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Bejel, pinta,
and yaws (endemic treponematoses) are chronic, tropical, nonvenereal,
spirochetal infections spread by body contact. Symptoms of bejel
are mucous membrane and mucocutaneous lesions, followed by bone
and skin gummas. Yaws causes periostitis and dermal lesions. Pinta
lesions are confined to the dermis. Diagnosis is clinical and epidemiologic. Treatment
is with penicillin.
The causative agents, Treponema pallidum subsp endemicum (bejel), T. pallidum subsp pertenue (yaws), and T. carateum (pinta), are morphologically and serologically indistinguishable from the agent of syphilis, T. pallidum subsp pallidum. Like syphilis, the typical course is an initial mucocutaneous lesion followed by diffuse secondary lesions, a latent period, and late destructive disease.
Transmission is by close skin contact—sexual or not—primarily between children living in conditions of poor hygiene. Bejel (endemic syphilis) occurs mainly in arid countries of the eastern Mediterranean and West Africa (Sahel). Transmission results from mouth-to-mouth contact or sharing eating and drinking utensils. Yaws (frambesia) is found in humid equatorial countries, where transmission is favored by scanty clothing and skin trauma. Pinta occurs among the natives of Mexico, Central America, and South America and is not very contagious. Transmission probably requires contact with broken skin.
Symptoms and Signs
Bejel begins in childhood as a mucous patch, usually on the buccal mucosa, followed by papulosquamous and erosive papular lesions of the trunk and extremities. Periostitis of the leg bones is common. Later, gummatous lesions of the nose and soft palate develop.
Yaws, after an incubation period of several weeks, begins as a granulomatous or macular lesion at the inoculation site, usually on the legs. The lesion heals but is followed by a generalized eruption of soft granulomas on the face, extremities, and buttocks, often at mucocutaneous junctions. Granulomas heal slowly and may recur. Keratotic lesions may develop on the soles, causing painful ulcerations (crab yaws). Later, destructive lesions may develop, including periostitis (particularly of the tibia), proliferative exostoses of the nasal portion of the maxillary bone (goundou), juxta-articular nodules, gummatous skin lesions, and, ultimately, mutilating facial ulcers, particularly around the nose (gangosa).
Pinta lesions are confined to the dermis. They begin at the inoculation site as small papules and progress over several months to erythematous squamous plaques, mainly on the extremities, face, and neck. Later, symmetric slate-blue patches develop, usually on the face and extremities and over bony prominences. Still later, lesions become depigmented, resembling vitiligo. Hyperkeratosis may occur on the soles and palms. Destructive lesions leave a scar.
Diagnosis
and Treatment
Diagnosis is by the typical appearance of lesions in people from endemic areas. Serologic tests for syphilis (the Venereal Disease Research Laboratory [VDRL] and fluorescent treponemal antibody absorption tests) are positive; thus, differentiation from venereal syphilis is clinical. Early lesions are often darkfield-positive for spirochetes and are indistinguishable from T. pallidum subsp pallidum.
Active disease is treated with 1 dose of penicillin benzathine 1.2 million units IM. Children < 45 kg should receive 600,000 units IM. Public health control includes active case finding and treatment of family and close contacts with penicillin benzathine.
Last full review/revision November 2005
Content last modified November 2005
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