Species: T. pallidum subsp. endemicum
Synonym: endemic syphilis, Arab syphilis
Classical distribution: West Africa, Botswana, Zimbabwe, Arabian peninsula, Iraq. It has spread to the Caribbean, Asia and other countries.
In endemic areas the disease is often acquired during childhood. It can also be acquired by other contacts, including sexual in men who have sex with men.
The infection proceeds through 3 stages:
(1) primary skin ulceration
(2) secondary with skin rash and lymphadenopathy
(3) tertiary
Early skin and mucosal lesions:
(1) mucous patches
(2) stomatitis
(3) skin rashes
(4) anogenital condylomata
(5) pigmentary changes
Other findings:
(1) hoarseness
(2) periostitis
(3) bone pain (ostealgia)
Late complications:
(1) destruction of nose and palate
(2) mutilating skin lesions
(3) skin gummata
(4) possibly aortitis
The organism cannot be cultivated but can be diagnosed by PCR. Serologic tests for syphilis may be positive.
