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Bejel, also known as endemic syphilis, is a chronic but curable disease, seen mostly in children in arid regions. Unlike the better-known venereal syphilis, endemic syphilis is not a sexually transmitted disease.


Bejel has many other names depending on the locality: siti, dichuchwa, njovera, belesh, and skerljevo are some of the names. It is most commonly found in the Middle East (Syria, Saudi Arabia, Iraq), Africa, central Asia, and Australia. Bejel is related to yaws and pinta, but has different symptoms.

Causes and symptoms

Treponema pallidum, the bacteria that causes bejel, is very closely related to the one that causes the sexually transmitted form of syphilis, but transmission is very different. In bejel, transmission is by direct contact, with broken skin or contaminated hands, or indirectly by sharing drinking vessels and eating utensils. T. pallidum is passed on mostly between children living in poverty in very unsanitary environments and with poor hygiene.
The skin, bones, and mucous membranes are affected by bejel. Patches and ulcerated sores are common in the mouth, throat, and nasal passages. Gummy lesions may form, even breaking through the palate. Other findings may include a region of swollen lymph nodes and deep bone pain in the legs. Eventually, bones may become deformed.


T. pallidum can be detected by microscopic study of samples taken from the sores or lymph fluid. However, since antibody tests don't distinguish between the types of syphilis, specific diagnosis of the type of syphilis depends on the patient's history, symptoms, and environment.


Large doses of benzathine penicillin G given by injection into the muscle can cure this disease in any stage, although it may take longer and require additional doses in later stages. If penicillin cannot be given, the alternative is tetracycline. Since tetracycline can permanently discolor new teeth still forming, it is usually not prescribed for children unless no viable alternative is available.


Bejel is completely curable with antibiotic treatment.


The World Health Organization (WHO) has worked with many countries to prevent this and other diseases, and the number of cases has been reduced somewhat. Widespread use of penicillin has been responsible for reducing the number of existing cases, but the only way to eliminate bejel is by improving living and sanitation conditions.



Fauci, Anthony S., et al., editors. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 1997.

Key terms

Endemic disease — An infectious disease that occurs frequently in a specific geographical locale. The disease often occurs in cycles. Influenza is an example of an endemic disease.
Lymph — This is a clear, colorless fluid found in lymph vessels and nodes. The lymph nodes contain organisms that destroy bacteria and other disease causing organisms (also called pathogens).
Syphilis — This disease occurs in two forms. One is a sexually transmitted disease caused by a bacteria. The second form is not sexually transmitted, but passed on by direct contact with the patient or through use of shared food dishes and utensils.


Nonvenereal endemic syphilis, now found chiefly among Arab children; apparently due to Treponema pallidum.
See also: nonvenereal syphilis.
[Ar. bajlah]


A nonvenereal form of syphilis that is endemic primarily among children in the Middle East and North Africa, characterized by mouth and skin lesions and destruction of long bone tissue, and caused by a strain of the spirochete Treponema pallidum that is transmitted by mouth-to-mouth contact or shared utensils.


Etymology: Ar, bajal
a nonvenereal form of endemic syphilis prevalent among children in the Middle East and North Africa, caused by the spirochete Treponema pallidum subsp. endemicum. It is transmitted by person-to-person contact and by the sharing of drinking and eating utensils. The primary lesion is usually on or near the mouth, appearing as a mucus patch, followed by the development of pimplelike sores on the trunk, arms, and legs. Chronic ulceration of the nose and soft palate occurs in the advanced stages of the infection. Destructive changes in the tissues of the heart, central nervous system, and mouth, often associated with the venereal form of syphilis, rarely develop. Intramuscular injection of penicillin is effective in curing the infection, but if extensive tissue destruction has occurred, scar tissue forms and may be permanently disfiguring. Also called dichuchwa, endemic syphilis, frenga, siti.


A non-venereal infection by Treponema pallidum endemicum—which is indistinguishable from venereal T pallidum pallidum—which causes syphilis, and affects children in Saharan Africa and the Middle East.
Clinical findings, early
Lymphadenitis, condyloma-like oropharyngeal, anogenital lesions.
Clinical findings, late
Lesions mimic tertiary syphilis—e.g., gumma of the nose and soft palate, bony deformities, nodular skin ulcers.
Penicillin, erythromycin, tetracycline.


Nonvenereal endemic syphilis, now found chiefly among Arab children; apparently due to Treponema pallidum.
[Ar. bajlah]


A non-venereal form of SYPHILIS affecting mainly children and occurring principally in the Eastern Mediterranean. The condition is becoming rare.
References in periodicals archive ?
Bejel considera que los discursos relacionados con las relaciones de genero y los conceptos de la familia se daban en esta epoca bajo el marco general del nacionalismo "that is, all of them declare their principles and practices in the name of some sort of national morality.
The next two chapters, on contemporary representations of Marti in film and painting, respectively, allow Bejel to more fully explore the relationship between historical image and contemporary viewer, left undeveloped in his introduction.
Emilio Bejel explores the feminist climate in Cuba during this time period in chapter 3 of Gay Cuban Nation.
senala Emilio Bejel, marcan a Lezama Lima (Bejel 23-24).
By the early 1970s, the global prevalence of endemic treponematoses (pinta, bejel, and yaws) had been reduced from 50 million to 2.
Emilio Bejel, en Gay Cuban Nation, traza la genealogia politica de la homofobia en Cuba: "The problematic image of the queer [.
The bejel (a musical instrument used to announce the arrival of VIPs) is one of our most essential instruments, often used during official functions," Al Shair said.
World distribution of spirochetal diseases", 1 yaws, pinta, Bejel, Atlas of Diseases, Plate 15, Geographical Review, vol.
There are four syndromes associated with treponematosis: yaws, treponarid (also known as bejel, endemic syphilis, irkintja), venereal syphilis and pinta (Ortner 2003).
Author Dennis DiClaudio makes deadly afflictions almost fun with his implausible humor, introducing the brave to wild gross-outs like alien hand syndrome (it ``won't always try to kill you'') and bejel (``in which you get syphilis just by touching someone'').
As Emilio Bejel comments, the two protagonists--David, a young, staunchly Marxist student and Diego, a disaffected homosexual--find mutual ground precisely through their nationalism (158, qtd in Fernandes 145).
Rothschild 1995 Treponemal disease revisited: skeletal discriminators for yaws, bejel, and venereal syphilis.