Bejel (also known as endemic syphilis or treponematosis) is a chronic, non-venereal treponemal infection caused by Treponema pallidum subsp. endemicum. It primarily affects children and adolescents in arid and semi-arid regions, especially parts of the Middle East, North Africa, Sahel region of Africa, and some parts of Central Asia. The disease spreads through direct skin-to-skin contact or shared utensils and is characterized by skin lesions, mucosal patches, and later bone involvement.

The Bejel treatment market focuses almost exclusively on antibiotics (mainly injectable benzathine penicillin G – the WHO-recommended first-line treatment) and supportive therapies. The market remains niche and geographically concentrated but is seeing renewed interest due to global health initiatives targeting neglected tropical diseases (NTDs) and yaws/bejel eradication programs.

Market Size and Growth Projections

The global bejel treatment market was valued at USD 68.45 million in 2024 and is projected to reach USD 112.37 million by 2032, growing at a compound annual growth rate (CAGR) of 6.40% during the forecast period from 2025 to 2032.

Growth is moderate but steady, driven mainly by:

• Increased case detection through surveillance programs
• WHO and UNICEF-led mass treatment campaigns
• Improved access to benzathine penicillin in endemic regions

Market Segmentation

• By Treatment Type
  • Benzathine Penicillin G (dominant segment – ~78% market share in 2024)
  • Procaine Penicillin
  • Azithromycin (used in penicillin-allergic patients or mass campaigns)
  • Tetracycline / Doxycycline (mainly for older children/adults)
  • Supportive therapies (topical agents, analgesics)
• By Route of Administration
  • Parenteral (largest share – mainly intramuscular benzathine penicillin)
  • Oral (fastest-growing segment due to azithromycin use in mass drug administration)
• By Age Group
  • Children (0–15 years) – largest segment (most cases occur in this group)
  • Adolescents & Adults (fastest-growing due to better detection in older populations)
• By Distribution Channel
  • Hospital Pharmacies (dominant)
  • Government & NGO Supply Chains (very significant in endemic areas)
  • Retail Pharmacies
  • Others
• By Region (highly geographically concentrated)
  • Middle East & Africa (largest revenue share – ~64% in 2024)
    • Key countries: Saudi Arabia, Yemen, Iraq, Sudan, Mali, Niger, Chad
  • Asia-Pacific (fastest-growing region)
    • Key countries: Afghanistan, Pakistan, parts of Central Asia
  • Rest of the World (small share – sporadic cases reported in other regions)

Key Drivers Fueling Growth

• Renewed global focus on yaws and bejel eradication (WHO 2030 target for yaws eradication has spillover effects on bejel surveillance & treatment)
• Increased case detection through improved primary healthcare and NTD programs
• Mass drug administration (MDA) campaigns using azithromycin in some regions
• Better availability of benzathine penicillin G through UNICEF/WHO procurement
• Growing political commitment and NGO funding in endemic countries

Challenges and Restraints

• Very limited commercial market – most treatments are procured through public health programs rather than private sales
• Persistent low awareness among healthcare workers and communities in some endemic areas
• Supply chain issues for benzathine penicillin (frequent global shortages reported)
• Diagnostic challenges – lack of simple, point-of-care tests (similar to yaws)
• Political instability in several high-burden countries (Yemen, Mali, Chad, Sudan)
• Competition from azithromycin (oral, single-dose) reducing demand for injectable penicillin in some campaigns
  
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Opportunities

• Development and adoption of oral single-dose regimens (azithromycin or potentially new drugs)
• Integration of bejel treatment into broader skin NTD programs (yaws, leprosy, Buruli ulcer)
• Introduction of rapid dual treponemal/non-treponemal diagnostic tests
• Increased funding through NTD road map 2021–2030 and Global Fund initiatives
• Potential for pharmaceutical companies to participate in public–private partnership procurement models

Competitive Landscape

The bejel treatment market is not highly commercialized. Most supply comes through:

• Generic manufacturers of benzathine penicillin G (e.g., companies in India, China, Egypt)
• UNICEF & WHO prequalified suppliers
• Few branded players with significant presence

Notable companies/suppliers active in the space include:

• Pfizer Inc. (Bicillin L-A – benzathine penicillin G)
• Sandoz (Novartis division)
• Strides Pharma
• Bharat Serums and Vaccines
• Fresenius Kabi
• Generic manufacturers in India, China, Egypt (major suppliers to UNICEF)

Future Trends and Opportunities

• Shift toward oral azithromycin for mass treatment campaigns (already started in some yaws/bejel co-endemic areas)
• Development of combination rapid diagnostic tests (treponemal + non-treponemal)
• Stronger integration of bejel into primary healthcare and school health programs
• Potential for new chemical entities if eradication goals are not met with current drugs
• Increased visibility of bejel as part of global skin NTD elimination efforts

Conclusion

The Global bejel treatment market remains small and highly specialized, concentrated in specific geographic regions and largely dependent on public health programs. While it is not a high-volume commercial market, steady growth is expected through 2032 due to intensified surveillance, mass treatment campaigns, and global NTD elimination efforts. Stakeholders should focus on improving supply chain reliability for benzathine penicillin, supporting diagnostic development, and aligning with WHO/UNICEF procurement mechanisms.

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