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Bejel, Yaws, and Pinta

by Matthew E. Levison, 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 very contagious infections are usually spread in areas 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 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, as is syphilis. Unlike syphilis, these infections are transmitted by nonsexual contact—chiefly between children living in conditions of poor hygiene. Bejel may be spread when eating utensils are shared.

Bejel occurs mainly in the hot arid countries of the eastern Mediterranean region and Saharan West Africa. Yaws occurs in humid equatorial countries. Pinta is common among the natives of Mexico, Central America, and South America. 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 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, 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 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 soft nodules (granulomas) form, then break open on the face, arms, legs, and buttocks. The granulomas heal slowly and may recur. Painful open sores on the soles of the feet (crab yaws) may develop, making 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 affects only the skin. It begins as flat, itchy, 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. They develop where bones are close to skin, for example, on the elbow. Later, the patches lose their color. The affected skin on the palms and soles may thicken.

Diagnosis

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 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 are given tetracycline if they are 8 years old or older or erythromycin if they are pregnant or under 8 years old. These drugs are given by mouth.

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

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  • ACHROMYCIN V
  • ERY-TAB, ERYTHROCIN