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Janečková K, Roos C, Fedrová P, Tom N, Čejková D, Lueert S, Keyyu JD, Chuma IS, Knauf S, Šmajs D. The genomes of the yaws bacterium, Treponema pallidum subsp. pertenue, of nonhuman primate and human origin are not genomically distinct. PLoS Negl Trop Dis 2023; 17:e0011602. [PMID: 37703251 PMCID: PMC10499264 DOI: 10.1371/journal.pntd.0011602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/17/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Treponema pallidum subsp. pertenue (TPE) is the causative agent of human yaws. Yaws is currently reported in 13 endemic countries in Africa, southern Asia, and the Pacific region. During the mid-20th century, a first yaws eradication effort resulted in a global 95% drop in yaws prevalence. The lack of continued surveillance has led to the resurgence of yaws. The disease was believed to have no animal reservoirs, which supported the development of a currently ongoing second yaws eradication campaign. Concomitantly, genetic evidence started to show that TPE strains naturally infect nonhuman primates (NHPs) in sub-Saharan Africa. In our current study we tested hypothesis that NHP- and human-infecting TPE strains differ in the previously unknown parts of the genomes. METHODOLOGY/PRINCIPAL FINDINGS In this study, we determined complete (finished) genomes of ten TPE isolates that originated from NHPs and compared them to TPE whole-genome sequences from human yaws patients. We performed an in-depth analysis of TPE genomes to determine if any consistent genomic differences are present between TPE genomes of human and NHP origin. We were able to resolve previously undetermined TPE chromosomal regions (sequencing gaps) that prevented us from making a conclusion regarding the sequence identity of TPE genomes from NHPs and humans. The comparison among finished genome sequences revealed no consistent differences between human and NHP TPE genomes. CONCLUSION/SIGNIFICANCE Our data show that NHPs are infected with strains that are not only similar to the strains infecting humans but are genomically indistinguishable from them. Although interspecies transmission in NHPs is a rare event and evidence for current spillover events is missing, the existence of the yaws bacterium in NHPs is demonstrated. While the low risk of spillover supports the current yaws treatment campaign, it is of importance to continue yaws surveillance in areas where NHPs are naturally infected with TPE even if yaws is successfully eliminated in humans.
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Affiliation(s)
- Klára Janečková
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Christian Roos
- Deutsches Primatenzentrum GmbH, Leibniz-Institute for Primate Research, Göttingen, Germany
| | - Pavla Fedrová
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Nikola Tom
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Darina Čejková
- Department of Biomedical Engineering, Brno University of Technology, Brno, Czech Republic
| | - Simone Lueert
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald—Insel Riems, Germany
| | - Julius D. Keyyu
- Tanzania Wildlife Research Institute (TAWIRI), Arusha, Tanzania
| | - Idrissa S. Chuma
- Department of Veterinary Medicine and Public Health, College of Veterinary and Medical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Sascha Knauf
- Deutsches Primatenzentrum GmbH, Leibniz-Institute for Primate Research, Göttingen, Germany
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald—Insel Riems, Germany
| | - David Šmajs
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Garcia LN, Morando N, Otero AV, Moroni S, Moscatelli GF, Gonzalez N, D Slojan A, Lascano F, Ballering G, Pando MA, Altcheh JM. Multilocus sequence typing of Treponema pallidum pallidum in children with acquired syphilis by nonsexual contact. Future Microbiol 2022; 17:1295-1305. [PMID: 36094429 DOI: 10.2217/fmb-2022-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: There are scarce data of Treponema pallidum subsp. pallidum (TPA) characterization in children with syphilis. Nonsexually acquired transmission (NSAT) of TPA is possible in infants through close contact. Methods: A descriptive study in five families with NSAT of syphilis was conducted. Polymerase chain reaction detection of TPA in pediatric index cases (n = 6) and their relatives (n = 44) were conducted followed by multilocus sequence typing (MLST). Results: TPA was detected in swab samples in 16 cases and 12 were characterized by MLST. Nichols lineage was identified in two of five families and SS14-lineage in three of five. In four families, MLST profiles linked index cases to relatives. Conclusion: This is the first report of TPA characterization in children infected by NSAT.
