International Journal of Infectious Diseases 50 (2016) 72–74

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International Journal of Infectious Diseases

journal homepage: www.elsevier.com/locate/ijid

Short Communication

Recall of symptoms and treatment of syphilis and yaws by healthy

blood donors screening positive for syphilis in Kumasi, Ghana
Francis Sarkodie a,b,*, Ellis Owusu-Dabo c,d, Oliver Hassall b, Imelda Bates b, Ib C. Bygbjerg e,
Henrik Ullum f
a
Komfo Anokye Teaching Hospital, Kumasi, Ghana
b
Liverpool School of Tropical Medicine, Liverpool, UK
c
School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
d
Kumasi Centre for Collaborative Research, KNUST, Kumasi, Ghana
e
Department of Public Health, University of Copenhagen, Copenhagen, Denmark
f
Department of Clinical Immunology, Copenhagen, University Hospital, Copenhagen, Denmark

A R T I C L E I N F O S U M M A R Y

Article history: Objective: To describe the recalled medical history, clinical manifestations, and treatment of yaws and
Received 3 April 2016 syphilis by syphilis seroreactive blood donors in Kumasi, Ghana.
Received in revised form 1 August 2016 Methods: Of the blood donors at Komfo Anokye Teaching Hospital, Kumasi, Ghana tested with the
Accepted 8 August 2016
syphilis rapid diagnostic test (RDT) and later by rapid plasma reagin (RPR) test, 526 were seroreactive.
Corresponding Editor: Eskild Petersen, Four hundred and seventy-one (89.5%) of these subjects were confirmed with the Ortho-Vitros Syphilis
Aarhus, Denmark
TP test as the gold standard and were interviewed to determine past or present clinical manifestations of
yaws and syphilis.
Keywords: Results: Of the 471 respondent donors, 28 (5.9%) gave a history of skin lesions and sores; four (14.3%) of
Recall of symptoms these subjects, who were all male and RPR-positive, recalled a diagnosis of syphilis. All four reported
Syphilis having had skin lesions/bumps with slow-healing sores, but only one of them had had these symptoms
Yaws
before the age of 15 years.
Epidemiological characteristics
Conclusions: A small proportion of confirmed seroreactive donors in this sample had any recall of
Sero-reactive
Blood donors symptoms or treatment for yaws or syphilis. These data suggest that clinical questioning adds little
further information to the current screening algorithm. The relative contribution of yaws and syphilis to
frequent positive tests in endemic areas remains speculative.
ß 2016 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).

pigmentation of the palms and soles, followed by gummata in the

1. Introduction
last stage.1
Syphilis is a sexually transmitted disease caused by Treponema
Yaws is a neglected non-venereal endemic treponematosis
pallidum subspecies pallidum. It can also be transmitted via blood
caused by the bacterium Treponema pallidum subspecies pertenue.1
transfusion, although the actual risk is low.4 Syphilis starts with a
It is spread by direct skin-to-skin contact and predominantly
primary lesion (chancre – usually on the genitals), followed by a
affects children less than 15 years of age living in poor socio-
polymorphic rash and lymphadenopathy. This is followed by the
economic conditions in certain rural, wet, and tropical areas.2 In
occurrence of a generalized condition with parenchymal, systemic,
Ghana, a total of 28 000 cases were reported in 2008 and 25 000 in
and mucocutaneous manifestations.5 The end result may include
2010. In 2012, the World Health Organization (WHO) launched a
dementia, gummata, blindness, paralysis, or death.
new initiative to eradicate yaws globally by 2020 using the Morges
Usually yaws and syphilis can only be distinguished by
strategy.3 The clinical manifestations of yaws include multiple
epidemiological characteristics and clinical manifestations, as
papillomas, non-tender ulcers, sores, plantar hyperkeratosis, and
the commonly used antibody tests cannot discriminate one disease
from the other.6
This paper reports on the recalled history of clinical manifesta-
* Corresponding author at: Francis Sarkodie Komfo Anokye Teaching Hospital,
Transfusion Medicine Unit Kumasi, Ghana. Tel.: +233244371770.
tions of yaws and syphilis by syphilis seroreactive blood donors in
E-mail address: fsarkodie29@gmail.com (F. Sarkodie). Kumasi, Ghana.

