Acquired Syphilis in a Family Cluster Without Evidence of Sexual Transmission

Pediatric patients may acquire syphilis through nonsexual transmission as a result of close and repetitive contact with lesions of individuals with active syphilis. We chronologically describe the evaluation of a family cluster in which several members acquired syphilis without evidence of sexual transmission. Clinical evaluation and psychosocial assessment of the index case, sibling, and family group showed no evidence of sexual abuse. The children's mother, who had negative serologic tests for syphilis during hospitalization, developed clinical signs of secondary syphilis 48 days after the diagnosis of the index case, with seroconversion in both treponemal and nontreponemal tests. We emphasize that in any minor diagnosed with syphilis, sexual abuse must always be ruled out. If no family behaviors suggest such a route, alternative modes of transmission should be considered.