Introduction
Endemic syphilis is an infectious disease that is common in some regions of the world but uncommon in the United States. The infection resembles syphilis greatly but is not spread sexually. The most typical methods of transmission include non-sexual skin-to-skin contact and routine use of eating and drinking utensils. Endemic syphilis is caused by a bacterium called Treponema, which is related to the bacteria that cause syphilis, pinta, and yaws. Spirochete-like bacteria called Treponemas have a spiral form. Endemic syphilis, also known as bejel, is characterized by skin and bone lesions that start in the mouth and advance gradually. The worst times occur in the later stages. Endemic syphilis is quite prevalent in hot, dry climates, particularly in the nations of the eastern Mediterranean and in Saharan West Africa.
What Are the Signs and Symptoms of Endemic Syphilis?
Endemic syphilis is regarded as a semi-mucosal condition. Endemic syphilis (in primary and secondary stages) is characterized by the early development of lesions. Primary lesions of the oral cavity can occasionally go unnoticed or manifest as tiny, painless ulcers. In the secondary stage, plaques and mucosal lesions are seen in the oropharynx and on the lips.
The most common secondary-stage endemic syphilis symptoms are mucosal eroding lesions and plaques in the lips and oropharynx, which can locally spread to the larynx (voice box) and cause hoarseness.
Mucosal lesions, papules at the oral commissures, and intertriginous condyloma lata (infectious lesions) are all symptoms that bejel and syphilis can both present with, and these symptoms should always be taken into consideration when making a diagnosis. It is more frequently observed in children under the age of 15 and is associated with dry, arid environments.
Lesions in the vaginal regions of patients as well as on the nipples of nursing women have also been documented. Although the transmission route has not been completely explained, it is usually believed that infections are spread through fomites or by direct contact with secretions from lesions.
Endemic syphilis can progress to a late-stage illness with gummatous lesions if it is not treated. Skin nodules that are gummatous might turn into infiltrating, abnormally pigmented lesions. Destruction-causing rhinopharyngitis (gangosa - ulcerative lesion) can result from gummata that affect the nasopharynx. Gummatous lesions in tertiary bejel may resemble signs of mycobacterial infection, cutaneous tuberculosis, leishmaniasis (a parasitic infection), or deep fungal infection. Despite the presence of plasmocytes, gumma cannot be identified clinically or histologically.
In contrast to venereal syphilis, tertiary endemic syphilis does not cause cardiovascular or neurological symptoms. Slow-moving osteoperiostitis (inflammation of the bone) causes bone deformation in the bejel region after diffuse cortical thickening. Long bones like the forearm, tibia, and fibula are the ones that are most frequently affected by this.
What Is the Epidemiology of Endemic Syphilis?
Typically, endemic syphilis is more prevalent in regions with a dry climate. The endemic syphilis Treponema loves moist body parts, including the lips, thus it spreads by direct or indirect contact. The epidemiology of endemic syphilis is poorly studied, with endemic reports coming from 22 countries in the Sahel and southern areas of Africa, as well as the Middle East.
Additionally, endemic syphilis from Mali, Pakistan, and the Republic of Senegal has been found in Canada and France. Additionally, Saudi Arabia, Iraq, and Syria have described it. Three endemic syphilis cases were reported in southeast Turkey in 1995, even though the disease was supposed to be extinct there. In 2012, there was also documentation of a case report from southwest Iran.
What Are the Causes of Endemic Syphilis?
Treponema pallidum endemicum, a spirochete with a spiral structure, is the culprit behind the uncommon infectious disease known as endemic syphilis. Under a microscope, Treponema pallidum, the bacterium that causes syphilis, and T. p. endemicum are almost identical. There is no sexual transmission of the illness.
What Are the Other Disorders That Have Similar Symptoms?
The following illnesses' symptoms can resemble those of bejel. A differential diagnosis may benefit from comparisons:
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Acquired Syphilis: The bacterium Treponema pallidum is a chronic infectious illness that causes acquired syphilis. Direct contact with an infected person, typically during sexual activity, is how HIV is spread. Syphilis symptoms (that is., the primary, secondary, and latent stages) worsen if untreated. Any organ or tissue in the body could eventually be impacted. Lesions (chancres) on the skin, anus, vagina, or the moist regions of the mouth are examples of early signs. For years, the symptoms might not manifest.
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Pinta: The bacteria Treponema Carateum, which causes the rare infectious tropical disease known as pinta and spreads through direct, nonsexual contact, is to blame. Pinta develops through three unique stages, each of which is distinguished by a different type of skin lesion and discoloration. None of the other organ systems are impacted. The face and extremities are the most frequently afflicted exposed skin parts.
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Yaws: The spirochete (spiral-shaped) bacteria Treponema pertenue is the infectious tropical disease of yaws. The illness manifests in three stages, the first and second of which are easily treatable. The third, though, can include intricate adjustments to the bones in numerous bodily regions. Small, painless bumps on the skin that cluster and enlarge until they resemble strawberries are the hallmark of the first stage. A skin ulcer could develop if the skin splits open. A crispy, crunchy rash that may cover the arms, legs, buttocks, and/or face first appears during the second stage, which often begins several weeks or months after the first. Walking becomes painful if the bottoms of the feet are affected, and this stage is referred to as "crab yaws." The long bones, joints, and/or skin are involved in stage 3 yaws. In contrast to the United States, tropical regions of the world have a high prevalence of yaws. This condition is not a sexually transmitted illness.
How Is Endemic Syphilis Diagnosed?
The patient's geographic history and laboratory testing of samples taken from the lesions (dark field examination) are both used to make the diagnosis of endemic syphilis. In a microscope, a Treponema is easily recognized as the offending bacterium. The VDRL and FTA-ABS (fluorescent treponemal antibody-absorption) tests performed on fluid samples taken from the lesions are successful. To distinguish between endemic syphilis and venereal syphilis, further history might be needed.
How Is Endemic Syphilis Treated?
The antibiotic Benzathine penicillin G is the recommended treatment for bejel. If someone has a penicillin allergy, they might be prescribed Doxycycline or Tetracycline. Patients should be examined two to four weeks after starting antibiotic therapy. The bejel lesions stop being contagious within 24 hours of treatment, and in most cases, the original and secondary lesions are fully healed in two to four weeks. Scarring, though, might last a lifetime.
Conclusion
Endemic syphilis, yaws, and pinta are three nonvenereal treponematoses that pose a serious health risk to many third-world nations. Mortality is unlikely unless the disease state is significantly exacerbated, either by a large inoculum or a catastrophic immune response, because the disease rarely exhibits clinically significant cardiovascular and neurologic signs. It is curable with penicillin or other antibiotics, leading to a full recovery.
