Medical Microbiology

Treponema(Syphilis,Yaws,Pinta) 323

Therapy.PenicillinGistheantibioticagentofchoice.Dosageanddurationof

therapydependonthestageofthediseaseandthegalenicformulationofthe

penicillinused.

Epidemiologyandprevention.Syphilisisknownallovertheworld.Annual

prevalencelevelsinEuropeandtheUSare 10 – 30 casesper 100000 inhab-

itants.Theprimarypreventivemeasureistoavoidanycontactwithsyphilitic

efflorescences.Whendiagnosingacase,thephysicianmusttrytodetermine

thefirst-degreecontactperson,whomustthenbeexaminedimmediately

andprovidedwithpenicillintherapyasrequired.Nationallawsgoverning

venerealdiseasemanagementinindividualcountriesregulatethemeasures

takentodiagnose,prevent,andhealthisdisease.Thereisnovaccine.

Treponemapallidum,subsp.endemicum

(NonvenerealSyphilis)

Thissubspeciesisresponsiblefornonvenerealsyphilis,whichoccursendem-

icallyincertaincircumscribedareasintheBalkans,theeasternMediterra-

nean,Asia,andAfrica.Thediseasemanifestswithmaculoustopapulous,of-

tenhypertrophiclesionsoftheskinandmucosa.Theselesionsresemblethe

venerealefflorescences.Thepathogensaretransmittedbydirectcontactor

indirectlyoneverydayobjectssuchasclothes,tableware,etc.Theincubation

periodisthreeweekstothreemonths.Penicillinisthetherapyofchoice.Se-

rologicalsyphilistestsarepositive.

Treponemapallidum,subsp.pertenue(Yaws)

Thisspeciescausesyaws(German“Frambo ̈sie,”French“pian”),achronicdis-

easeendemicinmoist,warmclimatescharacterizedbyepidermalproli-

ferationandulceration.Transmissionisbydirectcontact.Theincubation

periodisthreetofourweeks.Treponemesmustbefoundintheearlylesions

toconfirmdiagnosis.Serologicalsyphilisreactionsarepositive.PenicillinGis

theantibioticofchoice.

Treponemacarateum(Pinta)

Thisspeciescausespinta,anendemictreponematosisthatoccursinpartsof

CentralandSouthAmerica,characterizedbymarkeddermaldepigmenta-

tions.Thepathogensaretransmittedbydirectcontact.Theincubationperiod

isonetothreeweeks.Thediseaseoftenhasachroniccourseandcanpersist

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Kayser, Medical Microbiology © 2005 Thieme