The disease is most often seen in Asia, Europe, North America. It is transmitted to people in around 10% of rat bites. Symptoms of the streptobacillary form include recurrent fever, rash, and arthralgias. The spirillary form causes relapsing fever, rash, and regional lymphadenitis. Treatment of RBF includes administration of amoxicillin 1 g per oral, procaine penicillin G 600,000 units IM every 12 hours, or penicillin V 500 milligrams per oral for 7 to 10 days. Erythromycin might be administered to people who are allergic to penicillin. Doxycycline 100 milligrams every 12 hours for 14 days is an alternative form of treatment.