Treponematosis (Endemic Syphilis) Medication
- Author: Steven Fine, MD, PhD; Chief Editor: Mark R Wallace, MD, FACP, FIDSA more...
The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.
Treponemes are highly sensitive to azithromycin and penicillin, which remain the drugs of choice. Yaws, pinta, and endemic syphilis are treated with azithromycin or penicillin G benzathine. Alternatives are appropriate only if penicillin cannot be used. Tetracyclines or chloramphenicol have been used. Treatment failures with penicillin have been reported, but reinfection could not be ruled out.
Azithromycin acts by binding to the 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Nucleic acid synthesis is not affected.
Azithromycin concentrates in phagocytes and fibroblasts as demonstrated by in vitro incubation techniques. In vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues. This drug is used to treat mild-to-moderate microbial infections.
Interferes with synthesis of cell wall mucopeptides during active multiplication, which results in bactericidal activity. Combination of 1 M penicillin and 2 M ammonium base. Repository form providing tissue depot from which the drug is absorbed over days. Must be administered IM and provides detectable serum levels for 15-30 d.
Treats gram-positive and gram-negative organisms as well as mycoplasmal, chlamydial, and rickettsial infections. Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s).
Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.
Binds to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. Effective against gram-negative and gram-positive bacteria. Well-absorbed from GI tract and metabolized in the liver, where it is inactivated by conjugation with glucuronic acid and then excreted by the kidneys.
Smajs D, Norris SJ, Weinstock GM. Genetic diversity in Treponema pallidum: Implications for pathogenesis, evolution and molecular diagnostics of syphilis and yaws. Infect Genet Evol. 2011 Dec 15. [Medline].
Mikalová L, Strouhal M, Cejková D, Zobaníková M, Pospíšilová P, Norris SJ, et al. Genome analysis of Treponema pallidum subsp. pallidum and subsp. pertenue strains: most of the genetic differences are localized in six regions. PLoS One. 2010 Dec 29. 5(12):e15713. [Medline]. [Full Text].
Centers for Disease Control and Prevention. Notice to readers: Recommendations regarding screening of refugee children for treponemal infection. MMWR Morb Mortal Wkly Rep. 2005. 54(37):933-4. [Full Text].
Julvez J, Michault A, Kerdelhue V. [Serologic studies of non-venereal treponematoses in infants in Niamey, Niger]. Med Trop (Mars). 1998. 58(1):38-40. [Medline].
World Health Organization. Yaws, Fact sheet no. 316, Updated February 2014. World Health Organization. Available at http://www.who.int/mediacentre/factsheets/fs316/en/. Accessed: June 4, 2014.
Maurice J. WHO plans new yaws eradication campaign. Lancet. 2012 Apr 14. 379(9824):1377-8. [Medline].
Tabbara KF, al Kaff AS, Fadel T. Ocular manifestations of endemic syphilis (bejel). Ophthalmology. 1989 Jul. 96(7):1087-91. [Medline].
Marks M, Mitjà O, Solomon AW, Asiedu KB, Mabey DC. Yaws. Br Med Bull. 2015 Mar. 113 (1):91-100. [Medline].
Backhouse JL, Hudson BJ, Hamilton PA. Failure of penicillin treatment of yaws on Karkar Island, Papua New Guinea. Am J Trop Med Hyg. 1998 Sep. 59(3):388-92. [Medline].
Kazura JW. Yaws eradication--a goal finally within reach. N Engl J Med. 2015 Feb 19. 372 (8):693-5. [Medline].
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].
Agadzi VK, Aboagye-Atta Y, Nelson JW. Resurgence of yaws in Ghana. Lancet. 1983 Aug 13. 2(8346):389-90. [Medline].
Anselmi M, Araujo E, Narvaez A. Yaws in Ecuador: impact of control measures on the disease in the Province of Esmeraldas. Genitourin Med. 1995 Dec. 71(6):343-6. [Medline].
Chulay JD. Treponema species (Yaws, Pinta, Bejel). Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Infectious Diseases. New York, NY: Churchill Livingston; 2000. 2490-4.
Engelkens HJ, Judanarso J, Oranje AP. Endemic treponematoses. Part I. Yaws. Int J Dermatol. 1991 Feb. 30(2):77-83. [Medline].
Farnsworth N, Rosen T. Endemic treponematosis: review and update. Clin Dermatol. 2006 May-Jun. 24(3):181-90. [Medline].
Kim SC, Guerrero R, Gonzalez R. A 23-year-old pregnant woman with left-foot and left-ankle ulceration. Clin Infect Dis. 2004 Jul 1. 39(1):81-2, 136-7. [Medline].
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].
Oriol Mitjà, Kingsley Asiedu, David Mabey. Published OnlineSeminar. Yaws February 13, 2013http://dx.doi.org/10.1016/S0140-6736(12)62130-8.
Perine PL, Hopkins DR, Niemel PLA. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. WHO Publications Centre, USA: World Health Organization; 1984.
Second International Conference on Control of Yaws. Report of Second International Conference on Control of Yaws: Nigeria, 1955. II. J Trop Med Hyg. 1957 Mar. 60(3):62-73. [Medline].
Vabres P, Roose B, Berdah S. [Bejel: an unusual cause of stomatitis in the child]. Ann Dermatol Venereol. 1999 Jan. 126(1):49-50. [Medline].
Walker DH, Guerrant RL, Weller PF. Treponemal infections. Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases: Principles, Pathogens, and Practice. New York, NY: Churchill Livingstone; 1999. 527-34.
Walker SL, Hay RJ. Yaws-a review of the last 50 years. Int J Dermatol. 2000 Apr. 39(4):258-60. [Medline].
World Health Organization. 1998 World Health Report: Health in the 21st Century: A Vision for All. 1998.
World Health Organization. WHO Expert Committee on Venereal Infections. Report on the third session. Vol 13. 1950.
Marks M, Lebari D, Solomon AW, Higgins SP. Yaws. Int J STD AIDS. 2015 Sep. 26 (10):696-703. [Medline].