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Yaws Treatment & Management

  • Author: Hassan I Galadari, MD; Chief Editor: William D James, MD  more...
 
Updated: Aug 17, 2015
 

Approach Considerations

Penicillin is the drug of choice for yaws. After a single penicillin injection, early lesions become noninfectious after 24 hours and heal within 1-2 weeks. Tetracycline, erythromycin, or doxycycline should be considered for patients allergic to penicillin.[17]

In one study in children in Papua New Guinea, oral azithromycin was found to be a reasonable alternative for treating yaws; in addition, it is a simpler regimen that does not require trained medical personnel for administration. In this study, children aged 6 months to 15 years who were diagnosed with yaws were randomly assigned to receive either one 30 mg/kg oral dose of azithromycin or an intramuscular (IM) injection of 50,000 units/kg of benzathine benzylpenicillin. After 6 months of follow-up, 96% of patients in the azithromycin group were cured, compared with 93% in the benzathine benzylpenicillin group.[9]

A new yaws eradication program was proposed in 2012 as the result of the azithromycin study conducted in Papua New Guinea.[9] The World Health Organization (WHO) has concluded that this new eradication campaign can completely eliminate yaws worldwide by 2020.[7]

Epidemiologic treatment recommendations for yaws are as follows:

  • If greater than 50% of children are seropositive (hyperendemic), treat the entire population
  • If 10-50% of children are seropositive (mesoendemic), treat active cases, contacts, and all children aged 15 years or younger
  • If less than 10 of children are seropositive (hypoendemic), treat active cases, household members, and other obvious contacts
 
 
Contributor Information and Disclosures
Author

Hassan I Galadari, MD Assistant Professor of Dermatology, Faculty of Medicine and Health Sciences, United Arab Emirates (UAE) University, UAE

Hassan I Galadari, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Medical Student Association/Foundation, American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Donald Belsito, MD Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center

Donald Belsito, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, New York County Medical Society, New York Dermatological Society, Noah Worcester Dermatological Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Richard B Brown, MD, FACP Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society

Disclosure: Nothing to disclose

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose

Gary L Gorby, MD Associate Professor, Departments of Internal Medicine and Medical Microbiology and Immunology, Division of Infectious Diseases, Creighton University School of Medicine; Associate Professor of Medicine, University of Nebraska Medical Center; Associate Chair, Omaha Veterans Affairs Medical Center

Gary L Gorby, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Natalie C Klein, MD, PhD Associate Director, Infectious Disease Division, Associate Professor of Medicine, The School of Medicine at Stony Brook University Medical Center

Natalie C Klein is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and New York County Medical Society

Disclosure: Nothing to disclose.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Caroline L Levine, MD Staff Physician, Department of Dermatology, Emerson Hospital, Mt Aburn Hospital

Caroline L Levine, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

References
  1. Koff AB, Rosen T. Nonvenereal treponematoses: yaws, endemic syphilis, and pinta. J Am Acad Dermatol. 1993 Oct. 29(4):519-35; quiz 536-8. [Medline].

  2. Sanchez MR. Endemic (Nonvenereal) Treponematoses. Freedberg IM, Eisen AZ, Wolff K, Austen F, Goldsmith LA, Katz S, eds. Fitzpatrick's Dermatology in General Medicine. 6th ed. New York, NY: McGraw-Hill; 2003.

  3. Yaws eradication: past efforts and future perspectives. Available at http://www.who.int/bulletin/volumes/86/7/08-055608/en/. Accessed: July 30, 2012.

  4. Lupi O, Madkan V, Tyring SK. Tropical dermatology: bacterial tropical diseases. J Am Acad Dermatol. 2006 Apr. 54(4):559-78; quiz 578-80. [Medline].

  5. Gerstl S, Kiwila G, Dhorda M, et al. Prevalence study of yaws in the Democratic Republic of Congo using the lot quality assurance sampling method. PLoS One. 2009 Jul 22. 4(7):e6338. [Medline]. [Full Text].

