Clinical diagnosis and changing manifestations of treponemal infection.

The symptomatology of the papillomas of yaws as described in the literature pertains to the disease in highly endemic areas only. Yaws with milder symptoms - attenuated yaws - occurs in areas that, possibly because of climatic influences, have a low endemicity of yaws. Receding yaws that follows mass treatment in previously highly endemic areas also has the features of attenuated yaws. Yaws symptomatology during the early papillomatous stage may assume any variation within two extreme clinical syndromes: holoendemic yaws, which is characterized by innumerable large, elevated, exuding papillomas of long duration (up to three years), relatively short latent periods, and high reagin levels; and attenuated yaws, which is characterized by scanty - or only one - small, dry papilloma(s) of short duration (only a few weeks), a dominance of latency, and low reagin levels. The public health importance of attenuated receding yaws lies in its potential to revert to classic yaws with high rates of transmission.