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April 1996

Professional Syphilis

Arch Dermatol. 1996;132(4):474. doi:10.1001/archderm.1996.03890280144025

Without further discussing this aspect of the question, it may be said that chancres of the fingers possess a peculiar interest for physicians, who from their occupation are most exposed to contract syphilis through this medium. While medical men can not claim an exclusive monopoly of digital chancres, yet they are immeasurably more common among accoucheurs and surgeons. In Fournier's statistics of forty-nine cases, thirty occurred in physicians. [Occupational HIV (human immunodeficiency virus): As of July 1995,46 health care workers—six of whom were physicians—had been 'nfected by HIV through occupational exposure.1] These facts emphasize the following points:

  1. The Personal Risks of the Physician.—Medical men, especially those engaged in obstetrical and surgical work, can not be too strongly impressed with a recognition of the risks incurred.... Forewarned is forearmed, and the recognition of the danger would lead to greater care in the protection of the fingers, and greater circumspection, not only in the examination of known syphilitics, but of patients of whose history and antecedents nothing is known. [There is no substitute for universal precautions. Studies have refuted the idea that knowing a patient's HIV status increases health care workers' diligence or reduces their risk of infection.2]

  1. The Risk to Others.—The important fact must not be lost sight of that the dangers of professional syphilis are not purely personal; they are not to be measured alone by the risks of contagion to the patient's family and intimates. A digital chancre involves serious danger to those with whom its bearer comes into professional relations.... I might refer to the historical epidemic of St. Euphémie, originating from a chancre on the finger of a midwife, where fifty women were the immediate victims; to the epidemic of Brives (1874), reported by Bardinet, when thirty-one cases of syphilis, with four deaths, were traced to a midwifery chancre, etc. [There has so far been only one known instance of a health care provider transmitting HIV to patients. Six patients of a dentist with AIDS (acquired immunodeficiency syndrome) were infected by him with HIV. The mode of transmission has never been determined.3]

These facts suggest an ethical question of great practical importance, viz., whether a physician is justified in continuing his professional work while he bears upon his hands such an active source of contagion. ... The fact that he can ill afford to give up his work during this long period does not affect the moral aspect of the question. [Guidelines issued by the Centers for Disease Control and Prevention recommend that medical organizations identify "exposureprone" invasive procedures; that physicians who do such procedures determine whether they are infected with HIV; and that physicians infected with HIV not do exposure-prone procedures without the explicit permission of local authorities.4]

J Cutan Genito-Urin Dis.

April 1896;14:125-140.

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