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Affiliation(s)
- Luciana N Garcia
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina.,Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), CONICET - GCBA, Buenos Aires, Argentina
| | - Nicolás Morando
- Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS) CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Adrián V Otero
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina
| | - Samanta Moroni
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina
| | - Guillermo F Moscatelli
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina.,Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), CONICET - GCBA, Buenos Aires, Argentina
| | - Nicolás Gonzalez
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina
| | - Alejandra D Slojan
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina
| | - Fernanda Lascano
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina.,Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), CONICET - GCBA, Buenos Aires, Argentina
| | - Griselda Ballering
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina
| | - Maria A Pando
- Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS) CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Jaime M Altcheh
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina.,Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), CONICET - GCBA, Buenos Aires, Argentina
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Dofitas BL, Kalim SP, Toledo CB, Richardus JH. Stigma, psychosocial and economic effects of yaws in the Philippines: an exploratory, qualitative study. Trop Med Health 2022; 50:43. [PMID: 35794656 PMCID: PMC9258159 DOI: 10.1186/s41182-022-00433-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Yaws is a chronic, non-venereal, highly contagious skin and bone infection affecting children living in impoverished, remote communities and caused by Treponema pallidum subspecie pertenue. Social stigma and economic losses due to yaws have been reported anecdotally in the Southern Philippines but have not been well-documented. Objective To describe and compare the psychological, social, and economic effects of yaws from the perspective of patients, contacts, and key informants in two areas of the Philippines. Materials and methods Yaws and contacts were identified through clinicoseroprevalence surveys conducted in the Liguasan Marsh area, Mindanao, Southern Philippines in 2017 and among the Aetas, an indigenous people community in Quezon province, Luzon region in 2020. Skin examinations and serologic tests confirmed the diagnosis of active, latent, or past yaws among the children and adults. Trained health personnel conducted in-depth interviews of those affected by yaws and their guardians, household contacts, and key informants, such as health workers regarding their perceptions, feelings, health-seeking behaviors, and effects of yaws on their lives. Results A total of 26 participants were interviewed: 17 from Mindanao and 9 from Luzon. Aside from the physical discomforts and embarrassment, yaws was considered stigmatizing in Mindanao, because positive non-treponemal tests or treponemal antibody tests were associated with syphilis and promiscuity. These have led to loss of employment and income opportunities for adults with latent or past yaws. In contrast, the Aetas of Luzon did not perceive yaws as stigmatizing, because it was a common skin problem. Plantar yaws interfered with the Aeta’s gold panning livelihood due to the pain of wounds. Conclusions Yaws is not merely a chronic skin and bone disease. It can lead to significant psychosocial and economic problems as well. Yaws is a generally forgotten disease in the Philippines. There is no yaws surveillance and control program. Treatments are not readily available for the populations affected, thus perpetuating the infection and negative effects. Significance of study This is the first study to document the psychosocial and economic effects of yaws among Filipinos. Information campaigns about yaws and a yaws control program are needed to reduce stigma and discrimination.
