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Orbe-Orihuela YC, Sánchez-Alemán MÁ, Hernández-Pliego A, Medina-García CV, Vergara-Ortega DN. Syphilis as Re-Emerging Disease, Antibiotic Resistance, and Vulnerable Population: Global Systematic Review and Meta-Analysis. Pathogens 2022; 11:1546. [PMID: 36558880 PMCID: PMC9785152 DOI: 10.3390/pathogens11121546] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/07/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
Syphilis is a sexually transmitted disease that has become a public health problem, especially in vulnerable populations. A systematic review and time-free meta-analysis of the publications on the molecular detection of syphilis and mutations associated with antibiotic resistance, CORE group, and syphilis genotypes in PubMed databases, Scielo, and Cochrane was performed, and the last search was conducted in June 2022. Proportions were calculated, and standard errors and confidence intervals were reported for all results of interest. We included 41 articles for quantitative extraction and data synthesis. An increase was observed in the proportion of subjects diagnosed with syphilis and the presence of the A2058G mutation during the 2018−2021 period compared to 2006 (70% 95%CI 50−87 vs. 58% 95%CI 12−78), and we observed that the greater the proportion of the population participating in men who have sex with men (MSM) (<50% and >50%) syphilis increased (78% 95%CI 65−90 vs. 33% 95%CI 19−49). In conclusion, we suggest that there are a set of characteristics that are contributing to the resurgence of syphilis and the selective pressure of bacteria. The MSM population could be a vulnerable factor for this scenario and the global presence of A2058G and A2059G mutations that confer resistance to macrolides.
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Affiliation(s)
| | | | | | | | - Dayana Nicté Vergara-Ortega
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico
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Tuddenham S, Ghanem KG. Management of Adult Syphilis: Key Questions to Inform the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines. Clin Infect Dis 2022; 74:S127-S133. [PMID: 35416969 PMCID: PMC9006973 DOI: 10.1093/cid/ciac060] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A panel of experts generated 5 "key questions" in the management of adult syphilis. A systematic literature review was conducted and tables of evidence were constructed to answer these questions. Available data suggest no clinical benefit to >1 dose of benzathine penicillin G for early syphilis in human immunodeficiency virus (HIV)-infected patients. While penicillin remains the drug of choice to treat syphilis, doxycycline to treat early and late latent syphilis is an acceptable alternate option if penicillin cannot be used. There are very limited data regarding the impact of additional antibiotic doses on serologic responses in serofast patients and no data on the impact of additional antibiotic courses on long-term clinical outcomes. In patients with isolated ocular or otic signs and symptoms, reactive syphilis serologic results, and confirmed ocular/otic abnormalities at examination, a diagnostic cerebrospinal fluid (CSF) examination is not necessary, because up to 40% and 90% of patients, respectively, would have no CSF abnormalities. Based on the results of 2 studies, repeated CSF examinations are not necessary for HIV-uninfected patients or HIV-infected patients on antiretroviral therapy who exhibit appropriate serologic and clinical responses after treatment for neurosyphilis. Finally, several important gaps were identified and should be a priority for future research.
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Affiliation(s)
- Susan Tuddenham
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khalil G Ghanem
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Liu D, He SM, Zhu XZ, Liu LL, Lin LR, Niu JJ, Yang TC. Molecular Characterization Based on MLST and ECDC Typing Schemes and Antibiotic Resistance Analyses of Treponema pallidum subsp. pallidum in Xiamen, China. Front Cell Infect Microbiol 2021; 10:618747. [PMID: 33680984 PMCID: PMC7935548 DOI: 10.3389/fcimb.2020.618747] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022] Open
Abstract
In total, 49 clinical samples were analyzed using two typing schemes, Enhanced Centers for Disease Control and Prevention (ECDC) and multilocus sequence typing (MLST), to describe the molecular characteristics of circulating Treponema pallidum isolates in Xiamen between 2016 and 2017. In addition, genetic mutations potentially related to antibiotic resistance of T. pallidum were also analyzed. Forty five samples were fully typed by ECDC, and 14 different subtypes were detected. The most common subtype was 16d/f (24.4%), followed by 14d/f (20.0%). All forty nine samples were successfully typed by MLST, while only four allelic profiles were identified, including three SS14-like profiles and one Nichols-like profile. Among them, the major allelic profile was 1.1.8 (85.7%). Interestingly, the allelic profile 1.3.1 widespread in Europe and North America was not detected in this region. Additionally, A2058G mutation in 23S rRNA was found in all detectable samples (38/38), and no mutation in 16S rRNA was observed (36/36). Four non-synonymous single-nucleotide polymorphisms in penicillin-binding protein genes were found in the 35 samples eligible for Sanger sequencing. Among them, the variant in tp0500 (P564I) can only be found in the SS14-like isolates. Homoplastic changes in tp0760 (I415F/I415M) and tp0705 (A506V/A506T) were found. Moreover, the variant tp0705 A506V and the variant tp0705 A506T separately appeared in the SS14-like isolates and Nichols-like isolates, respectively. This study showed that the genotypes of T. pallidum isolates in Xiamen between 2016 and 2017 were different from those in other geographic areas. The resistance-related variants of T. pallidum isolates identified in this study could provide awareness for clinicians in the treatment of syphilis.