  6. Guerrier G, Marcon S, Garnotel L, Deltour R, Schinas S, Mathelin JP, et al. Yaws in Polynesia's Wallis and Futuna Islands: a seroprevalence survey. N Z Med J. 2011 Apr 29. 124(1333):29-31. [Medline].

  7. Consultation on yaws elimination 5-7 March 2012, WHO Headquarters, Geneva, Room M505. Available at http://www.who.int/neglected_diseases/NTD_RoadMap_2012_Fullversion.pdf. Accessed: July 30, 2012.

  8. Maurice J. WHO plans new yaws eradication campaign. Lancet. 2012 Apr 14. 379(9824):1377-8. [Medline].

  9. Mitjà O, Hays R, Ipai A, Penias M, Paru R, Fagaho D, et al. Single-dose azithromycin versus benzathine benzylpenicillin for treatment of yaws in children in Papua New Guinea: an open-label, non-inferiority, randomised trial. Lancet. 2012 Jan 28. 379(9813):342-7. [Medline].

  10. Agmon-Levin N, Bat-sheva PK, Barzilai O, et al. Antitreponemal antibodies leading to autoantibody production and protection from atherosclerosis in Kitavans from Papua New Guinea. Ann N Y Acad Sci. 2009 Sep. 1173:675-82. [Medline].

  11. Mitjà O, Hays R, Ipai A, Gubaila D, Lelngei F, Kiara M, et al. Outcome predictors in treatment of yaws. Emerg Infect Dis. 2011 Jun. 17(6):1083-5. [Medline].

  12. Etymologia: yaws. Emerg Infect Dis. 2011 Jun. 17(6):1082. [Medline].

  13. Rothschild BM, Heathcote GM. Characterization of the skeletal manifestations of the treponemal disease yaws as a population phenomenon. Clin Infect Dis. 1993 Aug. 17(2):198-203. [Medline].

  14. Capuano C, Ozaki M. Yaws in the Western pacific region: a review of the literature. J Trop Med. 2011. 2011:642832. [Medline]. [Full Text].

  15. Fegan D, Glennon MJ, Thami Y, Pakoa G. Resurgence of yaws in Tanna, Vanuatu: time for a new approach?. Trop Doct. 2010 Apr. 40(2):68-9. [Medline].

  16. Engelkens HJ, ten Kate FJ, Judanarso J, et al. The localisation of treponemes and characterisation of the inflammatory infiltrate in skin biopsies from patients with primary or secondary syphilis, or early infectious yaws. Genitourin Med. 1993 Apr. 69(2):102-7. [Medline].

  17. Farnsworth N, Rosen T. Endemic treponematosis: review and update. Clin Dermatol. 2006 May-Jun. 24(3):181-90. [Medline].

  18. Scolnik D, Aronson L, Lovinsky R, Toledano K, Glazier R, Eisenstadt J, et al. Efficacy of a targeted, oral penicillin-based yaws control program among children living in rural South America. Clin Infect Dis. 2003 May 15. 36(10):1232-8. [Medline].

  19. Manirakiza A, Boas SV, Beyam NE, Zadanga G, Konamna FX, Njuimo SP, et al. Clinical outcome of skin yaws lesions after treatment with benzathinebenzylpenicillin in a pygmy population in Lobaye, Central African Republic. BMC Res Notes. 2011 Dec 15. 4(1):543. [Medline].

  20. Mitjà O, Hays R, Rinaldi AC, McDermot R, Bassat Q. New treatment schemes for yaws: the path toward eradication. Clin Infect Dis. 2012 Aug. 55(3):406-12. [Medline].

 
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Initial papilloma, also called mother yaw or primary frambesioma (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
Plantar papillomata with hyperkeratotic macular plantar early yaws (ie, crab yaws) (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta.Geneva, Switzerland: World Health Organization; 1984.).
Osteoperiostitis of the tibia and fibula in early yaws (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
Early yaws papillomata (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
Early ulceropapillomatous yaws on the leg (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
Squamous macular palmar yaws (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
 
 
 
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