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Affiliation(s)
- Belen Lardizabal Dofitas
- Department of Dermatology, College of Medicine, University of the Philippines Manila, Metro Manila, Philippines. .,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Sherjan P Kalim
- Department of Pathology, Cotabato Regional and Medical Center, Sinsuat Ave., Cotabato City, Philippines
| | - Camille B Toledo
- Institute of Psychiatry and Behavioral Medicine, Southern Philippines Medical Center, Davao City, Philippines
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Zhou Y, Gao G, Zhang X, Gao B, Duan C, Zhu H, Barbera AR, Halcrow S, Pechenkina K. Identifying treponemal disease in early East Asia. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022. [PMCID: PMC9545539 DOI: 10.1002/ajpa.24526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objectives Historic records suggest that a virulent form of treponematosis, sexually transmitted syphilis was introduced to Asia from Europe by the da Gama crew, who landed in India in 1498. Our objective is to assess the gross pathology of human skeletal remains from the Tang dynasty of China to test the presence of treponemal infection in East Asia before 1498. We interpret this paleopathological evidence in the context of site ecology and sociocultural changes during the Tang dynasty. Materials and methods We examined the gross pathology of 1598 human skeletons from Xingfulindai (AD 618 to AD 1279) archeological site located on the Central Plain of China. Using the modified diagnostic criteria defined by Hackett's classical work, we classify the pathology as consistent, strongly suggestive, or pathognomonic for treponemal infection. Results Twelve adult individuals from Xingfulindai had bone lesions suggestive of systemic pathology. Two of these individuals displayed a combination of lesion patterns pathognomonic of treponemal disease and one had lesions consistent with treponematosis. The radiocarbon dates for the bone samples from these skeletons place them before AD 1200. Conclusions The location of Xingfulindai in a continental climatic zone is not typical for yaws and bejel ecology, because these strains occur in the tropics, or in hot, dry environments, respectively. The urban setting, where there is documented evidence for increased interaction between multiple ethnic groups and a developed institution of courtesans during the Tang dynasty, favors sexually transmitted syphilis as the more likely diagnosis. This study supports an earlier spread of syphilis to China than 1498.
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Affiliation(s)
- Yawei Zhou
- College of History Zhengzhou University Zhengzhou Henan China
| | - Guoshuai Gao
- School of Archaeology Jilin University Changchun Jilin China
| | - Xiangyu Zhang
- Xi'an Institute of Cultural Relics Protection and Archaeology Xian Shanxi China
| | - Bo Gao
- Xi'an Institute of Cultural Relics Protection and Archaeology Xian Shanxi China
| | - Chenggang Duan
- Xi'an Institute of Cultural Relics Protection and Archaeology Xian Shanxi China
| | - Hong Zhu
- School of Archaeology Jilin University Changchun Jilin China
| | - Aida R. Barbera
- Université Laval Québec Quebec Canada
- Department of Anthropology Queens College of the City University of New York Queens New York USA
| | | | - Kate Pechenkina
- Department of Anthropology Queens College of the City University of New York Queens New York USA
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Baker BJ, Crane-Kramer G, Dee MW, Gregoricka LA, Henneberg M, Lee C, Lukehart SA, Mabey DC, Roberts CA, Stodder ALW, Stone AC, Winingear S. Advancing the understanding of treponemal disease in the past and present. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2020; 171 Suppl 70:5-41. [PMID: 31956996 DOI: 10.1002/ajpa.23988] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022]
Abstract
Syphilis was perceived to be a new disease in Europe in the late 15th century, igniting a debate about its origin that continues today in anthropological, historical, and medical circles. We move beyond this age-old debate using an interdisciplinary approach that tackles broader questions to advance the understanding of treponemal infection (syphilis, yaws, bejel, and pinta). How did the causative organism(s) and humans co-evolve? How did the related diseases caused by Treponema pallidum emerge in different parts of the world and affect people across both time and space? How are T. pallidum subspecies related to the treponeme causing pinta? The current state of scholarship in specific areas is reviewed with recommendations made to stimulate future work. Understanding treponemal biology, genetic relationships, epidemiology, and clinical manifestations is crucial for vaccine development today and for investigating the distribution of infection in both modern and past populations. Paleopathologists must improve diagnostic criteria and use a standard approach for recording skeletal lesions on archaeological human remains. Adequate contextualization of cultural and environmental conditions is necessary, including site dating and justification for any corrections made for marine or freshwater reservoir effects. Biogeochemical analyses may assess aquatic contributions to diet, physiological changes arising from treponemal disease and its treatments (e.g., mercury), or residential mobility of those affected. Shifting the focus from point of origin to investigating who is affected (e.g., by age/sex or socioeconomic status) and disease distribution (e.g., coastal/ inland, rural/urban) will advance our understanding of the treponemal disease and its impact on people through time.
