Direct sexual contact is the primary mode of acquisition, though syphilis can also be passed by close contact with an active lesion, as well as congenitally. The risk of disease spread with sexual intercourse is greatest in the early stages, particularly when the primary lesion, or chancre, is present. Risk of sexual transmission remains high when manifestations of secondary syphilis are present, but as it progresses to latent syphilis, the risk of sexual transmission is thought to be nearly resolved as long as the host is immunologically intact (7). While transmission to the anogenital region is most common, any contact with an active lesion, especially with a primary chancre, can transmit the organism through small breaches in the epithelial surface. Oropharyngeal mucosa involvement is therefore noted with some frequency. Congenital syphilis is typically seen with fetal infection in utero upon T. pallidum crossing the placental barrier. However, infection can also occur during passage through the birth canal. Transmission is most likely when the mother is in early stages of syphilis; nonetheless, there remains potential for fetal infection even in latent syphilis. Blood-borne transmission via transfusion or needle-stick is theoretically possible, though exceptionally rare.
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