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Yaws Disease
Yaws is a skin disease you get from the bacteria Treponema pallidum pertenue. You get it through contact with the broken skin of someone who has it. It causes skin growths that can spread and cause serious damage to your skin, bones and tissues if left untreated. Antibiotics can cure yaws but can’t reverse extensive damage.
Yaws Understanding
Yaws is a chronic and potentially disfiguring skin disease caused by a bacterial infection. It results from an infection with a specific subspecies of the bacterium Treponema pallidum (T. pallidum). Yaws gives rise to skin lesions that initially develop in one area and can subsequently spread to other parts of the body. If left untreated, the infection can recur months or even years later, leading to permanent damage to the skin, bones, and tissues.
Yaws belongs to a group of bacterial infections known as endemic treponematoses and is also referred to by alternative names such as “pian,” “framboesia,” and “bouba.”
Yaws Stages
Yaws in four potential stages:
- Primary Yaws: This marks the onset of symptoms, characterized by the appearance of a skin lesion. Initially, it starts as a small growth, which then enlarges, forms a crust, and may persist for three to six months.
- Secondary Yaws: Secondary yaws typically occurs several months after the initial symptoms. It results in multiple skin lesions, often progressing to bone infections.
- Latent Yaws: Latent yaws is a stage where individuals test positive for T. pallidum but do not exhibit any symptoms. This latent period can last for years, during which individuals may still be contagious.
- Tertiary (Late) Yaws: Without treatment, approximately 10% of individuals develop tertiary yaws, also known as “late yaws,” five to ten years after the initial symptoms. Tertiary yaws results in widespread and destructive skin lesions.
Distinguishing Yaws from Syphilis
Yaws is caused by bacteria closely related to those responsible for syphilis. However, yaws is not transmitted through sexual contact; instead, it spreads through direct skin-to-skin contact.
Symptoms and Causes
Symptoms of Yaws:
The primary symptoms of yaws are the development of skin nodules, ulcers, and sores that evolve through three distinct phases. Additional symptoms may include:
- Swollen lymph nodes.
- Bone pain and swelling.
- Fatigue.
- General malaise.
Primary Yaws Symptoms:
Primary yaws typically represents the initial manifestation upon infection with Treponema pallidum pertenue. It can emerge anywhere on the body but is most commonly observed on the legs or feet. Often referred to as the “mother yaw,” it begins as a cyst, evolving into a sizable, itchy ulcer that may be pus-filled and eventually crusts over. It can spontaneously heal over several months, leaving behind a scar.
Secondary Yaws Symptoms:
Secondary yaws symptoms typically appear one to two months after the initial lesion, but they can manifest up to two years later. Secondary yaws results in multiple skin lesions, often on the hands, arms, legs, or feet. These lesions may exhibit wart-like, ulcer-like, raised and bumpy, red or yellow, scaly and flat, or hard and thick characteristics. During this stage, yaws can extend to the bones, leading to pain and swelling in the fingers, toes, arms, or legs.
Tertiary Yaws Symptoms:
Without treatment, some individuals develop late yaws (tertiary) five to ten years after the initial symptoms. This stage involves extensive skin lesions distributed across various body parts, including large growths near joints, deep skin, cartilage, and bone wounds, as well as hard plaques on the hands and feet.
Causes of Yaws:
Yaws is caused by a specific subspecies of the bacterium Treponema pallidum. During the first two stages of yaws, the skin lesions contain live bacteria, and infection can occur through contact with these ulcers or skin growths of an individual with yaws.
Is Yaws Contagious?
Yes, yaws is contagious and spreads through direct skin-to-skin contact with yaws lesions. It is contagious during the first two stages but not during the third (tertiary) stage.
Who Is at Risk for Yaws?
In regions where yaws is prevalent, children under the age of 15 are at the highest risk of contracting the disease, although adults can also be affected. Over time, adults living in endemic areas may develop immunity to the infection, whereas individuals from non-endemic areas traveling to these regions may lack such immunity.
Geographical Distribution of Yaws:
Yaws is primarily found in humid tropical regions, including:
- Southeast Asia.
- West and Central Africa.
- The Pacific Islands.
It is typically encountered in rural areas, where transmission is more likely.
Complications of Yaws:
Complications associated with yaws include:
- Dactylitis (swollen fingers and toes).
- Periostitis (infection of bones or their lining).
- Tissue necrosis.
- Disfigurement.
- Gangosa (destruction of bone and cartilage in the nose).
- Secondary bacterial infections.
- Impaired mobility or other physical limitations resulting from damage to the body.
Diagnosis and Tests
Diagnosing Yaws:
Healthcare providers diagnose yaws through clinical examination of the skin and inquiry into the patient’s medical history. They may also conduct tests on samples from the sores or blood to detect the presence of T. pallidum. Microscopically, the bacteria responsible for yaws and syphilis appear identical, and differentiation relies on the patient’s symptoms.
Management and Treatment
Is Yaws Curable?
Yes, yaws is curable, and a single high-dose antibiotic treatment is highly effective. Healthcare providers typically treat yaws with a single dose of azithromycin or an injection of benzathine penicillin G. Yaws can be treated at any stage, but early intervention reduces the risk of severe complications.
Prevention
Preventing Yaws:
Prevention of yaws involves avoiding skin-to-skin contact with individuals who have yaws lesions. Additionally, healthcare providers may administer antibiotics to close contacts of yaws patients to prevent infection.
The World Health Organization (WHO) is actively working on the global eradication of yaws by providing treatment to all individuals, whether symptomatic or asymptomatic, in communities where yaws is prevalent.
Outlook/Prognosis
The prognosis for yaws is generally favorable if treated early in the infection. However, if left untreated, yaws can lead to permanent scarring and disfigurement as it spreads.
Living With
When to Seek Medical Attention:
Consult a healthcare provider if:
- You have traveled to or reside in a yaws-endemic area and exhibit symptoms.
- You have had close contact with an individual diagnosed with yaws.
- You have a non-healing or recurrent wound.
Early treatment can effectively cure the infection before it results in permanent damage.
When to Visit the Emergency Room:
Visit the emergency room if you experience signs of a severe infection, including:
- High fever (above 103 degrees Fahrenheit/40 degrees Celsius).
- Red, hot, or painful skin around a wound.
- Dizziness or weakness.
- Rapid heart rate.
- Low blood pressure.
- Reduced or minimal urination.
Questions to Ask Your Doctor:
Consider asking your healthcare provider the following questions:
- What stage of yaws is this?
- Will my skin lesions heal, and how can I care for them during the healing process?
- Should my close contacts receive antibiotic treatment?
- How long will I remain contagious?