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Affiliation(s)
- Brenda J Baker
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona
| | - Gillian Crane-Kramer
- Department of Anthropology, State University of New York at Plattsburgh, Plattsburgh, New York
| | - Michael W Dee
- Centre for Isotope Research, University of Groningen, Groningen, Netherlands
| | - Lesley A Gregoricka
- Department of Sociology, Anthropology, and Social Work, University of South Alabama, Mobile, Alabama
| | - Maciej Henneberg
- Biological Anthropology and Comparative Anatomy Unit, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Christine Lee
- Department of Anthropology, California State University Los Angeles, Los Angeles, California
| | - Sheila A Lukehart
- Department of Medicine/Infectious Diseases and Global Health, University of Washington, Seattle, Washington
| | - David C Mabey
- Communicable Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ann L W Stodder
- Office of Archaeological Studies, The Museum of New Mexico, Santa Fe, New Mexico
| | - Anne C Stone
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona
| | - Stevie Winingear
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona
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Maděránková D, Mikalová L, Strouhal M, Vadják Š, Kuklová I, Pospíšilová P, Krbková L, Koščová P, Provazník I, Šmajs D. Identification of positively selected genes in human pathogenic treponemes: Syphilis-, yaws-, and bejel-causing strains differ in sets of genes showing adaptive evolution. PLoS Negl Trop Dis 2019; 13:e0007463. [PMID: 31216284 PMCID: PMC6602244 DOI: 10.1371/journal.pntd.0007463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 07/01/2019] [Accepted: 05/14/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pathogenic treponemes related to Treponema pallidum are both human (causing syphilis, yaws, bejel) and animal pathogens (infections of primates, venereal spirochetosis in rabbits). A set of 11 treponemal genome sequences including those of five Treponema pallidum ssp. pallidum (TPA) strains (Nichols, DAL-1, Mexico A, SS14, Chicago), four T. p. ssp. pertenue (TPE) strains (CDC-2, Gauthier, Samoa D, Fribourg-Blanc), one T. p. ssp. endemicum (TEN) strain (Bosnia A) and one strain (Cuniculi A) of Treponema paraluisleporidarum ecovar Cuniculus (TPeC) were tested for the presence of positively selected genes. METHODOLOGY/PRINCIPAL FINDINGS A total of 1068 orthologous genes annotated in all 11 genomes were tested for the presence of positively selected genes using both site and branch-site models with CODEML (PAML package). Subsequent analyses with sequences obtained from 62 treponemal draft genomes were used for the identification of positively selected amino acid positions. Synthetic biotinylated peptides were designed to cover positively selected protein regions and these peptides were tested for reactivity with the patient's syphilis sera. Altogether, 22 positively selected genes were identified in the TP genomes and TPA sets of positively selected genes differed from TPE genes. While genetic variability among TPA strains was predominantly present in a number of genetic loci, genetic variability within TPE and TEN strains was distributed more equally along the chromosome. Several syphilitic sera were shown to react with some peptides derived from the protein sequences evolving under positive selection. CONCLUSIONS/SIGNIFICANCE The syphilis-, yaws-, and bejel-causing strains differed relative to sets of positively selected genes. Most of the positively selected chromosomal loci were identified among the TPA treponemes. The local accumulation of genetic variability suggests that the diversification of TPA strains took place predominantly in a limited number of genomic regions compared to the more dispersed genetic diversity differentiating TPE and TEN strains. The identification of positively selected sites in tpr genes and genes encoding outer membrane proteins suggests their role during infection of human and animal hosts. The driving force for adaptive evolution at these loci thus appears to be the host immune response as supported by observed reactivity of syphilitic sera with some peptides derived from protein sequences showing adaptive evolution.