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Affiliation(s)
- Dan Liu
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Shu-Min He
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Xiao-Zhen Zhu
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Li-Li Liu
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Li-Rong Lin
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Jian-Jun Niu
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Tian-Ci Yang
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
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Grillová L, Noda AA, Lienhard R, Blanco O, Rodríguez I, Šmajs D. Multilocus Sequence Typing of Treponema pallidum subsp. pallidum in Cuba From 2012 to 2017. J Infect Dis 2020; 219:1138-1145. [PMID: 30325448 DOI: 10.1093/infdis/jiy604] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/10/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The increased prevalence of syphilis in Cuba prompted us to map the circulating Treponema pallidum subsp. pallidum allelic profiles in this geographic region. METHODS Samples were collected from 2012 to 2017, from 83 male patients with ulcers or skin lesions, and were examined using multilocus sequence typing. Additionally, we analyzed the 23S rDNA and 16S rDNA regions for the presence of possible mutations leading to macrolide and tetracycline resistance. RESULTS Among 94% of fully typed strains, we found 7 different allelic profiles, of which 4 had not been previously described. More than 87% of patients were infected with the T. pallidum SS14-like group and only 8.2% with T. pallidum Nichols-like group. As in other countries, the 1.3.1 allelic profile (ie, SS14-like) was the most common. In addition, 1 of the newly described allelic profiles represents T. pallidum strains that arose by recombination events between members of different T. pallidum subgroups. More than 90% of patients were infected with treponemes harboring the A2058G mutation. However, we found no potential tetracycline-resistant T. pallidum mutations. CONCLUSIONS Our results suggest that, in Cuba, tetracycline antibiotics could be used to treat syphilis in penicillin-allergic patients instead of macrolides.
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Affiliation(s)
- Linda Grillová
- Department of Biology, Masaryk University, Brno, Czech Republic
| | - Angel A Noda
- Department of Mycology-Bacteriology, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba
| | - Reto Lienhard
- Department of Bacteriology and Serology, Analyses and Diagnostics Medical Microbiology, La Chaux-de-Fonds, Switzerland
| | - Orestes Blanco
- Department of Mycology-Bacteriology, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba
| | - Islay Rodríguez
- Department of Mycology-Bacteriology, Institute of Tropical Medicine Pedro Kourí, Havana, Cuba
| | - David Šmajs
- Department of Biology, Masaryk University, Brno, Czech Republic
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Xiao H, Li Z, Li F, Wen J, Liu D, Du W, Hou J, Li Z, Zheng R, Liu D, Chu T, Du D, Tian H. Preliminary study of tetracycline resistance genes in Treponema pallidum. J Glob Antimicrob Resist 2017; 9:1-2. [PMID: 28274848 DOI: 10.1016/j.jgar.2017.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 12/07/2016] [Accepted: 02/08/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hailu Xiao
- University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China; Shandong Provincial Hospital for Skin Diseases, Jinan, Shandong, China
| | - Zhen Li
- University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China; Shandong Provincial Hospital for Skin Diseases, Jinan, Shandong, China
| | - Furong Li
- University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China; Shandong Provincial Hospital for Skin Diseases, Jinan, Shandong, China
| | - Jing Wen
- University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China; Shandong Provincial Hospital for Skin Diseases, Jinan, Shandong, China
| | - Danxuan Liu
- University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China; Shandong Provincial Hospital for Skin Diseases, Jinan, Shandong, China
| | - Wenli Du
- University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China; Shandong Provincial Hospital for Skin Diseases, Jinan, Shandong, China
| | - Jianling Hou
- University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China; Shandong Provincial Hospital for Skin Diseases, Jinan, Shandong, China
| | - Zhongwei Li
- University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China; Shandong Provincial Hospital for Skin Diseases, Jinan, Shandong, China
| | - Rongtao Zheng
- University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China; Shandong Provincial Hospital for Skin Diseases, Jinan, Shandong, China
| | - Dianchang Liu
- University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China; Shandong Provincial Hospital for Skin Diseases, Jinan, Shandong, China
| | - Tongsheng Chu
- University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China; Shandong Provincial Hospital for Skin Diseases, Jinan, Shandong, China
| | - Donghong Du
- University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China; Shandong Provincial Hospital for Skin Diseases, Jinan, Shandong, China.
