Endemic Syphilis

Organism Treponema pallidum subspecies endemicum, which is indistinguishable from the T. pallidum that causes venereal syphilis.

Clinical features The primary lesion is commonly found at the angle of the mouth, appearing as a raised mucous plaque. A more florid skin infection follows with moist papules under the arms and between the buttocks and a maculo-papular rash on the trunk and limbs, resembling venereal syphilis. Destructive tertiary signs in the skin, nasopharynx and bones develop after months or years, but the nervous and cardiovascular systems are rarely involved.

Diagnosis is made on clinical grounds in endemic areas and by detecting the organism with dark ground microscopy. Serological tests for syphilis are positive and remain so for many years.

Transmission Because of the site of the primary lesion on the mouth, transmission by shared drinking vessels and eating utensils is considered the most likely route. Direct contact with lesions is also a likely method of spread. It resembles venereal syphilis in many of its features except that it is not spread venereally.

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