Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 34-06: Pinta + Key Features Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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