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High frequency of the 23S rRNA A2058G mutation of Treponema pallidum in Shanghai is associated with a current strategy for the treatment of syphilis.
Emerg Microbes Infect. 2015 Feb; 4(2):e10.EM

Abstract

The preferred drugs for the treatment of syphilis, benzathine and procaine penicillin, have not been available in Shanghai for many years, and currently, the incidence of syphilis is increasing. Alternative antibiotics for patients with syphilis during the benzathine and procaine penicillin shortage include macrolides. The failure of macrolide treatment in syphilis patients has been reported in Shanghai, but the reason for this treatment failure remains unclear. We used polymerase chain reaction technology to detect a 23S rRNA A2058G mutation in Treponema pallidum in 109 specimens from syphilis patients. The use of azithromycin/erythromycin in the syphilis patients and the physicians' prescription habits were also assessed based on two questionnaires regarding the use of macrolides. A total of 104 specimens (95.4%) were positive for the A2058G mutation in both copies of the 23S rRNA gene, indicating macrolide resistance. A questionnaire provided to 122 dermatologists showed that during the penicillin shortage, they prescribed erythromycin and azithromycin for 8.24±13.95% and 3.21±6.37% of their patients, respectively, and in the case of penicillin allergy, erythromycin and azithromycin were prescribed 15.24±22.89% and 7.23±16.60% of the time, respectively. A second questionnaire provided to the syphilis patients showed that 150 (33.7%), 106 (23.8%) and 34 (7.6%) individuals had used azithromycin, erythromycin or both, respectively, although the majority did not use the drugs for syphilis treatment. Our findings suggest that macrolide resistance in Treponema pallidum is widespread in Shanghai. More than half of the syphilis patients had a history of macrolide use for other treatment purposes, which may have led to the high prevalence of macrolide resistance. Physicians in China are advised to not use azithromycin for early syphilis.

Authors+Show Affiliations

STD Institute, Shanghai Skin Disease Hospital , Shanghai 200050, China.STD Institute, Shanghai Skin Disease Hospital , Shanghai 200050, China.STD Institute, Shanghai Skin Disease Hospital , Shanghai 200050, China.STD Institute, Shanghai Skin Disease Hospital , Shanghai 200050, China.STD Institute, Shanghai Skin Disease Hospital , Shanghai 200050, China.STD Institute, Shanghai Skin Disease Hospital , Shanghai 200050, China.STD Institute, Shanghai Skin Disease Hospital , Shanghai 200050, China.STD Institute, Shanghai Skin Disease Hospital , Shanghai 200050, China.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26038763

Citation

Lu, Haikong, et al. "High Frequency of the 23S rRNA A2058G Mutation of Treponema Pallidum in Shanghai Is Associated With a Current Strategy for the Treatment of Syphilis." Emerging Microbes & Infections, vol. 4, no. 2, 2015, pp. e10.
Lu H, Li K, Gong W, et al. High frequency of the 23S rRNA A2058G mutation of Treponema pallidum in Shanghai is associated with a current strategy for the treatment of syphilis. Emerg Microbes Infect. 2015;4(2):e10.
Lu, H., Li, K., Gong, W., Yan, L., Gu, X., Chai, Z., Guan, Z., & Zhou, P. (2015). High frequency of the 23S rRNA A2058G mutation of Treponema pallidum in Shanghai is associated with a current strategy for the treatment of syphilis. Emerging Microbes & Infections, 4(2), e10. https://doi.org/10.1038/emi.2015.10
Lu H, et al. High Frequency of the 23S rRNA A2058G Mutation of Treponema Pallidum in Shanghai Is Associated With a Current Strategy for the Treatment of Syphilis. Emerg Microbes Infect. 2015;4(2):e10. PubMed PMID: 26038763.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High frequency of the 23S rRNA A2058G mutation of Treponema pallidum in Shanghai is associated with a current strategy for the treatment of syphilis. AU - Lu,Haikong, AU - Li,Kang, AU - Gong,Weimin, AU - Yan,Limeng, AU - Gu,Xin, AU - Chai,Ze, AU - Guan,Zhifang, AU - Zhou,Pingyu, Y1 - 2015/02/11/ PY - 2014/10/27/received PY - 2015/01/07/revised PY - 2015/01/14/accepted PY - 2015/6/4/entrez PY - 2015/6/4/pubmed PY - 2015/6/4/medline KW - Treponema pallidum KW - gene mutation KW - macrolide resistance KW - syphilis SP - e10 EP - e10 JF - Emerging microbes & infections JO - Emerg Microbes Infect VL - 4 IS - 2 N2 - The preferred drugs for the treatment of syphilis, benzathine and procaine penicillin, have not been available in Shanghai for many years, and currently, the incidence of syphilis is increasing. Alternative antibiotics for patients with syphilis during the benzathine and procaine penicillin shortage include macrolides. The failure of macrolide treatment in syphilis patients has been reported in Shanghai, but the reason for this treatment failure remains unclear. We used polymerase chain reaction technology to detect a 23S rRNA A2058G mutation in Treponema pallidum in 109 specimens from syphilis patients. The use of azithromycin/erythromycin in the syphilis patients and the physicians' prescription habits were also assessed based on two questionnaires regarding the use of macrolides. A total of 104 specimens (95.4%) were positive for the A2058G mutation in both copies of the 23S rRNA gene, indicating macrolide resistance. A questionnaire provided to 122 dermatologists showed that during the penicillin shortage, they prescribed erythromycin and azithromycin for 8.24±13.95% and 3.21±6.37% of their patients, respectively, and in the case of penicillin allergy, erythromycin and azithromycin were prescribed 15.24±22.89% and 7.23±16.60% of the time, respectively. A second questionnaire provided to the syphilis patients showed that 150 (33.7%), 106 (23.8%) and 34 (7.6%) individuals had used azithromycin, erythromycin or both, respectively, although the majority did not use the drugs for syphilis treatment. Our findings suggest that macrolide resistance in Treponema pallidum is widespread in Shanghai. More than half of the syphilis patients had a history of macrolide use for other treatment purposes, which may have led to the high prevalence of macrolide resistance. Physicians in China are advised to not use azithromycin for early syphilis. SN - 2222-1751 UR - https://www.unboundmedicine.com/medline/citation/26038763/High_frequency_of_the_23S_rRNA_A2058G_mutation_of_Treponema_pallidum_in_Shanghai_is_associated_with_a_current_strategy_for_the_treatment_of_syphilis_ L2 - https://www.tandfonline.com/doi/full/10.1038/emi.2015.10 DB - PRIME DP - Unbound Medicine ER -