Caseation necrosis also can be seen. Plasma cells and histiocytes, in contrast to early yaws, are scarce. They are seen in a band-like pattern or in clusters in the epidermis. Unlike T. pallidum , which is found in both the epidermis and dermis, T. pallidum subsp pertenue is almost entirely epidermotropic. Electron microscopy of early lesions demonstrates scarce treponemes in clusters in the intercellular spaces of the epidermis among inflammatory cells, within the cytoplasm of macrophages, and in the dermis.
Treatment consists of appropriate antibiotic therapy.
This suggests that some strains of T pallidum subsp pertenue may have reduced susceptibility or increased tolerance to penicillin treatment. Nonetheless, according to the 1980 WHO Scientific Group on Treponemal Infections, penicillin is the recommended treatment. Consider tetracycline, erythromycin, or doxycycline for penicillin-allergic patients. Refer to the Table in this section for epidemiologic treatment recommendations. Treat entire population.