Sounding more like a troublesome consequence of prostitution, ‘occupational syphilis’ has been recorded in a recent report from the US.

Previous reports have described many cases of occupational syphilis in healthcare personnel but these have occurred but virtually all such reports were published before 1950. In those reports, contact with a mucosal lesion was the most frequent route of transmission and sharps injury was not mentioned.

Education and prevention have made occurrences of occupational syphilis exceedingly rare since hygiene precautions are far better and the case incidence of syphilis is now much lower, decreasing the possibility of exposure.

A review of the literature found only 1 report of transmission of syphilis through sharps injury. That report, however, did not involve a healthcare worker but a family caregiver who stuck herself with a needle used to treat her uncle who had neurosyphilis.

Now, in the US report, a surgeon cut his finger with a scalpel blade used to incise a suspicious lesion on the lip of an HIV positive male homosexual. Follow-up of patient and surgeon confirmed that the lesion on the patient’s lip was syphilitic, and a lesion developing at the site of injury on the surgeon’s finger was also syphilitic. Both patients responded well to a large dose of penicillin.

Sharps injury can results from a needle, scalpel blade or any other sharp item that can break the skin. Similar transmissions can occur following ‘soft’ contamination of already broken skin surfaces or following splash exposure to the mouth or eyes.

There is an increasing tendency to downplay the likelihood of infection following sharps injury. Fortunately, bloodborne virus transmission among ancillary staff and waste handlers is extremely low and no cases of bloodborne virus transmission have been reported. However, recognition is uncertain and some cases may have occurred without proper documentation or linkage to a specific waste-related transmission event.

Bloodborne virus transmission, of HIV, Hepatitis B and Hepatitis C are the obvious concerns but other infections can occur. Most are uncommon, possibly rare, and many have been seen only after some laboratory ‘accident’. Nonetheless, those accidents could occur through the wall of a plastic waste sack, or from items spilling from an unsealed or damaged sharps bin.

Other more common infections may be those typical of minor cuts and abrasions becoming septic. Trivial and short lasting, these infections which occur most commonly on fingers, hands and forearms are of little consequence but can be serious and I have one case of records of a waste handler requiring hugely disfiguring surgery to his lower arm, wrist and hand to save the limb after what was initially a minor graze resulting days later in limb- and life-threatening sepsis.

see Raguse JD, Camerer C, Bergmann F, Schewe C, Schürmann D. Occupational Syphilis Following Scalpel Injury. Ann Intern Med 2012 156:5-476