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Affiliation(s)
- Denisa Maděránková
- Department of Biomedical Engineering, Brno University of Technology, Brno, Czech Republic
| | - Lenka Mikalová
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Strouhal
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Šimon Vadják
- Department of Biomedical Engineering, Brno University of Technology, Brno, Czech Republic
| | - Ivana Kuklová
- Department of Dermatology, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Petra Pospíšilová
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lenka Krbková
- Department of Children's Infectious Diseases, Faculty of Medicine and University Hospital, Masaryk University, Brno, Czech Republic
| | - Pavlína Koščová
- Department of Biomedical Engineering, Brno University of Technology, Brno, Czech Republic
| | - Ivo Provazník
- Department of Biomedical Engineering, Brno University of Technology, Brno, Czech Republic
| | - David Šmajs
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- * E-mail:
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Treponema pallidum 11qj Subtype May Correspond to a Treponema pallidum Subsp. Endemicum Strain. Sex Transm Dis 2018; 43:517-8. [PMID: 27419817 DOI: 10.1097/olq.0000000000000474] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Webster JP, Borlase A, Rudge JW. Who acquires infection from whom and how? Disentangling multi-host and multi-mode transmission dynamics in the 'elimination' era. Philos Trans R Soc Lond B Biol Sci 2017; 372:20160091. [PMID: 28289259 PMCID: PMC5352818 DOI: 10.1098/rstb.2016.0091] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 12/21/2022] Open
Abstract
Multi-host infectious agents challenge our abilities to understand, predict and manage disease dynamics. Within this, many infectious agents are also able to use, simultaneously or sequentially, multiple modes of transmission. Furthermore, the relative importance of different host species and modes can itself be dynamic, with potential for switches and shifts in host range and/or transmission mode in response to changing selective pressures, such as those imposed by disease control interventions. The epidemiology of such multi-host, multi-mode infectious agents thereby can involve a multi-faceted community of definitive and intermediate/secondary hosts or vectors, often together with infectious stages in the environment, all of which may represent potential targets, as well as specific challenges, particularly where disease elimination is proposed. Here, we explore, focusing on examples from both human and animal pathogen systems, why and how we should aim to disentangle and quantify the relative importance of multi-host multi-mode infectious agent transmission dynamics under contrasting conditions, and ultimately, how this can be used to help achieve efficient and effective disease control.This article is part of the themed issue 'Opening the black box: re-examining the ecology and evolution of parasite transmission'.
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Affiliation(s)
- Joanne P Webster
- Department of Pathology and Pathogen Biology, Centre for Emerging, Endemic and Exotic Diseases, Royal Veterinary College, University of London, Hatfield AL9 7TA, UK
| | - Anna Borlase
- Department of Pathology and Pathogen Biology, Centre for Emerging, Endemic and Exotic Diseases, Royal Veterinary College, University of London, Hatfield AL9 7TA, UK
| | - James W Rudge
- Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Faculty of Public Health, Mahidol University, 420/1 Rajavithi Road, Bangkok 10400, Thailand
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Origin of modern syphilis and emergence of a pandemic Treponema pallidum cluster. Nat Microbiol 2016; 2:16245. [PMID: 27918528 DOI: 10.1038/nmicrobiol.2016.245] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 11/03/2016] [Indexed: 11/08/2022]
Abstract
The abrupt onslaught of the syphilis pandemic that started in the late fifteenth century established this devastating infectious disease as one of the most feared in human history1. Surprisingly, despite the availability of effective antibiotic treatment since the mid-twentieth century, this bacterial infection, which is caused by Treponema pallidum subsp. pallidum (TPA), has been re-emerging globally in the last few decades with an estimated 10.6 million cases in 2008 (ref. 2). Although resistance to penicillin has not yet been identified, an increasing number of strains fail to respond to the second-line antibiotic azithromycin3. Little is known about the genetic patterns in current infections or the evolutionary origins of the disease due to the low quantities of treponemal DNA in clinical samples and difficulties in cultivating the pathogen4. Here, we used DNA capture and whole-genome sequencing to successfully interrogate genome-wide variation from syphilis patient specimens, combined with laboratory samples of TPA and two other subspecies. Phylogenetic comparisons based on the sequenced genomes indicate that the TPA strains examined share a common ancestor after the fifteenth century, within the early modern era. Moreover, most contemporary strains are azithromycin-resistant and are members of a globally dominant cluster, named here as SS14-Ω. The cluster diversified from a common ancestor in the mid-twentieth century subsequent to the discovery of antibiotics. Its recent phylogenetic divergence and global presence point to the emergence of a pandemic strain cluster.
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