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Author: Dr Jane Morgan, Sexual Health Physician, Hamilton, New Zealand, 2008.
Yaws is a chronic tropical skin infection that may also infect bones in its late stages.
Yaws is caused by a spiral-shaped bacterium (spiroch(a)ete), Treponema pallidum pertenue. Yaws belongs to the same family of bacteria as syphilis, Treponema pallidum pallidum.
Yaws may be locally known as pian, parangi, paru, patek, buoba, coko and tona.
Yaws was nearly eradicated by a worldwide treatment program in the 1950-60s. Between 1959-1961, people from Fiji, Samoa, Tonga, Cook Islands and Tokelau Islands were given injections of penicillin as part of a World Health Organisation (WHO) campaign.
However, a 2007 WHO report suggests yaws is on the rise again, mostly in poor, rural areas of West and Central Africa, Southeast Asia (Indonesia), and some Pacific Islands, such as Papua New Guinea and the Solomon Islands.
Yaws affects young children under 15 years of age. It occurs mainly in warm, humid, tropical areas of Africa, Southeast Asia, South America, and Oceania among poor rural populations living in overcrowded conditions.
Yaws is spread from person to person through direct contact with infectious ulcers. The bacteria enter the skin at sites of trauma such as scratches and bites on the legs.
Yaws is characterised by four distinct stages.
Yaws is usually diagnosed on the clinical findings of characteristic skin changes because T pallidum pertenue cannot be distinguished from T pallidum pallidum or other treponemal subspecies with commercially available laboratory tests. Other tests such as PCR are not yet routinely available.
Spirochetes may be detected during the primary or secondary infectious stages by dark-field microscopic examination of tissue or tissue fluid taken from a papule, ulcer or lymph node.
There are two important blood tests:
Blood tests are often done for syphilis as part of antenatal screening, an immigration medical, or as a workup for undiagnosed health problems. It can be difficult to work out the exact cause for a positive result.
Positive syphilis test results may be due to current or past infection with any treponeme, as the same antibody is produced in response to yaws, syphilis and a less common infection, pinta.
Because of the potentially severe consequences of late syphilis infection, it is prudent to assume anyone born after 1960 has syphilis and to treat accordingly, unless there is clear documentation suggesting otherwise.
If appropriately treated in its early stages, yaws is highly curable. A single injection of long-acting penicillin into a muscle is effective.
Skin lesions may take several months to heal. If treated in its late stage, significant disfigurement may persist permanently.
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