Secondary yaws

**Definition:** Secondary yaws results from lymphatic and haematogenous spread of Treponema pallidum subsp. pertenue spirochaetes from the initial inoculation site and appears from a few weeks to 2 years after the primary infection. The commonest initial symptoms are non-specific and include arthralgia and malaise. Secondary skin lesions consist of multiple papules and nodules similar to the initial lesion but smaller. They may be localised, regional or generalised; they may ulcerate and on moist areas may mimic syphilitic condylomata lata. Hyperkeratotic plaques on the palms and soles may develop painful fissures and secondary infection, resulting in a characteristic ‘crab-like’ gait.

**Long definition:** Secondary lesions, which are the result of lymphatic and haematogenous spread of organisms, appear from a few weeks to 2 years after the primary lesion. Arthralgias and malaise are probably the most common, albeit non-specific symptoms of secondary yaws; up to 75% of children under 15 years with yaws presented with arthralgia in Papua New Guinea. Secondary skin lesions consist of multiple smaller excrescences, often resembling the initial papule, that may ulcerate. A generalized eruption may cover a region of the body or the whole body. The lesions may be irregular, crescentic or discoid in shape, and on moist areas may mimic the condylomata lata of venereal syphilis. Hyperkeratotic plaques may form on the palms and soles, fissuring into painful secondary infections responsible for a characteristic ‘crablike’ gait.