Bejel in Cuba: molecular identification of Treponema pallidum subsp. endemicum in patients diagnosed with venereal syphilis

Human treponematosis is caused by various pathogenic Treponema pallidum subspecies, including T. pallidum subsp. pallidum, T. pallidum subsp. pertenue, T. pallidum subsp. endemicum, and Treponema carateum. The global prevalence of syphilis has been increasing since the 2000s. Men account for more than 90% of the cases, with the majority being men who have sex with men (MSM). In Japan, the increase in the number of syphilis patients began in 2011, a 10-year delay from the global trend. In 2017, a total of 5,829 syphilis cases (3,934 men and 1,895 women) were reported, with an outstanding increase in cases among young adult women; the number reported for women age 15 to 20 years was 1,100. Hence, a molecular epidemiological study was conducted on circulating T. pallidum strains using two strain typing methods, the enhanced CDC method and sequencing-based molecular typing. Clinical specimens from 95 adults suspected of syphilis were collected from September 2013 to August 2017 in Osaka, Japan. T. pallidum DNA was detected in specimens from 25 males and 11 females, including seven MSM. The majority of the heterosexual patients (66.7% and 90.9% of males and females, respectively) were positive for 14d/f-SSR8. In contrast, the genotypes identified in the MSM group were significantly divergent. T. pallidum subsp. endemicum was notably identified in two MSM patients. Macrolide-sensitive or Nichols-like strains were significantly associated with the MSM group. These data suggest that distinct T. pallidum strains were circulating in the heterosexual and MSM groups. Our findings imply that independent factors may contribute to the increased syphilis prevalence in heterosexual and MSM populations.

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“…T. pallidum subsp. endemicum can be transmitted via sexual contact (37). Further studies are needed to clarify whether T. pallidum subsp.…”

Section: Discussionmentioning

confidence: 99%

Circulation of Distinct Treponema pallidum Strains in Individuals with Heterosexual Orientation and Men Who Have Sex with Men

Kojima

Furubayashi²,

Kawahata

et al. 2019

J Clin Microbiol

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“…It has been shown that in very dry areas, yaws and bejel symptoms are highly overlapping [43]. The clinical manifestation of TPA and TEN infections is also highly similar, and recent reports have described bejel treponemes in patients suspected of having syphilis in France, Cuba, and Japan [9][10][11][12]. Despite the relatedness of the TPA, TPE, and TEN treponemes, strains belonging to different subspecies cluster together, and this clustering corresponds to disease classification.…”

Section: Plos Onementioning

confidence: 99%

“…Several imported cases of yaws and bejel in children and adults in Europe and North America have been described [7][8][9][10]. In addition, recent studies by Noda et al [11] and Kawahata et al [12] have identified TEN in clinical samples from Cuban and Japanese patients, respectively, who had previously been diagnosed with syphilis.…”

Section: Introductionmentioning

confidence: 99%

“…Variability in clinical symptoms and transmission modes make precise identification of the causative agent in early-stage treponemal infection difficult, if not impossible [9]. The recent identification of TEN in Cuba and Japan among patients diagnosed with syphilis demonstrates the difficulties inherent to diagnosis based exclusively on serology, geographical occurrence, clinical symptoms, and anamnestic data [11,12] and emphasizes the role of molecular tools for differentiation between TPA/TPE/ TEN infections. Bejel, classified so far as endemic treponematosis, might be more widespread than originally expected especially due to the recent findings of sexual transmission of this neglected disease and ability to mimic syphilis infection [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Whole genome sequence of the Treponema pallidum subsp. endemicum strain Iraq B: A subpopulation of bejel treponemes contains full-length tprF and tprG genes similar to those present in T. p. subsp. pertenue strains

et al. 2020

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“…More recently, reports of clinically diagnosed genital primary chancres, sexually transmitted and presumed to be syphilis, were shown to have been caused by T. pallidum subsp. endemicum (Grange et al, ; Kawahata et al, ; Mikalova et al, ; Noda et al, ). Thus, “molecular subspeciation” does not always correlate with the clinical manifestations or mode of transmission.…”

Section: Epidemiological and Genetic Researchmentioning

confidence: 99%

Advancing the understanding of treponemal disease in the past and present

Baker

Crane-Kramer

Dee

et al. 2020

American J Phys Anthropol

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Syphilis was perceived to be a new disease in Europe in the late 15th century, igniting a debate about its origin that continues today in anthropological, historical, and medical circles. We move beyond this age-old debate using an interdisciplinary approach that tackles broader questions to advance the understanding of treponemal infection (syphilis, yaws, bejel, and pinta). How did the causative organism(s) and humans co-evolve? How did the related diseases caused by Treponema pallidum emerge in different parts of the world and affect people across both time and space? How are T. pallidum subspecies related to the treponeme causing pinta? The current state of scholarship in specific areas is reviewed with recommendations made to stimulate future work. Understanding treponemal biology, genetic relationships, epidemiology, and clinical manifestations is crucial for vaccine development today and for investigating the distribution of infection in both modern and past populations.Paleopathologists must improve diagnostic criteria and use a standard approach for recording skeletal lesions on archaeological human remains. Adequate contextualization of cultural and environmental conditions is necessary, including site dating and justification for any corrections made for marine or freshwater reservoir effects. Biogeochemical analyses may assess aquatic contributions to diet, physiological changes arising from treponemal disease and its treatments (e.g., mercury), or residential mobility of those affected. Shifting the focus from point of origin to investigating who is affected (e.g., by age/sex or socioeconomic status) and disease distribution (e.g., coastal/ inland, rural/urban) will advance our understanding of the treponemal disease and its impact on people through time. K E Y W O R D S archaeological biogeochemistry,

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Bejel in Cuba: molecular identification of Treponema pallidum subsp. endemicum in patients diagnosed with venereal syphilis

Cited by 41 publications

References 24 publications

Circulation of Distinct Treponema pallidum Strains in Individuals with Heterosexual Orientation and Men Who Have Sex with Men

Circulation of Distinct Treponema pallidum Strains in Individuals with Heterosexual Orientation and Men Who Have Sex with Men

Whole genome sequence of the Treponema pallidum subsp. endemicum strain Iraq B: A subpopulation of bejel treponemes contains full-length tprF and tprG genes similar to those present in T. p. subsp. pertenue strains

Advancing the understanding of treponemal disease in the past and present

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