| | - Hongqing Tian
- University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China; Shandong Provincial Hospital for Skin Diseases, Jinan, Shandong, China.
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Dubourg G, Raoult D. The challenges of preexposure prophylaxis for bacterial sexually transmitted infections. Clin Microbiol Infect 2016; 22:753-756. [PMID: 27585939 DOI: 10.1016/j.cmi.2016.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 11/18/2022]
Abstract
Preexposure prophylaxis (PrEP) against HIV is currently the subject of great interest, as clinical trials have shown high efficacy in terms of decreasing transmission among men who have sex with men. Because the prevalence of bacterial sexual transmitted infections (STIs) is increasing within this community, a recent pilot study demonstrated the efficacy of reducing transmission of bacterial STIs by administering PrEP with daily doxycycline to men who have sex with men. This creative initiative raises several questions which are discussed in this review. Relevant information should be drawn from the huge amount of available epidemiologic data to identify those who could benefit from such prophylactic treatment. The choice of antimicrobial agents is crucial, as antimicrobial susceptibility of STI agents is heterogeneous. Finally, we discuss challenges to improve the control of STIs through the use of PrEP.
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Affiliation(s)
- G Dubourg
- Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, Timone University Hospital Centre, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Assistance Publique-Hôpitaux de Marseille, France; Université Aix-Marseille, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE) UM 63 CNRS 7278 IRD 198 INSERM U1095, Facultés de Médecine et de Pharmacie, Marseille, France.
| | - D Raoult
- Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, Timone University Hospital Centre, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Assistance Publique-Hôpitaux de Marseille, France; Université Aix-Marseille, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE) UM 63 CNRS 7278 IRD 198 INSERM U1095, Facultés de Médecine et de Pharmacie, Marseille, France
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Stamm LV. Syphilis: Re-emergence of an old foe. MICROBIAL CELL (GRAZ, AUSTRIA) 2016; 3:363-370. [PMID: 28357375 PMCID: PMC5354565 DOI: 10.15698/mic2016.09.523] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/11/2016] [Indexed: 11/13/2022]
Abstract
Syphilis is caused by infection with Treponema pallidum subsp. pallidum, a not-yet-cultivable spiral-shaped bacterium that is usually transmitted by sexual contact with an infected partner or by an infected pregnant woman to her fetus. There is no vaccine to prevent syphilis. Diagnosis and treatment of infected individuals and their contacts is key to syphilis control programs that also include sex education and promotion of condom use to prevent infection. Untreated syphilis can progress through four stages: primary (chancre, regional lymphadenopathy), secondary (disseminated skin eruptions, generalized lymphadenopathy), latent (decreased re-occurrence of secondary stage manifestations, absence of symptoms), and tertiary (gummas, cardiovascular syphilis and late neurological symptoms). The primary and secondary stages are the most infectious. WHO estimates that each year 11 million new cases of syphilis occur globally among adults aged 15-49 years. Syphilis has re-emerged in several regions including North America, Western Europe, China and Australia. Host-associated factors that drive the re-emergence and spread of syphilis include high-risk sexual activity, migration and travel, and economic and social changes that limit access to health care. Early, uncomplicated syphilis is curable with a single intramuscular injection of benzathine penicillin G (BPG), the first line drug for all stages of syphilis. Emergence of macrolide-resistant T. pallidum has essentially precluded the empirical use of azithromycin as a second-line drug for treatment of syphilis. Virulence attributes of T. pallidum are poorly understood. Genomic and proteomic studies have provided some new information concerning how this spirochete may evade host defense mechanisms to persist for long periods in the host.
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Affiliation(s)
- Lola V. Stamm
- Department of Epidemiology, Gillings School of Global Public Health,
University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435
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