eMedicine Specialties > Dermatology > Bacterial Infections

Endemic Syphilis: Differential Diagnoses & Workup

Author: Hassan I Galadari, MD, MBBS, Assistant Professor of Dermatology, Faculty of Medicine and Health Sciences, United Arab Emirates University
Coauthor(s): Ibrahim Galadari, MD, MB, BCh, MSc, Professor of Dermatology, Department of Internal Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University
Contributor Information and Disclosures

Updated: Feb 13, 2009

Differential Diagnoses

Syphilis

Other Problems to Be Considered

Because of the overlap between treponematoses, endemic syphilis has to be correctly differentiated from venereal syphilis, yaws, and pinta. The differential diagnoses of the diseases are very similar, and some features, such as nasopharyngeal lesions, can be difficult to differentiate.

During the early stages, features in endemic syphilis resemble a number of dermatoses, mainly eczema, mycoses, psoriasis, leprosy, herpes simplex, perlèche, and condylomata acuminata.

In the late stages, the features overlap that of malignant tumors, including carcinoma, mycosis fungoides, lupus vulgaris, and lupus erythematosus.3

The mutilating nasopharyngeal lesions can be mistaken for tertiary venereal syphilis, tuberculosis, leprosy, rhinoscleroma, and mucocutaneous leishmaniasis.

Workup

Laboratory Studies

  • The best and most reliable method to diagnose endemic syphilis is a thorough clinical history and a complete physical examination. Geographic data, including travel information, is invaluable in establishing the diagnosis.
    • Laboratory tests confirm the clinical based diagnosis. These laboratory tests are the same as those used for the diagnosis of venereal syphilis.
    • Serologic, morphologic, and biochemical tests are not useful in distinguishing between the types of treponemal infections.
  • Serologic tests
    • Results of treponemal tests, such as the fluorescence treponemal antibody absorption (FTA-ABS) test, are positive in all stages of the disease.
    • Nontreponemal tests, such as the Venereal Disease Research Laboratory (VDRL) test and the rapid plasma reagent (RPR) test, are reactive 2-3 weeks after the onset of the primary lesion. These tests have a sensitivity of 80% in patients with a 2- to 3-month history of symptomatic primary syphilis. In the secondary stage, these tests have a sensitivity of near 100%.
  • Dark-field microscopy
    • This is the best method to confirm a treponemal disease. Although it does not specify the correct species because of similarities in morphology, the test promptly confirms that the infection is caused by a treponeme.
    • Serum is obtained by squeezing the base of the lesion.

More on Endemic Syphilis

Overview: Endemic Syphilis
Differential Diagnoses & Workup: Endemic Syphilis
Treatment & Medication: Endemic Syphilis
Follow-up: Endemic Syphilis
References
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References

  1. Clyti E, dos Santos RB. [Endemic treponematoses in Maputo, Mozambique]. Bull Soc Pathol Exot. May 2007;100(2):107-8. [Medline].

  2. Parish JL. Treponemal infections in the pediatric population. Clin Dermatol. Nov-Dec 2000;18(6):687-700. [Medline].

  3. Sharma VK, Kumar B. Malignant syphilis or syphilis simulating malignancy. Int J Dermatol. Sep 1991;30(9):676. [Medline].

  4. Antal GM, Lukehart SA, Meheus AZ. The endemic treponematoses. Microbes Infect. Jan 2002;4(1):83-94. [Medline].

  5. Blount JH, Holmes KK. Epidemiology of syphilis and the non-venereal treponematoses. In: Johnson RC, ed. The Biology of Parasitic Spirochetes. New York, NY: Academic; 1976:157-76.

  6. Cutler JC. Endemic syphilis, yaws, and pinta. In: Johnson RC, ed. The Biology of Parasitic Spirochetes. New York, NY: Academic; 1976:365-73.

  7. Engelkens HJ, Niemel PL, van der Sluis JJ, Meheus A, Stolz E. Endemic treponematoses. Part II. Pinta and endemic syphilis. Int J Dermatol. Apr 1991;30(4):231-8. [Medline].

  8. Falabella R. Nonvenereal treponematoses: yaws, endemic syphilis, and pinta. J Am Acad Dermatol. Dec 1994;31(6):1075. [Medline].

  9. Farnsworth N, Rosen T. Endemic treponematosis: review and update. Clin Dermatol. May-Jun 2006;24(3):181-90. [Medline].

  10. Kanan MW, Kandil E. Bejel or non-venereal endemic syphilis. Br J Dermatol. May 1971;84(5):461-4. [Medline].

  11. Knox JM, Musher D, Guzick ND. The pathogenesis of syphilis and the related treponematoses. In: Johnson RC, ed. The Biology of Parasitic Spirochetes. New York, NY: Academic; 1976:249-59.

  12. Koff AB, Rosen T. Nonvenereal treponematoses: yaws, endemic syphilis, and pinta. J Am Acad Dermatol. Oct 1993;29(4):519-35; quiz 536-8. [Medline].

  13. Meheus A, Antal GM. The endemic treponematoses: not yet eradicated. World Health Stat Q. 1992;45(2-3):228-37. [Medline].

  14. Morand JJ, Simon F, Garnotel E, Mahe A, Clity E, Morlain B. [Overview of endemic treponematoses]. Med Trop (Mars). Feb 2006;66(1):15-20. [Medline].

  15. Nsanze H, Lestringant GG, Ameen AM, Lambert JM, Galadari I, Usmani MA. Serologic tests for treponematoses in the United Arab Emirates. Int J Dermatol. Nov 1996;35(11):800-1. [Medline].

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Further Reading

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Keywords

nonvenereal syphilis of children, sibbens, radseyege, siti, therlijevo, njovera, frenjak, Treponema pallidum subsp endemicum, T pallidum subsp endemicum, nonvenereal endemic syphilis Bejel, non-venereal endemic syphilis Bejel

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Contributor Information and Disclosures

Author

Hassan I Galadari, MD, MBBS, Assistant Professor of Dermatology, Faculty of Medicine and Health Sciences, United Arab Emirates University
Hassan I Galadari, MD, MBBS is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Medical Student Association/Foundation, and American Society for Dermatologic Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Ibrahim Galadari, MD, MB, BCh, MSc, Professor of Dermatology, Department of Internal Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University
Ibrahim Galadari, MD, MB, BCh, MSc is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Craig A Elmets, MD, Director of Dermatology, Departments of Dermatology, Pathology, and Environmental Health Sciences; Professor, The Kirklin Clinic, University of Alabama at Birmingham
Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, and Society for Investigative Dermatology
Disclosure: Palomar Medical Technologies Stock None; Merck Consulting fee Independent contractor; Tronox Consulting fee Independent contractor; Amgen Consulting fee Review panel membership; Astellas Consulting fee Review panel membership; Massachusetts Medical Society Salary Employment

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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