PintaA67.9

Treponema carateum (see below Spirochetes). Phylo-genomic, pan-genomic, core-genomic and singleton analyses reveal the close association between all strains of T. pallidum. Based on genome plasticity analysis, differences in the presence/absence of pathogenicity islands (PAIs) and genomic islands (GIs) can be detected on a subsp. basis. Some genes related to lipid and amino acid biosynthesis are found to be present only in the subsp. of T. pallidum but not in T. pallidum subsp. carateum, T. pallidum subsp. endemicum and T. pallidum subsp. pertenue. The subspecies T. pallidum subsp. endemicum and T. pallidum subsp. pertenu are so similar that they cannot be distinguished serologically. They are antigenically cross-reactive (Jaiswal AK et al. 2020). Their morphology is also indistinguishable.

In the 1980s, very limited genetic diversity was found among these pathogen species. Later, it was demonstrated that the genomes of syphilis, yaws and bejel treponemes have an overall similarity of 97-100% and the molecular organization is also identical. This evidence suggests that only small genetic changes in key genes between these organisms are responsible for the reported differences in disease pathogenesis. When looking at the genes in PAIs and GIs, it is noticeable that there are no pathogenicity islands in any of the subspecies. Genes present in pathogenicity islands (PAIs) or genomic islands (GIs) of subspecies pallidum are absent in subspecies endemicum and pertenue (Jaiswal AK et al. 2020).

Transmission probably by direct (smear infection), possibly also by indirect contact.

• Stage I (primary lesion): Erythematous papule, which is usually overlooked. Subsequently peripheral expansion of the papules and development of a sharp-edged, scaly papule/plaque.
• Stage II (lymphohematogenic seeding): With simultaneous lymph node swelling, feeling of illness and fever, scaly erythematous, hyperkeratotic, whitish or black-grey plaques (pintide) develop in addition to the primary lesion.
• Stage III (dyschromic stage): Whitish or slate grey-violet areas, alopecia and juxtaarticular nodules may develop.

Serological detection of treponemal antibodies (syphilis serology is positive).

Treatment of non-venereal treponematoses is in principle carried out using the same therapeutic approaches and dosages as for venereal treponematoses (see syphilis below).

WHO recommends 1.2-2.4 million IU of benzathine benzylpenicillin (e.g., Pendysin, Tardocillin) i.m. as a single therapy. In children younger than 10 years, 600,000-800,000 IU. Benzathine penicillin G i.m. Alternatively doxycycline 2 times/day 100 mg p.o. for 14 days. In children, in case of contraindication to penicillin G, erythromycin 4 times/day 8-10 mg/kg bw p.o. may be used. Children > 8 years: 4 times/day 250 mg erythromycin p.o.).

1. Centurion-Lara A et al. (2006) Molecular differentiation of Treponema pallidum subspecies. J Clin Microbiol 44:3377-3780.
2. Giacani L et al (2014) . The endemic treponematoses. Clin Microbiol Rev 27:89-115.
3. Jaiswal AK et al. (2020) The pan-genome of Treponema pallidum reveals differences in genome plasticity between subspecies related to venereal and non-venereal syphilis BMC Genomics 21: 33.
4. Nyatsanza F et al (2016) Syphilis: presentations in general medicine. Clin Med (Lond) 16:184-188.
5. Mitja O et al (2013) Advances in the diagnosis of endemic treponematoses: yaws, bejel, and pinta. PLoS Negl Trop Dis 7:e2283.
6. Radolf JD et al (2016) Treponema pallidum, the syphilis spirochete: making a living as a stealth pathogen. Nat Rev Microbiol 14:744-759.