The endemic treponematoses are chronic diseases that are transmitted by direct contact, usually during childhood, and, like syphilis, can cause severe late manifestations years after initial infection. These diseases are caused by very close relatives of Treponema pallidum subspecies pallidum, the etiologic agent of venereal syphilis (Chap. 206). Yaws, pinta, and endemic syphilis are traditionally distinguished from venereal syphilis by mode of transmission, age of acquisition, geographic distribution, and clinical features; however, there is some overlap for each of these factors. Generally, yaws flourishes in moist tropical areas of several regions, endemic syphilis is found primarily in arid climates, and pinta is found in temperate foci in the Americas (Fig. 207e-1). These infections are usually limited to rural areas of developing nations and are seen in developed countries only among recent immigrants from endemic regions. Our “knowledge” about the endemic treponematoses is based on observations by health care workers who have visited endemic areas; virtually no well-designed studies of the natural history, diagnosis, or treatment of these infections have been conducted. The treponemal infections are compared and contrasted in Table 207e-1.
TABLE 207e-1Comparison of the Treponemes and Associated Diseases |Favorite Table|Download (.pdf) TABLE 207e-1Comparison of the Treponemes and Associated Diseases
|Feature ||Venereal Syphilis ||Yaws ||Endemic Syphilis ||Pinta |
|Organism ||T. pallidum subsp. pallidum ||T. pallidum subsp. pertenue ||T. pallidum subsp. endemicum ||T. carateum |
|Common modes of transmission ||Sexual, transplacental ||Skin-to-skin ||Mouth-to-mouth or via shared drinking/eating utensils ||Skin-to-skin |
|Usual age of acquisition ||Sexual maturity or in utero ||Early childhood ||Early childhood ||Late childhood |
|Primary lesion ||Cutaneous ulcer (chancre) ||Papilloma, often ulcerative ||Mucosal papule, rarely seen ||Nonulcerating papule with satellites, pruritic |
|Common location ||Genital, oral, anal ||Extremities ||Oral ||Extremities, face |
|Secondary lesions ||Mucocutaneous lesions; condylomata lata ||Cutaneous papulosquamous lesions; condylomata lata, osteoperiostitis ||Mucocutaneous lesions (mucous patch, split papule, condylomata lata); osteoperiostitis ||Pintides, pigmented, pruritic |
|Infectious relapses ||~25% ||Common ||Unknown ||Unknown |
|Late complications ||Gummas, cardiovascular and central nervous system involvementa ||Destructive gummas of skin, bone, cartilage ||Destructive gummas of skin, bone, cartilage ||Nondestructive, dyschromic, achromic macules |
In a World Health Organization (WHO)–sponsored mass eradication campaign from 1952 to 1969, more than 160 million people in Africa, Asia, and South America were examined for treponemal infections, and more than 50 million cases, contacts, and persons with latent infections were treated. This campaign reduced the prevalence of active yaws from >20% to <1% in many areas. In recent decades, lack of focused surveillance and diversion of resources have resulted in documented resurgence of these infections in some regions. The most recent WHO global estimate (1995) suggested that there are 460,000 new cases per year (mostly yaws) and a prevalence of 2.5 million infected persons; during subsequent years, an increased incidence was documented in some countries. Recent areas of resurgent yaws morbidity include West Africa (Ivory Coast, Ghana, Togo, Benin), the Central African Republic, Nigeria, and rural Democratic Republic of the Congo. The prevalence of endemic syphilis is estimated to be >10% in some regions of northern Ghana, Mali, Niger, Burkina Faso, and Senegal. In Asia and the Pacific Islands, reports suggest active outbreaks ...