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Key Features

  • A non–sexually transmitted spirochetal infection caused by Treponema pallidum subspecies carateum

  • Occurs endemically in rural areas of Latin America, especially in Mexico, Colombia, and Cuba, and in some areas of the Pacific

Clinical Findings

  • Nonulcerative, erythematous primary papule

    • Spreads slowly into a papulosquamous plaque

    • Shows a variety of color changes (slate, lilac, black)

  • Secondary lesions

    • Resemble the primary one and appear within a year after it

    • Appear successively, new lesions together with older ones

    • Occur most common on the extremities

    • Later show atrophy and depigmentation

  • Some cases show pigmentary changes and atrophic patches on the soles and palms, with or without hyperkeratosis, that are indistinguishable from "crab yaws"

Diagnosis

  • Organisms can be demonstrated in infectious lesions with darkfield microscopy or immunofluorescence but cannot be cultured in artificial media

  • Serologic tests for syphilis are positive

Treatment

  • Penicillin, 2.4 million units of benzathine penicillin G intramuscularly, is generally curative in any stage of the non–sexually transmitted treponematoses

  • In cases of penicillin hypersensitivity, tetracycline, 500 mg orally four times a day for 10–14 days, is the recommended alternative

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