How is Bejel / Endemic Syphilis diagnosed?

Bejel, also known as endemic syphilis, is a chronic infectious disease caused by the bacterium Treponema pallidum subsp. endemicum. It primarily affects individuals living in impoverished and overcrowded conditions in certain regions of the world, including parts of Africa, the Middle East, and Asia.

Diagnosing Bejel involves a combination of clinical evaluation, laboratory tests, and epidemiological information. The following methods are commonly used:

1. Clinical Evaluation: A healthcare professional will assess the patient's medical history, symptoms, and physical examination findings. Bejel typically presents with non-specific symptoms such as skin lesions, ulcers, and gummatous growths. The characteristic lesions are painless, non-itchy, and can occur on the skin, mucous membranes, or bones.


2. Serological Tests: Blood tests are crucial for diagnosing Bejel. The most commonly used serological tests are the non-treponemal tests (e.g., Venereal Disease Research Laboratory [VDRL] test, Rapid Plasma Reagin [RPR] test). These tests detect antibodies produced by the body in response to the infection. However, it's important to note that these tests may also yield false-positive results due to cross-reactivity with other diseases.


3. Treponemal Tests: If the non-treponemal tests are positive, treponemal tests (e.g., Treponema pallidum particle agglutination [TPPA] test, fluorescent treponemal antibody absorption [FTA-ABS] test) are performed to confirm the diagnosis. These tests detect antibodies specifically targeting the Treponema pallidum bacterium.


4. Dark-Field Microscopy: In some cases, dark-field microscopy may be used to directly visualize the Treponema pallidum bacteria in samples collected from skin lesions or ulcers. This technique can provide rapid and specific confirmation of the infection.

It is important to consult a healthcare professional for an accurate diagnosis of Bejel. They will consider the patient's clinical presentation, perform the necessary tests, and interpret the results in the context of the individual's medical history and epidemiological factors.