[Review: endemic treponematoses are not always eradicated]

Yaws and other endemic treponematoses (bejel or endemic syphilis, pinta) are resurging in many countries of the tropical belt. Today there are more than 2.5 million cases of these diseases, 75% of them in children. More than 100 million additional children are at risk for these disabling and disfiguring infections which destroy tissue and bone. In the 1950's and 1960's, through concerted efforts and leadership of UNICEF and WHO, more than 50 million individuals in 46 countries were cured and the diseases were brought under control or even eliminated from large parts of the world. Despite the success, endemic foci remained and in the last years there has been an alarming resurgence of the endemic treponematoses, in particular in parts of West and Central Africa. Endemic treponematosis control is based on treatment with single-dose penicillin of the entire treponemal reservoir. No instances of penicillin-resistance have been documented and these infections should be eliminated while the organisms still remain sensitive to penicillin. An endemic treponematosis control programme must be fully integrated into the primary health care system and the persistence of endemic treponematoses in an area is an indicator of the failing effectiveness of primary health care.