*Purpose: Syphilis is a sexually transmitted infection that affects people worldwide. While transmission generally occurs via sexual contact, other modes of transmission are possible, including solid organ transplantation (SOT). There are case reports of transplant recipients who have received grafts from donors with active syphilis infection. The objective of this study was to determine the rate of syphilis transmission from rapid plasma reagin (RPR) positive SOT donors to recipients at a large volume transplant center.

*Methods: A single center, retrospective review of all SOT patients between January 1, 2008 and October 1, 2018 was performed to identify patients whose donors had positive RPR testing. Demographic data, RPR testing, treponemal confirmatory testing, and syphilis treatment in both donors and recipients was collected.

*Results: A total of 28 patients received organs from RPR-positive donors. Treponemal confirmatory testing was positive in 8 donors (29%), negative in 10 donors (36.5%), and not documented in 10 donors (36.5%). Three recipients of treponemal-positive organs were not tested for syphilis post-transplant. RPR was tested in the remaining 5 recipients, and 1 patient was RPR-positive. Transmission was confirmed with treponemal testing. (Figure 1).

Antibiotic treatment varied among both donors and recipients (Table 1). Fifteen donors received treatment with penicillin G potassium, either alone or in combination with a number of other agents. Other antibiotics included cefazolin, piperacillin-tazobactam, and azithromycin. Two donors with positive treponemal testing received appropriate antibiotic treatment for syphilis. Thirty-two percent of recipients (n=9) were treated with penicillin G potassium. Of the 8 recipients whose donors had positive treponemal testing, 4 received appropriate antibiotic therapy, including the patient with confirmed transmission. This patient received 3 doses of penicillin G potassium. The remaining recipients did not have documented treatment.

*Conclusions: Documented syphilis transmission occurred in 1 patient. Inconsistencies in post-transplant testing as well as antibiotic dose, duration, and choice of agent in both donors and recipients highlight the need for further investigation and standardization in this population.

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