Endemic syphilis in Europe
Introduction
Human treponematoses (some prefer singular, treponematosis) are chronic infectious diseases caused by noncultivable, strictly parasitic bacteria of the genus Treponema (formerly Spirochetae), characterized by a very small genome (about 1.1 Mb) and accordingly limited metabolic capabilities, thus deriving important macromolecules from the host.1
Some authors believed there was only one disease, treponematosis,2, 3 with different clinical patterns, linked to various climatic, socioeconomic, and hygienic conditions, while others thought that there were four diseases (treponematoses) caused by different pathogenic Treponemas, more or less widely distributed in the world.
Cecil J. Hackett (1905-1995) has proposed dividing treponematoses in two distinct groups4:
- 1.
venereal (or sporadic) treponematosis, ie, venereal syphilis caused by the subspecies Treponema pallidum, transmitted mostly by sexual contact and very rarely by accidental transmission or from mother to fetus
- 2.
nonvenereal treponematoses (endemic) or extravenereal treponematoses for which the living conditions are essential, affecting especially children, and acquired by social contacts in undeveloped rural regions. These nonvenereal treponematoses encompass endemic (nonvenereal) syphilis caused by the Treponema pallidum subspecies endemica; yaws (framboesia) mostly occurring in the tropics and caused by the subspecies Treponema pallidum subspecies pertenue; and finally pinta (carate) present in Central and South America, caused by Treponema carateum, a disease confined only to the skin.5
The etiologic agent(s) of these treponematoses are closely related and impossible to distinguish by dark field microscopy, electron microscopy, serology, and even histopathologic examination.6, 7 The treatment of treponematoses is also characterized by similar response to drugs. This makes the diagnosis of a specific disease based not on the etiologic agent, but on the clinical manifestations, epidemiology, and geographic factors. Recently, owing to new investigations, the issue of their diagnosis can be improved by subtle genetic differences.8, 9
Section snippets
Characteristics of endemic syphilis in Europe
There are several possibilities to define endemic diseases, and some believe the term is not completely appropriate. According to the opinion of Franjo Kogoj (1894-1983) (Figure 1), Josip Fleger (1896-1966), Kristian Grön, and others,10, 11, 12 endemic treponematoses have been characterized by the presence for a longer or shorter time in a specific territory and transmitted regardless of age and sex, mainly extragenitally in unsanitary living conditions. Sometimes, with changing local
Endemic syphilis in the 16th century
Syphilis, after its emergence in Europe in the 1490s, soon spread as a venereal disease throughout Europe and even worldwide. It became clear that it could also propagate in other ways. As early as 1524, Erasmus from Rotterdam (1466?-1536) described transmission of syphilis in some Denmark baths.10
In 1575, in Brno (formerly Brünn), a strange contagious disease appeared affecting about 200 people in the urban area and more in the rural parts, over a period of several months. The disease was
Endemic syphilis in Scotland
In the mid-17th century, a peculiar disease appeared in southwest Scotland, which in that period was an impoverished country. The disease was more present in villages and was called sibbens or sivvens, the name derived from the Celtic word swinn meaning raspberry, because the lesions were similar to this wild fruit. Some physicians even believed the disease was yaws.18
The first to describe the disease was Freer in his thesis.19 Later, Hill wrote on the disease in 1772, who believed it was a
Endemic syphilis in 20th century
In the early 20th century, some cases of endemic syphilis were observed in Russia before the revolution in 1917,10 and later in Bulgaria.62 In the second half of the century, some cases of endemic syphilis and yaws were seen in immigrants in Vienna, England, and the Netherlands.63, 64, 65, 66, 67
Conclusions
After the successful eradication of endemic syphilis in Europe, the WHO tried to eradicate endemic treponematoses (or treponematosis) on other continents; however, one must be aware of the disparity between developed and underdeveloped regions, in which the cost, habits, poor health care organization, and insanitary housing can pose problems. We agree with Professor M. Waugh that in the propagation of sexually transmitted infections, of paramount importance are travel, trade, wars, colonial
References (68)
- et al.
Genetic diversity in Treponema pallidum. Implication for pathogenesis, evolution and molecular diagnostics of syphilis and yaws
Infect Genet Evol
(2012) - et al.
Endemic treponematosis: Review and update
Clin Dermatol
(2006) - et al.
Biological basis for syphilis
Clin Microbiol Rev
(2006) The treponematoses—or treponematosis?
Br J Vener Dis
(1958)Treponematosis in perspective
Bull World Health Organ
(1965)On the origin of the human treponematoses (pinta, yaws, endemic syphilis and venereal syphilis)
Bull World Health Organ
(1963)Endemic treponematoses
- et al.
Histopathology of the Skin
(1983) - et al.
Histologie bei endemischer Syphilis
Arch Klin Exp Dermatol
(1962) - et al.
Whole genome analyses of treponemes: New targets for strain- and subspecies-specific molecular diagnostics
Syphilis—Endemien
Syphilis and other dermatoses
Non-venereal treponematoses
J Am Acad Dermatol
Endemic syphilis in Bosnia. Clinical and epidemiological observations on a successful mass-treatment campaign
Bull World Health Organ
Concerning sibbens and the Scottish yaws
Caledonian Med J
The sibbens of Scotland
Med Hist
Another look at the morbus Gallicus
Br J Vener Dis
The history of venereology in Norway
Genitourin Med
Traite de la Radesyge. (Syphilis tertiaire). Christiana
J. Dahl
Though about rade' disease in Norway—take its victims slowly
Tidsskr Nor Laegeforen
Syphilis in the innocents—syphilis insontium
History of a fungous eruption
Med Chir Trans
The Button scurvy of Ireland
Br J Vener Dis
Spyrokolon
Med News
Trate pratiquedes maladies venerien
Paris
Cited by (4)
Clinical perspectives of Treponema pallidum subsp. Endemicum infection in adults, particularly men who have sex with men in the Kansai area, Japan: A case series
2022, Journal of Infection and ChemotherapyCitation Excerpt :Historically, the primary lesions of bejel were frequently not observed because of their small size and location within the oral and nasopharyngeal mucosa [1,11]. Furthermore, the lack of genital lesions was previously considered to be crucial for differentiating bejel from venereal syphilis [12]. In early studies on bejel, venereal syphilis and bejel were distinguished solely based on epidemiological and clinical features [13].
Spatiotemporal distribution and sociodemographic and socioeconomic factors associated with primary and secondary syphilis in guangdong, china, 2005–2017
2021, PLoS Neglected Tropical DiseasesBejel, a nonvenereal treponematosis, among men who have sex with men, Japan
2019, Emerging Infectious Diseases