Bejel is a chronic skin and tissue disease caused by infection by a subspecies of the spirochete Treponema pallidum.

Although the organism that causes bejel, Treponema pallidum endemicum, is morphologically and serologicallyindistinguishable from Treponema pallidum pallidum, which causes venereal syphilis, transmission of bejel is not venereal in nature, generally resulting from mouth-to-mouth contact or sharing of domestic utensils, and the courses of the two diseases are somewhat different.

Regions and countries endemic for Treponema pallidum subspecies^[1]

Because the diseases caused by T. pallidum subsp. pertenue, T. pallidum subsp. endemicum, and T. carateum (i.e.,yaws, bejel/endemic syphilis, andpinta, respectively) usually occur during childhood, the CDC recommends that all refugee children from areas where treponemes are known to be endemicundergo nontreponemal serologic testing at the initial health screening.^[2] If the screening test is positive, a treponemal confirmatory test should be performed.

Bejel usually begins in childhood as a small mucous patch, often on the interior of the mouth, followed by the appearance of raised, eroding lesions on the limbs and trunk. Periostitis (inflammation) of the leg bones is commonly seen, and gummas of the nose and soft palate develop in later stages.

Bejel is treatable with penicillin or other antibiotics, and with treatment a complete recovery is expected.

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Although the organism that causes bejel, Treponema pallidum endemicum, is morphologically and serologically indistinguishable from Treponema pallidum pallidum, which causes venereal syphilis, transmission of bejel is not venereal in nature, generally resulting from mouth-to-mouth contact or sharing of domestic utensils, and the courses of the two diseases are somewhat different.

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Bejel is mainly found in arid countries of the eastern Mediterranean region and in West Africa, where it is known as sahel.

Regions and countries endemic for Treponema pallidum subspecies ^[1]:

• Angola
• Benin
• Botswana
• Burkina Faso
• Cameroon
• Central African Republic
• Chad
• Cote d’Ivoire
• Democratic Republic of the Congo Table 3. Regions and countries endemic for Treponema pallidum subspecies
• Ethiopia
• Gabon
• Ghana
• Liberia
• Mali
• Mauritania
• Niger
• Republic of the Congo
• Rwanda
• Senegal
• Somalia
• South Africa
• Sudan
• Togo

• Colombia
• Ecuador
• Haiti
• Guyana
• Martinique
• Mexico
• Surinam
• Venezuela

• Cambodia
• India
• Indonesia
• Pakistan
• Sri Lanka
• Middle East

• Saudi Arabia

• Papua New Guinea
• Solomon Islands
• Vanuatu

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Because the diseases caused by T. pallidum subsp. pertenue, T. pallidum subsp. endemicum, and T. carateum (i.e.,yaws, bejel/endemic syphilis, and pinta, respectively) usually occur during childhood, the CDC recommends that all refugee children from areas where treponemes are known to be endemic undergo nontreponemal serologic testing at the initial health screening.^[1] If the screening test is positive, a treponemal confirmatory test should be performed.

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