash the exposed area immediately with soap and water 3
• Document the exposure and follow institutional protocols for post-exposure management 3
• Remember that the risk of occupational transmission of syphilis is extremely low when standard precautions are followed 3

By following these precautions, healthcare providers can safely examine and treat patients with syphilis while minimizing any risk of transmission in the healthcare setting.