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Cited by 137Syphilis Diagnosis and TreatmentReproductive tract infections researchVector-borne infectious diseases

Azithromycin-resistant syphilis infection: San Francisco, California, 2000–2004.

Mitchell, S. J., Engelman, J., Kent, C. K., Lukehart, S. A., Godornes, C., Klausner, J. D.·2006·Clinical Infectious Diseases
DOI 10.1086/498899
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Abstract

BACKGROUND: The incidence of syphilis has been increasing in the United States since reaching a nadir in 2000. Several clinical trials have demonstrated that treatment with oral azithromycin may be useful for syphilis control. After reports of azithromycin treatment failures in San Francisco, we investigated the clinical and epidemiologic characteristics of patients with syphilis due to azithromycin-resistant Treponema pallidum infection. METHODS: We reviewed city-wide case reports and conducted molecular screening for patients seen at the San Francisco metropolitan STD clinic (San Francisco City Clinic) to identify patients who did not respond to azithromycin treatment for syphilis or who were infected with azithromycin-resistant T. pallidum. We conducted an epidemiologic investigation and retrospective case-control study to identify risk factors for acquiring syphilis due to azithromycin-resistant T. pallidum. RESULTS: From January 2000 through December 2004, molecular screening of 124 samples identified 46 azithromycin-resistant T. pallidum isolates and 72 wild-type T. pallidum isolates. Six instances of treatment failure were identified through record review. In total, we identified 52 case patients (one of whom had 2 episodes) and 72 control patients. All case patients were male and either gay or bisexual, and 31% (16 of 52) were infected with human immunodeficiency virus. Investigation of patient-partner links and a retrospective case-control study did not reveal a sexual network or demographic differences between cases and controls. However, 7 case patients had recently used azithromycin, compared with 1 control patient. Surveillance data demonstrated that azithromycin-resistant T. pallidum prevalence increased from 0% in 2000 to 56% in 2004 among syphilis cases observed at the San Francisco City Clinic. CONCLUSIONS: Azithromycin-resistant T. pallidum is widespread in San Francisco. We recommend against using azithromycin for the management of syphilis in communities where macrolide-resistant T. pallidum is present and recommend active surveillance for resistance in sites where azithromycin is used.

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Crossref · 10.1086/498899

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  • T. pallidum chromosomal mutations are associated with azithromycin and other macrolide resistance.

    “because of T. pallidum chromosomal mutations associated with azithromycin and other macrolide resistance”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [607]

  • Documented treatment failures with azithromycin for syphilis have occurred in multiple U.S. geographic areas.

    “documented treatment failures in multiple U.S. geographic areas”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [607]

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Authors
Mitchell, S. J., Engelman, J., Kent, C. K., Lukehart, S. A., Godornes, C., & Klausner, J. D.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • San Francisco Department of Public Health (US)
  • University of Washington (US)
Corresponding author
Klausner, J. D.
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2006-02-01
Volume
42
Issue
3
Pages
337-345
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1086/498899
OpenAlex
W2162192112
Cited by
137
References
40
Citations by year
2026: 1 · 2025: 3 · 2024: 2 · 2023: 11 · 2022: 5 · 2021: 4 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 5 · 2016: 8 · 2015: 10 · 2014: 8 · 2013: 7 · 2012: 16
FWCI
7.07
Type
journal article
Language
en
Open access
closed
Locations
  • Clinical Infectious Diseases (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Allergy and Infectious Diseases (R01AI042143, AI-42143, P01AI034616, AI 34616)
Topics
  • Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
  • Life Sciences › Immunology and Microbiology › Parasitology › Vector-borne infectious diseases
Keywords
syphilis, Treponema pallidum, azithromycin resistance, macrolide resistance, syphilis incidence, HIV coinfection, men who have sex with men, San Francisco, molecular screening, resistance monitoring, risk factors
MeSH terms
Anti-Bacterial Agents, Humans, Male, Risk Factors, San Francisco, Syphilis, Case-Control Studies, Contact Tracing, Treatment Failure, Azithromycin, Drug Resistance, Bacterial

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