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. 177). Yaws, pinta, and endemic syphilis (bejel) 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. Our “knowledge” about these infections is based on observations by health care workers who have visited endemic areas. Except for recent pilot programs of mass drug administration (MDA) for yaws, 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 178-1.
TABLE 178-1Comparison of the Treponemes and Associated Diseases |Favorite Table|Download (.pdf) TABLE 178-1 Comparison 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 ||Cutaneous rash and mucocutaneous lesions; condylomata lata ||Cutaneous papillomatous or ulcerative 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 |
Generally, yaws flourishes in moist tropical areas (Fig. 178-1); endemic syphilis has been found primarily in arid climates of West Africa and the Middle East; and pinta has been found in temperate foci in the Americas. Because no recent data are available for bejel and pinta, the extent of these infections today is unknown. The endemic treponematoses are usually limited to rural areas of developing nations and are seen in developed countries only among recent immigrants from endemic regions.
In a World Health Organization (WHO)–sponsored mass eradication campaign from 1952 to 1969, >160 million people in Africa, Asia, and South America were examined for treponemal infections, and >50 million cases, contacts, and persons ...