• 1.

    Marks M, Solomon AW, Mabey DC, 2014. Endemic treponemal diseases. Trans R Soc Trop Med Hyg 108: 601607.

  • 2.

    Mitjà O, Hays R, Ipai A, Penias M, Paru R, Fagaho D, de Lazzari E, Bassat Q, 2012. Single-dose azithromycin versus benzathine benzylpenicillin for treatment of yaws in children in Papua New Guinea: an open-label, non-inferiority, randomised trial. Lancet 379: 342347.

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    • Export Citation
  • 3.

    Marks M, Goncalves A, Vahi V, Sokana O, Puiahi E, Zhang Z, Dalipanda T, Bottomley C, Mabey D, Solomon AW, 2014. Evaluation of a rapid diagnostic test for yaws infection in a community surveillance setting. PLoS Negl Trop Dis 8: e3156.

    • Search Google Scholar
    • Export Citation
  • 4.

    Marks M, Chi K-H, Vahi V, Pillay A, Sokana O, Pavluck A, Mabey DC, Chen CY, Solomon AW, 2014. Haemophilus ducreyi associated with skin ulcers among children, Solomon Islands. Emerg Infect Dis 20: 17051707.

    • Search Google Scholar
    • Export Citation
  • 5.

    Mitjà O, Lukehart SA, Pokowas G, Moses P, Kapa A, Godornes C, Robson J, Cherian S, Houinei W, Kazadi W, Siba P, de Lazzari E, Bassat Q, 2014. Haemophilus ducreyi as a cause of skin ulcers in children from a yaws-endemic area of Papua New Guinea: a prospective cohort study. Lancet Glob Health 2: e235e241.

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    • Export Citation

 

 

 

 

 

New Diagnostics for Yaws

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  • 1 Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • 2 The Hospital for Tropical Diseases, London, United Kingdom.

Yaws, caused by Treponema pallidum subsp. pertenue, is an important public health problem in many tropical countries.1 Like syphilis, the disease manifests in three stages; however, unlike syphilis, its route of transmission is non-genital skin-to-skin contact and not by sexual intercourse. Primary yaws manifests as either a papilloma or a chronic ulcer. Typically, ulcers are painless, with a raised edge and friable base (Figure 1). In secondary yaws, skin manifestations, involvement of the bones and joints including periostitis have been reported. Tertiary yaws develops in a minority of patients causing destructive lesions of the skin and soft tissues. Interest in yaws has been revived by the finding that azithromycin is a highly effective treatment of both primary and secondary yaws.2 Clinical diagnosis alone of primary yaws is unreliable, but a point-of-care test has been shown to be of value.3 This test provides a result analogous to a T. pallidum particle agglutination assay (Figure 2, line 1) and a rapid plasma reagin (RPR) assay (Figure 2, line 2). In early infection, only the RPR may be positive. Diagnosis has been further complicated by the discovery that Haemophilus ducreyi may cause clinically similar ulcers.4 New polymerase chain reaction (PCR) assays have been developed for yaws.5 DNA suitable for can be extracted directly from swabs collected into dry tubes without the need for transport medium. Figure 3 demonstrates real-time PCR amplification curves of positive and negative controls and a clinical swab from a yaws lesion containing T. pallidum pertenue DNA. Both serological and molecular tests have a major role to play in the World Health Organization yaws eradication campaign.

Figure 1.
Figure 1.

Classical primary ulcer of yaws.

Citation: The American Society of Tropical Medicine and Hygiene 96, 1; 10.4269/ajtmh.16-0639

Figure 2.
Figure 2.

Combined treponemal and nontreponemal rapid diagnostic test for yaws.

Citation: The American Society of Tropical Medicine and Hygiene 96, 1; 10.4269/ajtmh.16-0639

Figure 3.
Figure 3.

Quantitative polymerase chain reaction for yaws.

Citation: The American Society of Tropical Medicine and Hygiene 96, 1; 10.4269/ajtmh.16-0639

  • 1.

    Marks M, Solomon AW, Mabey DC, 2014. Endemic treponemal diseases. Trans R Soc Trop Med Hyg 108: 601607.

  • 2.

    Mitjà O, Hays R, Ipai A, Penias M, Paru R, Fagaho D, de Lazzari E, Bassat Q, 2012. Single-dose azithromycin versus benzathine benzylpenicillin for treatment of yaws in children in Papua New Guinea: an open-label, non-inferiority, randomised trial. Lancet 379: 342347.

    • Search Google Scholar
    • Export Citation
  • 3.

    Marks M, Goncalves A, Vahi V, Sokana O, Puiahi E, Zhang Z, Dalipanda T, Bottomley C, Mabey D, Solomon AW, 2014. Evaluation of a rapid diagnostic test for yaws infection in a community surveillance setting. PLoS Negl Trop Dis 8: e3156.

    • Search Google Scholar
    • Export Citation
  • 4.

    Marks M, Chi K-H, Vahi V, Pillay A, Sokana O, Pavluck A, Mabey DC, Chen CY, Solomon AW, 2014. Haemophilus ducreyi associated with skin ulcers among children, Solomon Islands. Emerg Infect Dis 20: 17051707.

    • Search Google Scholar
    • Export Citation
  • 5.

    Mitjà O, Lukehart SA, Pokowas G, Moses P, Kapa A, Godornes C, Robson J, Cherian S, Houinei W, Kazadi W, Siba P, de Lazzari E, Bassat Q, 2014. Haemophilus ducreyi as a cause of skin ulcers in children from a yaws-endemic area of Papua New Guinea: a prospective cohort study. Lancet Glob Health 2: e235e241.

    • Search Google Scholar
    • Export Citation

Author Notes

* Address correspondence to Michael Marks, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. E-mail: michael.marks@lshtm.ac.uk

Financial support: Michael Marks is supported by a Wellcome Trust Clinical Research Fellowship (102807) and Robert Butcher is supported by the Fred Hollows Foundation (1041).

Authors' addresses: Christian Kosizt and Robert Butcher, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mails: christian.kositz@gmail.com and robert.butcher@lshtm.ac.uk. Michael Marks, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom, and The Hospital for Tropical Diseases, London, United Kingdom, E-mail: michael.marks@lshtm.ac.uk.

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