Makindo Medical Notes

Related Subjects: |Treponema |Bejel (Endemic syphilis) |Pinta |Yaws (Frambesia) |Syphilis

🌍 Bejel is a chronic, nonvenereal treponemal infection, spread by close body contact. The word “Bejel” comes from a Bedouin term. It occurs mainly among seminomadic tribes in the arid regions of North Africa, Southwest Asia, and the eastern Mediterranean. It is one of the three endemic treponematoses (with Yaws and Pinta).

🔎 About

• Seen mostly in children in poor rural populations with low hygiene standards.
• Endemic in hot, dry regions such as the eastern Mediterranean and Saharan West Africa.
• Spread by close household contact rather than sexual transmission.

🧬 Aetiology

• Caused by Treponema pallidum subspecies endemicum.
• Spread through skin-to-skin contact, sharing of utensils, or oral contact.

🩺 Clinical Features

• Transmission often via mouth-to-mouth contact or contaminated drinking vessels.
• Affects skin, oral mucosa, and skeletal system.
• Early signs:
  • Shallow, painless ulcers ± laryngitis.
  • Split papules, angular cheilitis.
  • Condylomatous lesions in axillae/groin folds.
  • Non-pruritic generalized papular rash.
• Other findings:
  • Generalized lymphadenopathy.
  • Osteoperiostitis of long bones → nocturnal leg pain.
  • Eye involvement: uveitis, choroiditis, optic atrophy.

🔬 Investigations

• Microscopy: Dark-field detection of spirochaetes from active lesions.
• Serology: Positive syphilis tests (VDRL, TPHA, RPR, FTA-ABS).

💊 Management

• First-line: Azithromycin (PO) single dose 30 mg/kg (max 2 g).
• Alternative: Benzathine penicillin (IM):
  • 0.6 million units if <10 years old.
  • 1.2 million units if ≥10 years old.
• Mass treatment programmes in endemic areas are highly effective in reducing transmission.

📚 References

• WHO: Endemic Treponematoses (Yaws, Bejel, Pinta)
• BNF: Azithromycin