Likewise, bejel might be changing from an endemic tropical disease to a global STI. Infectious diseases that have been historically not considered to be sexually transmitted infections (STIs), such as amebiasis, hepatitis A, and shigellosis, often show manifestations of STIs. endemicum in eastern Asia and the Pacific region.Ĭlinical manifestations of venereal syphilis and bejel are similar, especially in the early stage for adults, which makes diagnosis difficult ( 7). Our findings provide molecular epidemiologic evidence for a local spread of T. endemicum is transmitted domestically in Japan by MSM. The 3 patients who were followedup responded well to standard therapy with penicillin. All 5 isolates had a mutation conferring azithromycin resistance. None of the patients had a history of overseas travel for a long period. Although the residential geographic areas were remote, the suspected locale of treponemal infection was the Kansai area, namely the city centers of Osaka and Kyoto. The other 4 patients lived in the Kansai area, including Osaka, Kyoto, and Hyogo Prefectures. The first patient lived in Yamaguchi Prefecture. pallidum latex agglutination test values were 2.4 × 10 3 and 20.8 × 10 3 units. The 2 secondary-stage patients had positive results for the rapid plasma reagin test, and their T. pallidum latex agglutination test (<10 units) and 1 had a titer of 35.7 units. Of these patients, 2 showed negative results of the T. The 2 patients in the secondary stage had systemic rashes and lymphadenopathy, in addition to pubic and perineal symptoms.įor serologic tests at admission, the 3 primary-stage patients showed negative results for the rapid plasma reagin test (<1.0 unit). Clinical manifestations of the 3 patients in the primary stage were penile erosion or ulcer. Two of the patients identified in 2017 were in the secondary stage of the disease the other 3 were in the primary stage. One patient was identified in 2014, another 3 in 2017, and 1 patient in 2018. We concluded that the 5 patients from whom these strains were isolated had bejel ( Figure).Īll 5 bejel patients were men from Japan 20–40 years of age all were MSM. Phylogenetic analysis showed that, of 58 isolates from nucleic acid test–positive specimens, 5 isolates (8.6%) were T. The tree was constructed by using MEGA6 ( ) with the. Phylogenetic tree for tp0548–tp0856 gene regions (1173–1233 bp) of clinical isolates of Treponema pallidum from Japan (bold) and reference isolates. pallidum strains based on the nucleic acid sequences of the tp0548 and tp0856 gene regions ( 3, 10).įigure. pallidum specific for the TpN47 and polA gene regions. We tested specimens from patients suspected of having or given a diagnosis of syphilis by using nucleic acid amplification tests for T. The study protocol was approved by the Ethical Review Board of Osaka Institute of Public Health. pallidum among patients with venereal syphilis after 2011 ( 9). We thus conducted a molecular epidemiologic study to characterize the genotypes of T. However, little attention has been paid to nonvenereal treponematosis. In Japan, syphilis has been reemerging since 2010 ( 8). No patient with nonvenereal treponematosis has been reported in Japan. Bejel in France was attributed to an imported case from Pakistan, and in Canada to an imported case from Senegal, whereas transmission in Cuba was regionalized. Only a few case reports of bejel have been reported in non-endemic areas since 1999, including France ( 3), Canada ( 6), and Cuba ( 7). Bejel can be transmitted sexually, but this route has not been studied because bejel affects mainly children. The main route of transmission is direct skin-to-skin contact. Bejel is still prevalent in dry and hot areas, such as the Sahel region in western Africa, part of Botswana, Zimbabwe, and the Arabian Peninsula ( 5). For this purpose, a nucleic acid test is useful ( 3).īejel was eradicated in Europe in the 20th century but was prevalent there in the 16th century ( 4). However, it is useful to differentiate them from a public health standpoint because their infection routes vary. Clinically, there is little need to differentiate them. These pathogens are morphologically and serologically indistinguishable ( 2). Other Treponema species cause nonvenereal endemic treponematosis (also called bejel, nonvenereal syphilis, or endemic syphilis, caused by T. Epidemics of syphilis among men who have sex with men (MSM) occur in high-income settings ( 1). Globally, syphilis remains a disease of heterosexual persons in low-to-middle-income countries. Treponema pallidum subspecies pallidum is the causative agent of venereal syphilis.
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