YAWS

also called frambesia contagious disease occurring in moist tropical regions throughout the world. It is caused by a spirochete, Treponema pertenue, that is structurally indistinguishable from T. pallidum, which causes syphilis. Some syphilologists contend that yaws is merely a tropical rural form of syphilis, but yaws is not contracted primarily through sexual activity, and later systemic complications from the disease are much rarer than in syphilis. The Wassermann and Kahn tests for syphilis, however, often read positive with yaws, and there is some degree of cross-immunity. The spirochetes of yaws are present in the discharge from lesions on the skin and are transferred by direct contact to the abraded skin of an uninfected person; by contaminated clothing; and by flies that feed on the sores. The disease is most frequently contracted in early childhood, and considerable immunity to subsequent infection is acquired. Yaws has three stages. The symptoms are an initial papule on the skin at the site of inoculation, followed by multiple cauliflower eruptions, and later, in some cases, by mutilating destruction of the skin, mucous membranes, and bones. The primary yaws sore is characterized by a wartlike thickening of the epidermis, which becomes fibrous, cracks open, bleeds easily, and discharges a serous fluid. A month or more later, when the first lesion may have disappeared except for a scar, multiple eruptions of the same type characteristically develop, often at junctions of the skin and mucous membranes, as around the mouth, nose, and anus, or on the skin of the crotch, neck, arms, legs, and buttocks. These lesions, whether initial or secondary, are yellowish-red and look somewhat like a raspberry (hence the name frambesia, latinized from the French framboise: raspberry). Later, the disease may subside, leaving only superficial scarring, but in some instances there may be deforming tertiary yaws involving the nose, long bones (boomerang leg of Australia), and, rarely, the spleen, brain, and great blood vessels. Penicillin is rapidly effective in killing the spirochete and in curing yaws except in the tertiary stage, when oxophenarsine with bismuth subsalicylate is used. Prevention centres on isolating and promptly treating cases to reduce exposure and on maintaining personal and group hygiene. All abrasions and sores of the skin and mucous membranes should be treated with appropriate antiseptics and covered with clean dressings, and all clothing in contact with yaws lesions should be sterilized or destroyed.