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Bejel
Last reviewed: 05.07.2025
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Bejel is a unique type of tropical treponematosis, observed mainly in children in Arab countries and manifested by lesions of the skin at various stages, and of the skeletal system at later stages.
Currently, bejel is found mainly in Arab countries (Syria, Yemen, Iraq, Jordan, United Arab Emirates), India, Afghanistan. The independence of bejel as a special nosology is based on the following points: there is a predominantly domestic nature of infection, the defeat of mainly children, frequent absence of primary affect, clear cyclicity of the course, absence of congenital transmission and lesions of internal organs and the nervous system, high efficiency of treatment.
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Epidemiology of bejel
The source of infection is a sick person. Infection usually occurs through everyday contact. The spread of infection is facilitated by the low sanitary and cultural standard of living of the population, the habit of drinking and eating from common utensils, frequent ablutions in mosques and homes. Children in poor rural families are most often infected. Children aged 2-10 years are especially susceptible to infection with bejel. 30-70% of patients are under 15 years old, and only 1% from 20 to 30 years old. Adults, as a rule, become infected from their children.
Bejel has a clearly endemic character and in one locality can affect up to 40-60% of the inhabitants.
What causes bejel?
The causative agent of bejel is Treponema bejel, in morphological and biological properties it is indistinguishable from the causative agents of syphilis and yaws. No significant differences were found in electron microscopic studies. In the experiment, vaccinations were successful in rabbits.
Symptoms of Bejel
There is no reliable data on the duration of the incubation period, it is believed that it is usually 2-5 weeks. This uncertainty is due to the fact that, unlike syphilis and yaws, with bejel the affect usually remains unnoticed, and the earliest symptoms of bejel are disseminated rash on the skin and mucous membranes. Probably, the pathogen is capable of rapid generalization from the entry gate.
The rash is usually localized on the trunk and face, less often on the limbs. The typical location of the rash is in the areas where the skin transitions to the mucous membrane (corners of the mouth, folds of the anus and genitals). The symptoms of bejel and its rash are similar to secondary syphilides (roseola, papules, pustules in all their varieties). Compared with secondary syphilis, the rash with bejel lasts longer - on average up to 12 months, its evolution is quite torpid. Serious disturbances of the general condition are not observed. Subcutaneous lymph nodes increase slightly, are painless, are not fused with each other and with the surrounding tissues, the skin above them is not changed.
After about a year, the rash partially or completely regresses, usually leaving no trace. Sometimes transient hyperpigmentation remains in its place.
After a long latent period (from 1 to 5 years), rashes resembling tertiary syphilides appear on the skin and mucous membranes, which marks the transition of the disease to a late stage. They have the character of gummas, developing not only on the skin and in the subcutaneous tissue, but also in the long tubular bones, as well as in the bones of the nose. Gummatous ostitis and periostitis with necrosis and spontaneous fractures are noted. When decaying, gummatous nodes produce extensive ulcerations with subsequent formation of disfiguring scars. Diffuse and focal dyschromia of the palms and soles, various forms of alopecia are also described. In the late stages of the disease, patients are not contagious.
After the disease, no lasting immunity is formed, which is why reinfection is possible.
Bejel diagnostics
Diagnosis of bejel is based on the epidemiological situation, a characteristic clinical picture, detection of the pathogen in a dark field in material from fresh rashes, and often positive serological reactions to syphilis (in reduced titers).
What do need to examine?
How to examine?
Treatment of bejel
Treatment of bejel is carried out with antisyphilitic drugs (both soluble and durable forms of penicillin), as well as reserve antibiotics. The disease bejel is treated quite quickly.
How is bejel prevented?
Prevention of bejel consists of timely detection and simultaneous treatment of all patients in a given endemic zone, as well as persons who were in close contact with them. Improvement of housing and living conditions, increased sanitary culture, and observance of personal hygiene standards play a major role.