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Last updated April 15, 2021

Reviewed by: Lester Fahrner, MD

Approved by: Krish Tangella MD, MBA, FCAP

Bejel is described as an uncommon infectious disease that is transmitted non-sexually, usually through skin contact or sharing of contaminated items.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Dichuchwa
  • Frenga
  • Nonvenereal Syphilis

What is Bejel? (Definition/Background Information)

  • Bejel is described as an uncommon infectious disease that is transmitted non-sexually, usually through skin contact or sharing of contaminated items. The condition is generally seen during childhood
  • The disease is classified as a treponematosis i.e., infectious disease caused by a spirochete (or spiral-shaped) bacterial organism, called Treponema pallidum endemicum. Since, the symptoms resemble that of syphilis, which is a sexually-transmitted Treponema pallidum infection, Bejel is also known as Non-Venereal Syphilis
  • Individuals with Bejel may present ulcerated mouth patches, which over time tend to involve other body areas including the bones. Individuals may experience emotional stress due to cosmetic concerns from the presence of the skin lesions. Initial stages of infection are generally mild, but the condition can be progressive and severe during the later stages, if left untreated
  • A healthcare provider may diagnose the condition through a physical exam and blood tests, to detect the presence of antibodies against the infection. Upon diagnosis, antibiotics are usually administered to treat Bejel. Typically, antibiotic therapy can help eliminate the bacteria from the body. Individuals with Bejel have an excellent prognosis, because the condition is curable with suitable treatment

Who gets Bejel? (Age and Sex Distribution)

  • Bejel is a rare condition that affects children and adolescents more than adults; about 80% of the cases are seen in children below 16 years of age. However, individuals of any age range may be affected
  • Both males and females and individuals of any racial or ethnic background may be affected
  • The condition only presents itself in the hot dry (endemic) regions of the world that includes Eastern Mediterranean region and parts of West Africa

What are the Risk Factors for Bejel? (Predisposing Factors)

The risk factors for Bejel include the following:

  • Residing in or visiting certain hot and arid countries, including those in Eastern Mediterranean region and parts of West Africa
  • Coming into direct contact with infected individuals; an unhygienic environment aids in quicker transmission of the disease
  • Sharing of items with infected individuals
  • Overcrowded spaces and unsanitary living conditions

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Bejel? (Etiology)

Bejel is a disease that is caused due to infection by Treponema pallidum endemicum, a spiral-shaped bacterium.

  • It is transmitted via direct, but non-sexual physical contact
  • Sharing items, such as kitchen vessels, mattresses, and towels, can also result in infection

It is important to note that a congenital transmission of Bejel is not known to take place.

What are the Signs and Symptoms of Bejel?

The signs and symptoms of Bejel and its progression can vary from one individual to another. It may be mild in some and severe in others. The signs and symptoms may include:

  • Presence of a small patch inside the mouth (ulcerated patch), affecting the oral mucosal membranes in the preliminary disease stage
  • This is followed by the appearance of skin ulcers on the limbs and trunk
  • The mouth and skin lesions may seem to resolve on their own; although without treatment, it can progress to the late stage of the disease
  • During the advanced (late) stages, the disease may be characterized by the following:
  • Formation of gummas (soft tissue nodules) in the mouth palate
  • The nodules may also develop inside the nasal passages
  • Infection of bones in the lower limbs
  • Ulceration affecting the underarms and groin region (around the anus)
  • Lymphadenitis (swelling of the lymph nodes)
  • Loss of skin pigmentation

How is Bejel Diagnosed?

Bejel may be diagnosed by a healthcare provider using the following tools:

  • Complete physical examination and analysis of previous medical and travel history
  • Blood tests for antibodies against the organism
  • Microscopic examination of tissue samples
  • Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist may arrive at a diagnosis of Bejel

Note: A skin biopsy may show the presence of the pathogenic organisms.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Bejel?

The complications for Bejel may include the following:

  • Emotional distress due to physical appearance from the lesions (cosmetic concerns)
  • It can become a chronic skin infection
  • Inflammation of the bones or periostitis
  • Eating, swallowing, and breathing difficulties due to presence of the nodules (gummas) in the mouth and nose

How is Bejel Treated?

Bejel is a curable disease that is generally treated by healthcare professionals using appropriate medications. The healthcare provider may administer the following antibiotics:

  • Benzathine penicillin G is the preferred choice
  • Tetracycline or erythromycin may be used in individuals who are allergic to penicillin

How can Bejel be Prevented?

Bejel may be prevented by considering the following measures:

  • Practicing proper sanitary techniques, such as washing one’s hands, to avoid the spread of infection
  • Minimizing travel to the endemic hot-dry regions of Eastern Mediterranean, Saharan West Africa, and Middle East Asia
  • Treating family members and friends who were in contact with the affected individual, to prevent further spread of the condition

What is the Prognosis of Bejel? (Outcomes/Resolutions)

  • The prognosis for Bejel is generally excellent with adequate and appropriate treatment
  • Antibiotic therapy can bring about a complete recovery if it is provided in a timely manner

Additional and Relevant Useful Information for Bejel:

  • Treponematosis consists of diseases caused by the bacterial species Treponema. It consists of non-sexually transmitted conditions including pinta, Bejel, and yaws, along-with the sexually transmitted infectious disease syphilis

Please visit our Infectious Diseases Health Center for more physician-approved health information:


What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Oct. 19, 2018
Last updated: April 15, 2021