Have just come across the concept of Endemic Syphilis in Arch Int Med 1961;108:1. This occurred under "unhygienic conditions of primitive life in huts and villages" in isolated parts of the world, chiefly among children. Having a suspicious mind, I wondered if in fact this was spread by unsuspected and undetected sexual abuse, an unmentioned possibility. I therefore followed up the reference to Lancet 1951;1:558, on njovera. "A boy, aged 7 years, with perianal condylomata, seen elsewhere, admitted to sexual interference, but it is thought that this is an unusual way to acquire njovera, and that usually dirt, flies, overcrowding, communal feeding and implements, and the fact that families sleep huddled together, are responsible for the transmission of the disease". This does nothing to allay my suspicion that endemic syphilis is due to sexual abuse or to sex with children. As with most disorders, the simple and generic explanation is usually the correct one, and there are not two types of syphilis.
Yes, think you are right that sexual abuse certainly often has been the transmission route. However, especially in the secondary stage, I think syphlis may be transmitted from moisten rashes, i. e. condylomata lata, under unhygienic and overcrowded conditions without sexual abuse. In the Mid-East, endemic syphilis was typically spread among children born in tents.
Bejel and venereal syphilis are different diseases. Endemic syphilis (bejel) is restricted to semi-arid areas such as the Sahel region of Africa. Bejel is caused by T. pallidum subsp. endemicum and venereal syphilis by T. pallidum subsp. pallidum. Transmission of bejel is through direct or indirect contact with infectious early lesions of skin and mucous membranes; the shared use of eating and drinking utensils, and generally unsatisfactory hygienic conditions.
It is most likely to be transmitted by a non-venereal route but theoretically it can also be transmitted through sexual contact. The site of the lesions helps to identify the likely route of transmission, that is if the primary lesion is in the oral cavity, perianal area or on the genetalia, the disease is venereal syphilis and not endemic syphilis. Now it is possible to differentiate the various subspecies of T.pallidum by PCR and sequencing so that would be the final way to differentiate endemic syphilis from venereal syphilis.
" Endemic syphilis (bejel) is restricted to semi-arid areas such as the Sahel region of Africa. Bejel is caused by T. pallidum subsp. endemicum and venereal syphilis by T. pallidum subsp. pallidum"
Is this an example where I have been let down by my old friend Wikipedia? See
"Although the organism that causes bejel, Treponema pallidum endemicum,[2] is morphologically and serologically indistinguishable from Treponema pallidum pallidum, which causes venereal syphilis, transmission of bejel is not venereal in nature,[3] generally resulting from mouth-to-mouth contact or sharing of domestic utensils, and the courses of the two diseases are somewhat different."
Is there actually any good concrete evidence for non-venereal transmission, or is this just wishful thinking?
"Transmission of bejel is through direct or indirect contact with infectious early lesions of skin and mucous membranes; the shared use of eating and drinking utensils, and generally unsatisfactory hygienic conditions"
This is what used to be said about the transmission of syphilis in general. But the CDC now says, according to Wikipedia:
"Syphilis cannot be contracted through toilet seats, daily activities, hot tubs, or sharing eating utensils or clothing."
The clue must be in the epidemiology of bejel, and in the early distribution of lesions (see Preena above):
"The site of the lesions helps to identify the likely route of transmission, that is if the primary lesion is in the oral cavity, perianal area or on the genetalia, the disease is venereal syphilis and not endemic syphilis".
So what did Hudson (1961, see question) have to say about this in endemic syphilis:
"Oral mucous patches are usually the first evidence of the disease; genital, perineal, and perianal condylomata are very common: skin lesions vary in prevalence.."
Surely this distribution is compelling evidence for sexual contact, and against other forms of contact where the skin should be the prime target.
Yaws, otherwise known as 'contact syphilis' is most definitely transmitted by contact and does not require sexual contact of any sort. I lived in Congo -Brazzaville with hunter-gatherers there who suffer endemic yaws infections, especially among children. With my wife we lead a major eradication campaign in 1996 in an area I still return to regularly. While the eradication was fairly effective, by 2000 new lesions were observable on young children again. Our conclusion from observing yaws on gorilla infants (and treating it the same way as with human infections with a muscular injection of penicillin-G) is that gorillas represent a pool of the disease that returns to infect humans when they play in the same areas of forest.
So I think that sexual abuse is only likely to account for a tiny minority of cases and not to be a significant vector of yaws.
"I think that sexual abuse is only likely to account for a tiny minority of cases and not to be a significant vector of yaws"
The epidemiology of yaws is consistent with spread by direct skin contact. This is different to the condition mentioned by Hudson (1961), who was describing bejel or njovera or endemic syphilis, and not yaws which he recognised as a different clinical entity.
"However, especially in the secondary stage, I think syphlis may be transmitted from moisten rashes"
Here is a case that does support the direct contact mechanism (A Whitfield A Case of Extra-genital Syphilis W Lond Med J 1904;9:123):
"One brother infects himself with scabies and syphilis by impure connection. He then sleeps with his elder brother until after symptoms of syphilis are very marked, and he has a freely discharging chancre upon which he wears no dressing. Owing to the fact that he sleeps only in a short flannel day-shirt and is very filthy, it is practically certain that a lot of discharge would reach the bedclothes. The brother, who sleeps with this patient, acquires scabies...In the scratching entailed by his scabies the second patient abrades the skin of the buttock...and then by means of the filthy bedclothes or possibly dirty hands, infects this abrasion with the virus of syphilis."
Search Result
T pallidum causes venereal syphilis. T carateum and T pertenue cause pinta and yaws, respectively. Endemic syphilis is caused by T pallidum subsp endemicum. Endemic syphilis is transmitted through direct or indirect skin-to-skin or mouth-to-mouth contact with the infected lesion.
Reference: https://emedicine.medscape.com/article/1952297-overview
"Endemic syphilis is transmitted through direct or indirect skin-to-skin or mouth-to-mouth contact with the infected lesion."
This does nothing to allay my suspicion that it is of venereal origin, ie via close sexual contact between and infected adult and a child.
Previous comments seem to have been erased (why?), so here is my last one from 2y ago.
"Endemic syphilis is transmitted through direct or indirect skin-to-skin or mouth-to-mouth contact with the infected lesion."
This does nothing to allay my suspicion that it is of venereal origin, ie via close sexual contact between an infected adult and a child.
Since then there has been a recent epidemic of monkeypox. Exactly the same method of spread, together with the respiratory route, was originally postulated for endemic syphilis. However, it now turns out that at least 95% of monkeypox is spread via sexual contact among men who have sex with men.
It is very easy (and convenient) to overlook sexual spread.
Pinta, Yaws, and Endemic Syphilis are examples of nonvenereal infection. According to Elston, Endemic syphilis is caused by gram negative bacteria which is Treponema pallidum.
Hassan I Galadari, M. D. (2021, July 19). Endemic syphilis: Environmental distribution, transmission, morbidity in endemic syphilis. Endemic Syphilis: Environmental Distribution, Transmission, Morbidity in Endemic Syphilis. Retrieved August 24, 2022, from https://emedicine.medscape.com/article/1952297-overview#a1
"The incidence of endemic syphilis has increased among HIV-infected men in same-sex relationships. A study at a hospital in Malaga, Spain, showed an increase from 1.2% in 2007 to 7.8% in 2012." (From the link in the previous answer).
In what way is this non-venereal?
- Badges
- Science topic
- Similar topics
- Medicine
- Disease
- Infectious Diseases