The gummas can ulcerate and develop chronic serpiginous tracts. Healing results in depigmented scars with a hyperpigmented border. Saddle nose deformity and palate perforation can occur. Rare atypical involvement of the cardiovascular and nervous systems can occur. Endemic syphilis is a disease common in areas of poor economic status, education and personal hygiene.
Transmission occurs when skin or mucous membranes come in contact with infected skin lesions.
It is imperative for the physician examining the lesion to wear gloves at all time. Due to the overlap between treponematoses, endemic syphilis has to be correctly differentiated from venereal syphilis, yaws and pinta. The differential diagnoses of the diseases are very similar, and there are some features, like nasopharyngeal lesions, which can be difficult to differentiate. During the early stages, features in endemic syphilis resemble a number of dermatoses, mainly eczema, mycoses, psoriasis, leprosy, herpes simplex, perleche and condylomata acuminata. In the late stages, the features overlap that of malignant tumors, including carcinoma, mycosis fungoides, lupus vulgaris, and lupus erythematosus.