Repurposing Clinically Approved Drugs for Yaws With an Insight Into the Cutaneous Ulcer Disease Syndrome (Trep-AByaws)

The goal of this clinical trial is to test the non inferiority of linezolid compared with azithromycin as a treatment for yaws . The main questions it aims to answer are: can linezolid cure active yaws, and can linezolid cure latent yaws. Participants with serologically confirmed yaws will be randomized to receive linezolid (experimental) or azithromycin (control group) treatment and followed up to assess clinical resolution.

Inclusion Criteria: 1. Participants 5-18 years identified during an active case search program at the elementary, primary and secondary schools in the Islands Region. 2. CUD syndrome suspected due to yaws: one or more ulcerative or nodular or papilloma skin lesion of more than 1.5 cm in diameter. 3. Positive treponemal (T1) and non-treponemal (T2) serology by Chembio dual path platform (DPP) syphilis screen \& confirm assay (DPP test). 4. Accepted and signed informed consent. 5. Ability to comply with the requirements of the study protocol including follow up visits. Exclusion Criteria: 1. Children younger than 5 years old. 2. Clinical late-stage possible yaws: destructive osteitis (rhinopharyngitis gangosa, sabre shins) or gummous nodules. 3. Known allergy to LZD or AZI antibiotics. 4. Pregnant or breastfeeding women. 5. Refusal at ward level or village chief (for village inclusion), or refusal of individual or guardian (for individual inclusion). 6. Have taken any antibiotics with potential activity against TPE within the last 7 days prior to randomization (i.e., beta lactams, cephalosporines, macrolides, tetracyclines). 7. Uncontrolled hypertension, pheochromocytoma, thyrotoxicosis, carcinoid syndrome, bipolar disorder, incapacitating psycho-affective disturbance, acute confusional state. 8. Renal function impairment requiring hemodialysis. 9. Current treatment with any drugs likely to interact with the study medication 10. Symptomatic concomitant infection requiring antibiotic treatment potentially active against TPE. 11. Having received treatment for yaws in the last 6 months. 12. Patients who are unable to take oral medication or having a gastrointestinal disease likely to interfere with drug absorption (including malnutrition and stomach flu).