Endemic treponematoses

One injection of penicillin, costing less than 50 US cents, could cure the endemic treponematoses in a few days, and thus save millions of children from suffering and disfigurement

by Georges Causse

he generic term "human tre­ ways, prevention is better than cure, lips, can provide an entry for tre­ ponematoses" embraces four and probably the most promising ponemes, while flies can sometimes 11 diseases which share very closely approach to prevention is sound carry them. Young children may even related pathogenic agents-the tre­ sex education, preferably beginning transmit the disease to their parents, if ponemes-but whose clinical expres­ during school days. they are not already immune to the sion and methods of transmission dif­ , bejel and , the signs of condition. fer widely. These are venereal , which are principally granulating and Poor personal and collective hy­ yaws, endemic syphilis (or bejel) and weeping cutaneous lesions containing giene linked to the scarcity of water pinta. large quantities of treponemes, are and soap which goes hand-in-hand Today there are more than two and with poverty, an unfavourable climate, a half million cases of these diseases, overcrowded houses, and malnutrition 75 per cent of them children, and (which reduces resistance to infec­ more than 100 million children risk tions) are essential factors explaining becoming infected. The consequences the prevalence of these diseases. In of an infection are serious and can lead fact they are rarely observed in towns. to permanent disfigurement. The dis­ Yaws, also known as framboesia, eases occur essentially in the poorest buba and pian, is prevalent in the hot countries of tropical Africa, Asia, and humid tropical regions of Africa, Central America, the Middle East Central America, Asia and the Pacific. and the Pacific, where malnutrition, It is caused by pertenue respiratory conditions, diarrhoea, and is found mainly in children malaria, schistosomiasis and other between the ages of two and 15 . The parasitic diseases help to increase the initial lesions on the exposed part of sickness and mortality rates. the body may disappear after three to Known since the dawn of mankind A health worker explains the symptoms and six months, but others come in crops; and clinically identified for four cen­ treatment of STD in a Nigerian village. these are secondary skin lesions, which turies past, their pathogenic agents, Photo WHO/P. Almasy are varied in appearance and may the treponemes, were described over a appear on any part of the body. The century ago. So they are thoroughly secondary and late stages may painful­ familiar to us, and we even have a fully highly contagious through simple di­ ly affect the bones or cartilages and effective remedy, penicillin, which rect contact, especially between chil­ lead to deformation of the legs or may can cure the infection in one single dren during their play, living together attack the face, especially the nose, injection. or using the same utensils for eating causing permanent disfigurement. Venereal syphilis is the only one of and drinking. They are often known as Endemic syphilis, also known in the four diseases which is transmitted endemic treponematoses of childhood. Arabic as bejel, is brought about by by sexual contact, and is therefore The slightest injury to the skin or , closely related virtually restricted to adults. As al- mucous membranes, especially the to the agent of venereal syphilis. Like

26 WoRLD HEA LTH, November 1986 Endemic treponematoses

Yaws, also known as framboesia, buba and pian, is prevalent in the hot and humid tropical regions of Africa, Central America, Asia and the Pacific. Here, a little girl in Laos receives treatment for non-venereal yaws. Photo WHO

yaws, it is a children's disease and camel-back or on foot to reach even exposed to these infections, while produces lesions of the skin, bones and the most remote villages sought to between two and ten per cent of them cartilages and also of the mucous reduce the diseases to a level where show serious lesions. membranes of the mouth. The lesions they no longer posed a serious public Aware that fresh and vigorous are drier than those of yaws but health problem. The results were action was essential, the inter­ endemic syphilis has the same disabl­ remarkable and the estimated number national community, through WHO, ing or disfiguring consequences. Bejel of cases fell from over 50 million in has appealed to the national and inter­ now principally affects the semi­ 1950 to fewer than two million at the national bodies, since 1978, to mobil­ nomadic peoples of the Arabian end of the 1960s. Clinical cases even ise their resources and collaborate in peninsula and the southern edge of the disappeared completely in some coun­ an attempt at the final elimination of Sahara (the Sahel). tries. It was thought that social and this plague. Pinta, also known as mal de pinto economic improvements, especially in Today, in the context of campaigns (Mexico), carate (Colombia and Ven­ collective and individual hygiene, aimed at Health for all, new ap­ ezuela) and azul (Chile and Peru), is would overcome these poverty-linked proaches are matched to each local caused by Treponema carateum. It endemic diseases. health situation. It is recognised that occurs only in tropical regions of the But such optimism is no longer activities in the fight against tre­ Americas, where it is particularly pre­ possible today. There have not been ponematoses must be integrated into valent in remote rural settlements and, the expected social, economic and other health and development pro­ unlike the other endemic trepone­ health improvements, many of the grammes provided for the same com­ matoses, it affects both children and treatment teams have been disbanded munities: vaccination, control of adults of all ages. Red areas on the or seconded to other work, and the respiratory or digestive conditions, skin spread and sometimes merge. The rural health centres, too few in health education, improving collective lesions become pigmented with age, number and seriously lacking staff and and individual hygiene, nutrition and changing slowly from copper to grey to medicines, have been unable to cope. so forth. slate-blue, while some victims may While endemic treponematoses have Many national, international, public develop a variegated skin-colouring. disappeared or are confined to iso­ and private organizations are mobilis­ The discovery of penicillin in the lated areas in a few countries of Cen­ ing in a generous and effective cam­ 1940s with its powerful effectiveness tral America, North Africa and the paign. We already have the right against these diseases through a single Pacific, the same is not true every­ weapons to deal with the suffering, intramuscular injection, raised great where. Yaws and bejel have spread, permanent disfigurement and disable­ hopes of eradicating them. WHO and often in epidemic form, reaching and ment every year of these millions of UNICEF launched a world-wide pro­ occasionally surpassing the levels of children. One injection of penicillin, gramme against yaws in 1948, extend­ the 1950s, starting from old and insuf­ costing less than 50 US cents, provides ing this later to the other trepone­ ficiently monitored centres of disease a cure in a few days. And tomorrow matoses, bejel and pinta. or areas where treatment did not cover we may discover an effective vaccine Mobile teams travelling through the all the population. In the Sahel alone, which will prevent the occurrence of countries by bicycle or canoe, on a third or even half of the children are these diseases. •

W oRLD HEALTH, November 1986 27