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Bejel, Yaws, and Pinta

by Larry M. Bush, MD

Bejel, yaws (frambesia), and pinta are infections caused by bacteria (called treponemal spirochetes) that are closely related to Treponema pallidum, which causes the sexually transmitted disease syphilis.

  • These usually very contagious infections are often spread in regions where hygiene is poor.

  • Bejel causes mouth sores and destructive lumps in bone, yaws causes skin sores and disfiguring growths on the legs and around the nose and mouth, and pinta causes itchy, thickened, discolored patches on the skin.

  • Doctors diagnose these infections when people have typical symptoms and have spent time in areas where the infections are common.

  • One injection of penicillin kills the bacteria.

Bejel, yaws, and pinta are treponematoses (disorders caused by Treponema bacteria), as is syphilis. Syphilis is transmitted only by sexual contact, whereas these infections are transmitted by any close contact (sexual or not) with the skin of an infected person—chiefly between children living in conditions of poor hygiene. Bejel may be spread when eating utensils are shared. Also unlike syphilis, these infections are not spread through contact with contaminated blood or from mother to fetus during pregnancy.

Bejel occurs mainly in the hot arid countries of the eastern Mediterranean region, southwest Asia, and North Africa. Yaws occurs in humid equatorial countries. Pinta is common among the natives of Mexico, Central America, and South America. Pinta is not very contagious. Bejel, yaws, and pinta rarely occur in the United States, except among immigrants from areas of the world where these diseases are common.

Symptoms

Yaws and pinta, like syphilis, begin with skin symptoms. Bejel begins with mouth sores. These symptoms subside, and after a period with few or no symptoms, new symptoms develop.

Bejel

Bejel affects the mucous membranes of the mouth, then the skin and bones. The initial mouth sore may not be noticed. Moist patches then develop in the mouth. They resolve over a period of months to years. During this time, people have few or no symptoms. Then, sores may develop on the trunk and limbs.

Lumps develop in long bones, mainly leg bones, and in the tissues around the mouth, nose, and roof of the mouth (palate). These lumps destroy tissue, causing bones to be deformed and disfiguring the face.

Yaws

Yaws also affects the skin and bones. Several weeks after exposure to Treponema, yaws begins as a slightly raised sore at the site of infection, usually on a leg. The sore heals, but later, soft nodules (granulomas) form, then break open on the face, arms, legs, and buttocks. The granulomas heal slowly and may recur. The skin on the palms and soles of the feet may thicken and break open to form painful sores. The sores on the feet (crab yaws) make walking difficult.

Later, areas of the shinbones may be destroyed, and many other destructive, disfiguring growths (gangosa), especially around the nose, mouth, and palate, may develop.

Pinta

Pinta affects only the skin. It begins as flat, itchy, reddened areas on the hands, feet, legs, arms, face, or neck. These areas enlarge and thicken. After several months, thick, flat patches develop all over the body. They tend to develop where bones are close to skin, for example, on the elbow.

Later, the patches lose their color or turn gray-blue. Without treatment, these patches usually do not go away.

Diagnosis

  • A doctor's evaluation

Doctors make the diagnosis when typical symptoms appear in people who live in or have visited an area where such infections are common. Because the bacteria that cause these infections and the bacteria that cause syphilis are so similar, people who have one of these infections test positive for syphilis.

Treatment

  • A single injection of penicillin or a single dose of azithromycin by mouth

A single injection of long-acting penicillin (benzathine penicillin) kills the bacteria. Then, the skin can heal. However, some scarring may remain, particularly if a lot of tissue has been destroyed. People who are allergic to penicillin may be given a single dose of azithromycin by mouth. For people who are not pregnant or are under 8 years old, doxycycline given by mouth for 14 days is an alternative.

Because the infections are very contagious, public health officials try to identify and treat infected people and their close contacts.

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • ZITHROMAX
  • PERIOSTAT, VIBRAMYCIN