– Endemic treponematoses are bacterial infections caused by 3 different types of treponema (other than Treponema pallidum). Human-to-human transmission may be direct or indirect.
– The 3 endemic treponematoses result in positive syphilis serology (TPHA-VDRL), but these tests are not necessary as diagnosis is clinical. There is no laboratory test that can distinguish between the different treponematoses.
– For the diagnosis and treatment of syphilis, see Genital infections, Chapter 9.
Treponema pallidum type M
Tropical and humid forests
Tropical zones of Latin America
Arid areas, semi-desert of the Middle East and Africa
Children between 4 and 14 years
Children and adults
Nomadic populations, particularly children
Yaws chancre: skin coloured lesion, non- indurated, itchy, on the lower limbs in 95% of cases, with peripheral adenopathy.
Annular, erythematous, scaly plaques, usually on uncovered body parts (face, extremities), resemble dermatophytes. Lesions heal sponta- neously leaving scars.
Discrete chancre: moist papule, most commonly on the mucous membranes or in dermal folds, with peripheral adenopathy.
Lesions appear 3 weeks after the initial chancre, occur in crops and heal spontaneously:
Pintids: plaques of various colours (bluish, reddish, whitish). May occur anywhere on the body.
• Mucous patches of the mouth common: very contagious ulcerated, round in form, indurated, with white coating, bleed easily, usually occur on the inside of the lips, cheek and tongue or labial folds
After some years of latency:
Symmetrical white patches on the limbs. The depigmentation is permanent, remaining after treatment.
After several years of latency:
Children and adults: 30 mg/kg single dose (max. 2 g)
or, if not available,
benzathine benzylpenicillin IM2,3
Children under 10 years: 1.2 MIU single dose
Children 10 years and over and adults: 2.4 MIU single dose
Pinta and bejel
benzathine benzylpenicillin IM
As for yaws.
For patients allergic to penicillin:
doxycycline PO (except in children under 8 years and pregnant or lactating women)
Children 8 years and over: 50 mg 2 times daily for 14 days
Adults: 100 mg 2 times daily for 14 days
– Antibiotic treatment will cure early stage cases and may relieve the pain of osteitis. It may be ineffective for late stage infections.
– Syphilis serology will remain positive despite clinical cure.
Treatment of contacts and latent cases
The same treatment should be administered to all symptomatic and asymptomatic contacts and to all latent cases (asymptomatic individuals with positive serologic test for syphilis) in endemic zones.