*Purpose: Sexually transmitted infections among solid organ transplant (SOT) recipients are understudied. We aim to analyze rates of syphilis testing and describe clinical manifestations of syphilis in liver and kidney recipients.

*Methods: Data were sourced from the University of California, San Francisco Transplant Outcomes in Anesthesia Database, which unifies electronic medical records, a manually curated registry, and national registry level data for 1,460 liver recipients and 3,072 kidney recipients. Recipients with syphilis testing were identified. Syphilis testing was defined as the following tests: serum rapid plasma reagin (RPR), serum treponemal antibody, venereal disease research laboratory (VDRL), and fluorescent treponemal antibody absorption test (FTA-Abs). Descriptive statistics were calculated, and manual chart review was performed to determine clinical presentations.

*Results: From 2001-2021, syphilis testing occurred in 84.9% (n=3,847) of liver or kidney transplant recipients. Median age was 51 years (range 1-87), 34% were Caucasian, and 31% identified as Hispanic. 83.8% (n=3,796, 97.5% of kidney recipients, 61.9% of liver recipients) were tested pre-transplant and 17.7% (n=804) were tested post-transplant. In total, 9,234 syphilis tests were performed (7,806 kidney recipients, 1,428 liver recipients).

21 patients had detectable RPR titers post-transplant. Of these, 12 patients were serofast after previously treated syphilis, 2 patients were treated preoperatively, and 1 test was a false-positive. 6 cases were new diagnosis of syphilis after transplantation (0.13% of patients in database), classified as follows: 1 primary, 4 secondary, 1 early latent. 66% (n=4) of syphilis cases post-transplant were HIV+. 33% (n=2) had neurosyphilis. One patient with neurosyphilis had delayed time to treatment, given concerns for other etiologies. Another renal recipient notably failed prior neurosyphilis treatment, prompting a second course of intravenous penicillin.

*Conclusions: We illustrate the frequency and presentation of syphilis after kidney or liver transplantation over 20 years at our institution. Notably, not all patients received syphilis screening prior to transplantation, and SOT recipients may have higher rates of neurosyphilis. Limitations include small sample size of positive syphilis cases, and potential for missing data due to testing outside of our center.

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