![]() ![]() ![]() Clinical manifestations of the 3 patients in the primary stage were penile erosion or ulcer. Two of the patients identified in 2017 were in the secondary stage of the disease the other 3 were in the primary stage. One patient was identified in 2014, another 3 in 2017, and 1 patient in 2018. We concluded that the 5 patients from whom these strains were isolated had bejel ( Figure).Īll 5 bejel patients were men from Japan 20–40 years of age all were MSM. Phylogenetic analysis showed that, of 58 isolates from nucleic acid test–positive specimens, 5 isolates (8.6%) were T. The tree was constructed by using MEGA6 ( ) with the. Phylogenetic tree for tp0548–tp0856 gene regions (1173–1233 bp) of clinical isolates of Treponema pallidum from Japan (bold) and reference isolates. pallidum strains based on the nucleic acid sequences of the tp0548 and tp0856 gene regions ( 3, 10).įigure. pallidum specific for the TpN47 and polA gene regions. We tested specimens from patients suspected of having or given a diagnosis of syphilis by using nucleic acid amplification tests for T. The study protocol was approved by the Ethical Review Board of Osaka Institute of Public Health. pallidum among patients with venereal syphilis after 2011 ( 9). We thus conducted a molecular epidemiologic study to characterize the genotypes of T. However, little attention has been paid to nonvenereal treponematosis. In Japan, syphilis has been reemerging since 2010 ( 8). No patient with nonvenereal treponematosis has been reported in Japan. Bejel in France was attributed to an imported case from Pakistan, and in Canada to an imported case from Senegal, whereas transmission in Cuba was regionalized. Only a few case reports of bejel have been reported in non-endemic areas since 1999, including France ( 3), Canada ( 6), and Cuba ( 7). Bejel can be transmitted sexually, but this route has not been studied because bejel affects mainly children. The main route of transmission is direct skin-to-skin contact. Bejel is still prevalent in dry and hot areas, such as the Sahel region in western Africa, part of Botswana, Zimbabwe, and the Arabian Peninsula ( 5). ![]() For this purpose, a nucleic acid test is useful ( 3).īejel was eradicated in Europe in the 20th century but was prevalent there in the 16th century ( 4). However, it is useful to differentiate them from a public health standpoint because their infection routes vary. Clinically, there is little need to differentiate them. These pathogens are morphologically and serologically indistinguishable ( 2). Other Treponema species cause nonvenereal endemic treponematosis (also called bejel, nonvenereal syphilis, or endemic syphilis, caused by T. Epidemics of syphilis among men who have sex with men (MSM) occur in high-income settings ( 1). Globally, syphilis remains a disease of heterosexual persons in low-to-middle-income countries. A single intramuscular injection of long-acting penicillin is effective against endemic treponematoses including pinta, yaws, and bejel.Treponema pallidum subspecies pallidum is the causative agent of venereal syphilis. The disease can be treated with penicillin, tetracycline (not to be used in pregnant women), azithromycin or chloramphenicol, and can be prevented through contact tracing by public health officials. Diagnosis ĭiagnosis is usually clinical, but as with yaws and bejel, serological tests for syphilis, such as rapid plasma reagin (RPR) and TPHA, will be positive, and the spirochetes can be seen on dark field microscopy of samples taken from the early papules. pallidum, which can cause endemic syphilis. Pinta is caused by the bacterium Treponema carateum. These generally resolve, but a proportion of people with pinta will go on to develop late-stage disease, characterised by widespread pigmentary change with a mixture of hyperpigmentation and depigmentation that can be disfiguring. Three to nine months later, further thickened and flat lesions (pintids) appear all over the body. Lesions are usually present in the exposed surface of arms and legs. Pinta, the least severe of treponemal infections being limited to the skin, is thought to be transmitted by skin-to-skin contact (similar to bejel and yaws), and after an incubation period of two to three weeks, produces a raised papule, which enlarges and becomes hyperkeratotic (scaly/flaky). The disease is endemic to Mexico, Central America, and South America. Pinta (also known as azul, carate, empeines, lota, mal del pinto, and tina) is a human skin disease caused by infection with the spirochete Treponema carateum, which is morphologically and serologically indistinguishable from the bacterium that causes syphilis. ![]()
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