Bejel, Yaws, and Pinta
Bejel (previously called endemic syphilis), yaws (frambesia), and pinta are nonsexually transmitted infections caused by treponemal spirochetes closely related to Treponema pallidum, the bacterium that causes the sexually transmitted disease syphilis.
Bejel, yaws, and pinta (collectively referred to as treponematoses) are diseases closely related to syphilis (see Section 17, Chapter 200) that mainly occur in the tropics and subtropics. Unlike syphilis, they are transmitted by nonsexual skin contact--chiefly between children living in conditions of poor hygiene.
Like syphilis, these diseases begin with skin sores and have a latent period that is followed by more destructive disease. Bejel occurs mainly in the arid countries of the eastern Mediterranean region and West Africa. Yaws occurs in humid equatorial countries. Pinta is common among the Indians of Mexico, Central America, and South America.
Symptoms
Bejel affects the skin, bones, and mucous membranes of the mouth. Symptoms begin with a slimy patch on the inside of the mouth followed by blisters on the trunk, arms, and legs. Bone infection develops later, mainly in the legs. Also in later stages, soft, gummy lumps may appear in the nose and on the roof of the mouth (soft palate).
Yaws affects the skin and bones. It begins several weeks after exposure to Treponema as a slightly raised sore at the site of infection, usually on a leg. The sore heals, but soft nodules of tissue (granulomas) erupt on the face, arms, legs, and buttocks. These granulomas heal slowly and may recur. Painful open sores may develop on the soles of the feet (crab yaws). Later, areas of the shinbones may be destroyed, and many other disfiguring growths, especially around the nose (gangosa), may develop.
Pinta involves only the skin. It begins as flat, reddened areas on the hands, feet, legs, arms, face, or neck. After several months, slate blue patches develop in the same areas on both sides of the body and over bony places, such as the elbow. Later, the patches lose their pigmentation. Thickened skin may develop in the patches on the palms and soles.
Diagnosis and Treatment
A doctor makes the diagnosis when typical symptoms appear in a person who lives in or has visited an area where such diseases are common. Because the bacteria causing the treponematoses and syphilis are so similar, a person with one of these infections tests positive for syphilis. Standard tests cannot distinguish between treponematoses and syphilis.
The lesions are destructive and leave scars. However, a single injection of penicillin kills the bacteria, so the skin can heal. Tetracycline and chloramphenicol given by mouth are also effective. Because the diseases are very contagious, public health measures seek out and treat infected people and their close contacts.
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