Editing Yaws (section)

==Signs and symptoms==
Yaws primarily occurs in children, most frequently in those aged 6–10.<ref name=WHO/>

Yaws is classified as primary, secondary, and tertiary; this can be clinically useful, but infected patients often have a mix of stages.<ref name=yaws/>

Within 9–90 days (but usually about 21 days<ref name=yaws/>) of infection, a painless but distinctive "mother yaw" [[nodule (medicine)|nodule]] appears.<ref name=yaws/> Initially [[erythematous|reddened and inflamed]],<ref name="advances"/> it may become a [[papilloma]], which can then become an [[ulcer (dermatology)|ulcer]],<ref name=WHO/> possibly with a yellow crust.<ref>{{cite journal |last1=Yotsu |first1=Rie R. |title=Integrated Management of Skin NTDs—Lessons Learned from Existing Practice and Field Research |journal=Tropical Medicine and Infectious Disease |date=14 November 2018 |volume=3 |issue=4 |pages=120 |issn=2414-6366 |pmid=30441754 |doi=10.3390/tropicalmed3040120 |doi-access=free |pmc=6306929}}</ref>{{better source needed|date=April 2020}} Mother yaws are most commonly found on the legs and ankles, and are rarely found on the genitals (unlike syphilis).<ref name=yaws/> The mother yaw enlarges and becomes warty in appearance. Nearby "daughter yaws" may also appear simultaneously.{{citation needed|date=April 2020}} This primary stage resolves completely, with scarring, within 3–6 months.<ref name="advances"/> The scar is often pigmented.<ref name=yaws/>

<gallery mode="packed" title="primary" yaws="" heights="150">
File:10.1177 0956462414549036-fig3-Papilloma of primary yaws.jpg|Papilloma mother yaw
File:Clinical presentation of skin NTDs tropicalmed-03-00120-g001 (cropped to yaws).jpg|Mother yaw nodule with central ulceration and a yellow crust
File:10.1177 0956462414549036-fig2-Ulcer of primary yaws.jpg|Ulcerated mother yaw
File:10.1177 0956462414549036-fig1-Ulcer of primary yaws.jpg|Ulcerated mother yaw
File:10.1177 0956462414549036-fig8-Primary yaws, healed Lesion.jpg|Healed primary yaw lesion, showing pigmented scar
</gallery>

The secondary stage occurs months to two years later (but usually 1–2 months later), and may thus begin when the mother's wound has not yet healed.<ref name=yaws/> It happens when the bacterium spreads in the blood and lymph. It begins as multiple, pinhead-like [[papules]]; these initial lesions grow and change in appearance and may last weeks before healing, with or without scarring.<ref name=yaws/>

Secondary yaws typically shows widespread skin lesions that vary in appearance, including "crab yaws" (areas of skin of abnormal color) on the palms of the hands and soles of the feet<ref name="advances"/> (named for the crab-like gait they cause people with painful soles to assume<ref name=yaws/>). These may show [[desquamation]].{{citation needed|date=April 2020}} These secondary lesions frequently ulcerate and are then highly infectious, but heal after 6 months or more.{{citation needed|date=April 2020}}

Secondary yaws affects the skin and bones.<ref name="advances"/> The most common bone-related problem is [[periostitis]], an inflammation around the bone, which often occurs in the bones of the fingers and the long bones of the lower arms and legs, causing [[dactylitis|swollen fingers]] and limbs.<ref name="advances"/> This causes pain at night and [[periosteal reaction|thickening of the affected bones]] (periostitis).<ref name=yaws/> About 75% of infected children surveyed in Papua New Guinea reported joint pain.<ref name=yaws/> [[Lymphadenopathy|Swollen lymph nodes]], fever, and malaise are also common.<ref name="advances"/>

A latent infection develops after primary and secondary yaws (and possibly, in some cases, without these phases).<ref name=yaws/> Within five years (rarely, within ten years<ref name=yaws/>), it can relapse and become active again, causing further secondary lesions, which may infect others.<ref name="advances"/> These relapse lesions are most commonly found around the armpits, mouth, and anus.<ref name=yaws/>

