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The secondary stage in nonvenereal syphilis usually involves the mucocutaneous junction of the lips, floor of the mouth, tonsils, palate, nasopharynx, and larynx (Fig. 35.3). All the moist lesions contain numerous spirochetes and are highly infective. In addition to the oropharyngeal lesions, there will be a skin rash over the entire body. In the moist flexures, and in the mouth and anogenital areas, the lesions are very similar to those of yaws and include condylomas. In other parts of the body the rash is chiefly maculopapular. All the skin lesions are also highly infective. Deep ulceration can occur, resulting in scarring, but the more superficial skin lesions leave only areas without pigment. When the skin around the eye is involved, the lacrimal duct may be damaged. The skin lesions in yaws and syphilis heal within a few months.

Fig. 35.3. A gumma in the posterior half of the tongue: this is probably due to nonvenereal syphilis, but such gummas may also occur in yaws. An African from Zimbabwe.

Bone pain and active osteoperiostitis are common to the secondary stage of yaws and both types of syphilis. The resulting thickening of the periosteum may be clinically palpable. The bone lesions progress to form gummas, which are tertiary lesions. At this final stage, there is destruction of the bone and, depending on its anatomical site, considerable deformity. When the face is involved in the treponematosis, particularly in the forms known as njovera, gangosa, rhinopharyngitis mutilans, and Bosnian syphilis, the destruction of the maxilla, palate, and nasal bones results in gross deformity. In yaws, periosteal thickening around the nose widens the bridge and is known as goundou. In syphilis and yaws, gummas in the skull bones may cause massive bony erosion and often sequestration and sinus formation.

Tertiary Stage

The tertiary stage of each disease is variable. The vascular and nervous complications, which are so common in venereal syphilis, are not common in yaws or endemic syphilis. However, aortitis, iritis, and tabes dorsalis have been reported in a few patients.
As already noted, it is possible that unexplained tropical myeloneuropathies are the sequelae of yaws and endemic syphilis. This variation in the tertiary stage has been used to justify the separation of the different clinical patterns into separate diseases, but it may be that these are only individual local differences in immunity, as occur in many infective conditions.

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Copyright: Palmer and Reeder