Bejel is a type of bacterial infection that is caused by a pathogen very similar to the one responsible for syphilis. Unlike syphilis, however, bejel is not contracted or transmitted through sexual activity. It is instead passed from one person to another through skin or mouth contact. The disease can cause open lesions in the mucous linings of the mouth and create soft masses in skin and bone tissue that can sometimes become painful and disfiguring. Infection is fairly prominent in Western Africa and some parts of the Middle East, but rare in most other regions of the world. Bejel is easily treatable in its early stages with injections of penicillin or similar antibiotics.
The bacterium that causes bejel outbreaks is known as Treponema pallidum endemicum. It is mainly found in warm, arid climates, and requires human hosts to survive for appreciable amounts of time. People who live in crowded, unsanitary conditions in such climates are at the highest risk of infection. Children and adolescents are more likely to acquire the disease than adults, partly because of poorer hygiene practices and the fact that younger immune systems are less adept at fighting off pathogens.
Bejel can be transmitted through direct contact with an infected person. Kissing or sharing eating utensils with a person with an active open mouth lesion is the most common way that people contract the disease. It is also possible to pick up bacteria on the skin by touching someone's infected sore. Pathogens can then be introduced into the mouth if the hands are not properly washed before handling food.
The first symptoms of bejel typically appear within 90 days of coming into contact with the bacteria. A person usually develops one or more moist sores along their tonsils or the roofs of their mouths. A lesion can also appear on the gums or lips. In most cases, mouth sores are painless and may go unnoticed for several months or years. If the disease is not discovered and treated, bacteria can invade bones, skin, and cartilage tissues throughout the body. Soft, fibrous masses called gummas develop that may cause bones to become displaced or result in painful, protruding skin masses.
A doctor can diagnose bejel based on blood tests and the physical appearance of gummas or sores. Current testing measures are unable to differentiate between bejel and venereal syphilis, so the physician may need to ask questions to determine which disease a patient currently has. An individual's age, geographical location, and recent travel history aids in making an accurate diagnosis.
Penicillin is the drug of choice for treatment. Single injections are effective at killing the bacteria and preventing further complications. Mouth sores tend to heal within a few days without additional medications or treatments. If bones or skin masses are already present at the time the infection is discovered, they may need to be surgically removed.