<gallery mode="packed" heights="150" title="Secondary" yaws="">
File:Hypopigmented patches with overlying pink papules with central depressions.jpg|Secondary yaws begin as multiple small lesions.
10.1177 0956462414549036-fig4-Secondary yaws- multiple small ulcerative lesions.jpg|The small lesions grow.
10.1177 0956462414549036-fig5-Secondary yaws- maculo-papular lesions with scaling.jpg|Secondary lesions vary in appearance (see [[Skin condition#Lesions|list of terms]])
File:Papulosquamous plaque and yellow-crusted nodules of secondary yaws on the leg (far view and close-up).jpg|Here, two different appearances (papulosquamous plaque and yellow-crusted [[nodule (medicine)|nodules]]) are seen in the same 10-year-old (large-scale of both, close-up of nodules)
File:Black-crusted erosion and surrounding hypopigmented patch on elbow.jpg|Hypopigmentation and a crusted erosion, elbow of a 5-year-old
File:Large, hypopigmented patches topped with scaly pink and brown papules on the dorsa of feet and ankles.jpg|Secondary yaws; [[hypopigmented]] areas of skin topped with pink and brown [[papule]]s, 9-year-old
File:Plantar yaw with moist yellow crusted erosion overlying pink granulation tissue.jpg|Erosion on the sole, close-up ([[:File:Plantar yaws lesions – deep punched-out erosions.jpg|large-scale]]). If deeper, it would be an ulcer
File:Moist, thick yellow crusted pink papilloma, 9-year-old boy.jpg|Secondary yaws papilloma (same 9-year-old as pictures of feet)
File:4150843630 bc699a7fa4 bPian.jpg|Secondary breakout in a 12-year-old  [[Javanese people|Javanese]] child (wax model)
File:Scars of yaws lesions on the legs of a female patient with a history of yaws skin lesions in childhood and positive non-treponemal and treponemal antibodies (latent yaws).jpg|Secondary yaws scars in an adult with a childhood history of yaws
</gallery>

An estimated 10% of people with yaws were formerly thought to develop tertiary disease symptoms, but more recently, tertiary yaws has been less frequently reported.<ref name="advances">{{cite journal |last1=Marks |first1=Michael |title=Advances in the Treatment of Yaws |journal=Tropical Medicine and Infectious Disease |date=29 August 2018 |volume=3 |issue=3 |pages=92 |issn=2414-6366 |pmid=30274488 |doi=10.3390/tropicalmed3030092 |doi-access=free |pmc=6161241}}</ref><ref name=yaws/>

Tertiary yaws can include [[gumma (pathology)|gummatous]] nodules. It most commonly affects the skin. The skin of the palms and soles may thicken ([[hyperkeratosis]]). Nodules ulcerating near joints can cause [[necrosis|tissue death]]. Periostitis can be much more severe. The shinbones may become bowed (saber shin)<ref name="advances"/> from chronic periostitis.<ref name=yaws/>

Yaws may or may not have [[cardiovascular]] or [[neurological]] effects; definitive evidence is lacking.<ref name=yaws/>

===Rhinopharyngitis mutilans===
'''Rhinopharyngitis mutilans''',<ref>{{cite journal |last1=L. H. |first1=Bittner |title=Some observations on the tertiary lesions of framboesia tropica, or yaws. |journal=The American Journal of Tropical Medicine and Hygiene |date=1926 |volume=1 |issue=2 |pages=123–130 |doi=10.4269/ajtmh.1926.s1-6.123}}</ref><ref name=IDN>{{cite book |last1=Berger |first1=Stephen |title=Infectious Diseases of Nauru |date=1 February 2015 |publisher=GIDEON Informatics Inc |isbn=9781498805742 |page=320 |url=https://books.google.com/books?id=LNt2BwAAQBAJ&q=%22Rhinopharyngitis+mutilans%22&pg=PA320 |access-date=31 October 2015}}</ref> also known as '''gangosa''', is a destructive [[ulcerative]] condition that usually originates about the [[soft palate]] and spreads into the [[hard palate]], [[pharynx#Nasopharynx|nasopharynx]], and [[human nose|nose]], resulting in mutilating [[cicatrice]]s, and outward to the face, eroding intervening [[bone]], [[cartilage]], and [[soft tissues]]. It occurs in the late stages of yaws, usually 5 to 10 years after the first symptoms of [[infection]]. This is now rare.<ref name=yaws/> Very rarely,<ref name=yaws/> yaws may cause [[exostosis|bone spurs]] in the upper jaw near the nose (gondou); gondou was rare even when yaws was a common disease.<ref name="advances"/>

<gallery mode="packed" heights="150" title="Tertiary" yaws="">
File:Medical diagnosis for the student and practitioner (1922) (14761746096).jpg|Deep ulceration occurs in tertiary yaws
File:Medical diagnosis for the student and practitioner (1922) (14804596673).jpg|Severe tertiary yaws; gangosa
File:Medical diagnosis for the student and practitioner (1922) p1117 (cropped to goundu).jpg|Goundu, a very rare yaws-caused deformity around the nose
</gallery>