http://dx.doi.org/10.1016/j.ijid.2016.08.006
1201-9712/ß 2016 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
 F. Sarkodie et al. / International Journal of Infectious Diseases 50 (2016) 72–74 73

2. Methods There were fewer females (29/471; 6.2%) than males (442/471;
93.8%). Of the 471 respondents, 28 (5.9%) gave a history of skin
Of the total of 16 016 blood donors tested with a treponemal lesions and sores (Figure 1). Four (14.3%) individuals out of the
Fortress rapid test (Fortress Diagnostics Ltd, Antrim, UK) for T. 28 donors with a history of skin lesions and sores – all male and
pallidum in serum or plasma antibodies (IgG and IgM), 526 (3.3%) RPR-positive – recalled a diagnosis of syphilis. These four donors
were seroreactive for syphilis. These subjects were further tested had previously received penicillin treatment during their exposure
with the rapid plasma reagin test (RPR) (BD Macro-Vue Card test; to syphilis. Additionally, the four donors with a recall of syphilis
BD, Franklin Lakes, New Jersey, USA) to detect potential active diagnosis reported the appearance of lesions/bumps on the skin
infections. Out of these, 478 cases were confirmed with the Ortho- and slow-healing sores, but only one of them had had these
Vitros Syphilis TP test as the gold standard. Four hundred and symptoms before the age of 15 years. It could not be clarified
seventy-one of these confirmed syphilis seroreactive blood donors whether this donor had had yaws or syphilis at this young age,
were interviewed to determine past or present clinical manifesta- although he had been treated.
tions of yaws and syphilis (response rate of 98.5%) (Figure 1).
Subjects were interviewed by a laboratory scientist using a semi- 4. Discussion
structured questionnaire in the local dialect for the presence or
The data presented here suggest that a clinical history of yaws is
absence of current or previous sores or skin ulcers, and skin
not frequent among syphilis-positive blood donors. However,
lesions/bumps on the face, hands, feet, or genitals. They were also
syphilis symptoms were also not reported frequently. Children
asked about slow-healing sores and at what age they had
aged below 15 years are the most vulnerable to yaws infection.7
experienced symptoms. Furthermore, they were asked about
Only a small proportion of confirmed seroreactive donors had any
any treatment given at the time of these symptoms.
recall of symptoms or treatment of yaws or syphilis. Thus the
Data were recorded on an Excel spreadsheet and exported into
relative contribution of yaws and syphilis to frequent positive tests
Stata version 12.0 software (StataCorp, TX, USA) for analysis.
in endemic areas remains speculative. The present authors have
Approval for this study was obtained from the ethics committees of
previously suggested combined specific and non-specific syphilis
Kwame Nkrumah University of Science and Technology (KNUST),
testing to identify potential infectious donors.8 The present data
Kumasi, Ghana, and the Liverpool School of Tropical Medicine,
suggest that clinical questioning adds little further information to
Liverpool, UK.
this screening algorithm. As a limitation, donors were interviewed
3. Results after knowing that they had a positive test for syphilis. This
represents a risk of recall bias, with reporting being influenced by
The age of confirmed syphilis seroreactive subjects ranged from the test results. There is furthermore a risk of misclassification bias,
17 to 53 years (mean age 31 years, standard deviation 8.6 years). as many differential diagnoses exist for both syphilis and yaws.

Figure 1. Flowchart of syphilis seroreactive blood donors interviewed for clinical manifestations of yaws.
74 F. Sarkodie et al. / International Journal of Infectious Diseases 50 (2016) 72–74

However, despite these limitations, the conclusion that clinical Conflict of interest: None of the authors declare any conflict of
questioning adds little further information when investigating interest regarding this article.
syphilis seropositive blood donors in areas where both trepone-
matoses exist seems solid. References
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