Diagnostic and therapeutic approach to Ethiopian immigrants seropositive for syphilis

Serologic tests for syphilis are frequently positive in Ethiopian Jewish immigrants in Israel. Forty-three of 358 adults (greater than 15 years of age) examined were found to have positive treponemal tests. Of the 418 children (1 to 15 years of age) none were found to have positive treponemal serology. Forty seropositive adults were examined for signs of tertiary syphilis and underwent lumbar puncture. No evidence of skin or cardiovascular involvement of tertiary syphilis was found. In three patients whose cerebrospinal fluid (CSF) was reactive in treponemal tests, there was no evidence of neuropsychiatric involvement. CSF cell count and protein content were normal in all three, and VDRL in the CSF was negative. None of the subjects was found to have stigmata of congenital syphilis. Negative serological findings in all the children led us to hypothesize whether the disease in question is venereal syphilis with an unusual course rather than endemic syphilis or yaws, both of which are known to exist in Africa. Due to the apparent benign course of syphilis in this ethnic group and recent evidence that lumbar puncture is not mandatory in patients with latent syphilis or asymptomatic neurosyphilis, we suggest that CSF should not be routinely examined in these patients. In view of the recommendations in the literature and the data that we have collected, we strongly feel that treatment with weekly i.m. injections of 2.4 x 10(6) u benzathine penicillin for a 3-week period is sufficient.