eMedicine Specialties > Infectious Diseases > Skin and Soft-Tissue Infections

Yaws: Treatment & Medication

Author: Natalie C Klein, MD, PhD, Associate Professor, Department of Medicine, Division of Infectious Diseases, SUNY School of Medicine at Stony Brook; Associate Director, Winthrop-University Hospital
Contributor Information and Disclosures

Updated: Nov 4, 2009

Treatment

Medical Care

  • Administer antibiotics.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Antibiotics

Benzathine penicillin is the DOC for treating yaws. In remote areas where benzathine penicillin is unavailable, oral penicillin V for 7-10 days can reduce the prevalence of yaws and is effective in treating individual children with active lesions.1


Benzathine penicillin G (Bicillin)

Interferes with cell wall synthesis during active multiplication, resulting in bactericidal activity against susceptible microorganisms.

Adult

2.4 million U IM once in 2 injection sites

Pediatric

50,000 U/kg IM once; not to exceed 2.4 million U

Probenecid can increase penicillin effectiveness by decreasing its clearance; coadministration with tetracyclines can decrease effectiveness

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in impaired renal function


Tetracycline (Achromycin, Sumycin)

Avoid benzathine penicillin in patients allergic to penicillin; tetracycline or erythromycin is alternate therapy.

Adult

500 mg PO qid for 15 d

Pediatric

<8 years: Not recommended
>8 years: 25-50 mg/kg/d (10-20 mg/lb) PO qid

Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; tetracyclines can increase hypoprothrombinemic effects of anticoagulants

Documented hypersensitivity; severe hepatic dysfunction

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines


Erythromycin (Erythrocin, E-Mycin, E.E.S.)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections. Indicated for the treatment of infections in children allergic to penicillin or in pregnant women.

Adult

250 mg erythromycin stearate/base (or 400 mg ethylsuccinate) PO q6h 1 h ac or 500 mg q12h
Alternately, use 333 mg PO q8h; increase up to 4 g/d depending on severity of infection

Pediatric

30-50 mg/kg/d (15-25 mg/lb/d) PO in divided doses; for severe infections, double dose

Theophylline, digoxin, carbamazepine, and cyclosporine toxicity may increase when administered concurrently; may potentiate anticoagulant effects of warfarin; when taken concurrently with lovastatin and simvastatin, risks of rhabdomyolysis significantly increase

Documented hypersensitivity; hepatic impairment

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in liver disease; estolate preparation may cause cholestatic jaundice; adverse GI effects are common (doses should be given after meals); discontinue use if nausea, vomiting, malaise, abdominal colic, and/or fever occur

More on Yaws

Overview: Yaws
Differential Diagnoses & Workup: Yaws
Treatment & Medication: Yaws
Follow-up: Yaws
Multimedia: Yaws
References
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References

  1. 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. May 15 2003;36(10):1232-8. [Medline].

  2. Anselmi M, Araujo E, Narvaez A, Cooper PJ, Guderian RH. Yaws in Ecuador: impact of control measures on the disease in the Province of Esmeraldas. Genitourin Med. Dec 1995;71(6):343-6. [Medline].

  3. Antal GM, Lukehart SA, Meheus AZ. The endemic treponematoses. Microbes Infect. Jan 2002;4(1):83-94. [Medline].

  4. Backhouse JL, Hudson BJ. Evaluation of immunoglobulin G enzyme immunoassay for serodiagnosis of yaws. J Clin Microbiol. Jul 1995;33(7):1875-8. [Medline].

  5. Bora D, Dhariwal AC, Lal S. Yaws and its eradication in India--a brief review. J Commun Dis. Mar 2005;37(1):1-11. [Medline].

  6. Chulay JD. Treponema Species (Yaws, Pinta Bejel). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Vol 2. 5th ed. Philadelphia, Pa: Churchill Livingstone; 2000:2490-4.

  7. Elimination of yaws in India. Wkly Epidemiol Rec. Apr 11 2008;83(15):125-32. [Medline].

  8. Engelkens HJ, Judanarso J, Oranje AP, Vuzevski VD, Niemel PL, van der Sluis JJ, et al. Endemic treponematoses. Part I. Yaws. Int J Dermatol. Feb 1991;30(2):77-83. [Medline].

  9. Engelkens HJ, Vuzevski VD, Stolz E. Nonvenereal treponematoses in tropical countries. Clin Dermatol. Mar-Apr 1999;17(2):143-52; discussion 105-6. [Medline].

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

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

  13. Hook III, EW. Treponemal Infections. In: Tropical Infectious Diseases: Principles, Pathogens, and Practice. Vol 1. 5th ed. Philadelphia, Pa: Churchill Livingstone; 1999:527-34.

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

  15. Macgregor JD. Disease in Africa: a medical perspective from the 1950s. Vesalius. Dec 2004;10(2):67-73. [Medline].

  16. Nnoruka EN. Skin diseases in south-east Nigeria: a current perspective. Int J Dermatol. Jan 2005;44(1):29-33. [Medline].

  17. Parish JL. Treponemal infections in the pediatric population. Clin Dermatol. Nov-Dec 2000;18(6):687-700. [Medline].

  18. Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.

  19. Rinaldi A. Yaws: A Second (and Maybe Last?) Chance for Eradication. PLoS Negl Trop Dis. 2008;2(8):e275. [Medline].

  20. Rothschild BM. History of syphilis. Clin Infect Dis. May 15 2005;40(10):1454-63. [Medline].

  21. Sarangapani S, Benjamin L. Posterior segment changes secondary to late yaws. Eye. Oct 2001;15(Pt 5):664-6. [Medline].

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Further Reading

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Keywords

yaws, framboesia, mother yaw, primary frambesioma, frambesia tropica, parangi, paru, buba, pian, bouba, endemic treponema, endemic treponematoses, treponemal infection, saber shins, hemagglutination, TPHA, microhemagglutination

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Contributor Information and Disclosures

Author

Natalie C Klein, MD, PhD, Associate Professor, Department of Medicine, Division of Infectious Diseases, SUNY School of Medicine at Stony Brook; Associate Director, Winthrop-University Hospital
Natalie C Klein, MD, PhD 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.

Medical Editor

Gary L Gorby, MD, Program Director of Adult Infectious Diseases Fellowship, Associate Professor, Department of Internal Medicine, Division of Infectious Disease, St Joseph Medical Center, Creighton University School of Medicine
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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

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.

 
 
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