Yaws — DTM&H MCQ

Correct answer: D — Single-dose oral azithromycin 30 mg/kg

The correct answer is D, single-dose oral azithromycin 30 mg/kg. This presentation (a papillomatous, raspberry-like skin lesion in a child from an endemic tropical region, darkfield-positive spirochaetes, positive RPR) is classic for yaws, caused by Treponema pallidum subsp. pertenue. The WHO Yaws Eradication Strategy (the Morges Strategy) now recommends a single oral dose of azithromycin 30 mg/kg (maximum 2 g) as the preferred first-line treatment, replacing intramuscular penicillin because of ease of administration, better logistics for mass treatment campaigns, and comparable cure rates demonstrated in trials including one conducted in Papua New Guinea. This single-dose oral regimen avoids injection risks and improves compliance in resource-limited endemic settings. Why the other options are wrong: B. Oral doxycycline for 14 days: Tetracyclines are contraindicated in children under 8 years due to risk of permanent tooth discolouration and effects on bone growth, and this is not the WHO-recommended regimen for yaws. E. Oral erythromycin for 14 days: This is an older alternative used mainly in penicillin allergy, but it requires prolonged multi-dose adherence, which is impractical for mass campaigns and inferior for programmatic use compared with single-dose azithromycin. C. IM benzathine penicillin G: This was the historical treatment of choice and remains effective, but it has been superseded as first-line by oral azithromycin because injections are logistically harder to deliver at scale, carry injection-related risks, and require trained personnel, unlike a single oral dose. A. Topical mupirocin: This is a topical antibacterial for localised skin infections such as impetigo; it has no role against systemic treponemal infection like yaws. Key point: In endemic settings, single-dose oral azithromycin 30 mg/kg (max 2 g) is now WHO first-line therapy for yaws, having replaced intramuscular benzathine penicillin for mass treatment campaigns.

Reference: World Health Organization, Yaws: Diagnosis and treatment, WHO Yaws Eradication Strategy (Morges Strategy), https://www.who.int/teams/control-of-neglected-tropical-diseases/yaws/diagnosis-and-treatment