oa South African Medical Journal - Endemic syphilis in a South African Coloured Community
It is popularly supposed that syphilis is acquired only congenitally or venereally. But where suitable conditions favourable to its spread are found, namely a high syphilis rate and low standards of living, it is possible for the disease to spread by contact among the age-group most vulnerable, the children. The disease is probably endemic, but improved medical supervision may make it appear as a sudden outbreak or epidemic. The signs of the disease are indistinguishable from congenital syphilis or from secondary venereal syphilis, its true nature being suspected only from the age-group attacked and the suggestion of contact-spread.
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