Table 3.
Sensitivity testing of T. pallidum isolates to azithromycin and other macrolides.
| Study (year) | Country | Year(s) | Specimen source | Sample size | Resistant mutation | Number resistant | Percent resistant | 95% CI | Additional details | Ref. |
|---|---|---|---|---|---|---|---|---|---|---|
| Low-risk populations | ||||||||||
| Chen et al. (2013) | USA | 2007-2009 | Surveillance | 129 | 2058A 2058G 2059G | 83 67 17 | 64.3% 51.9% 13.2% |
55.8–72.1% 43.4–60.4% 8.4–20.1% | From patients with primary of secondary syphilis attending STI clinics | [133] |
| Van Damme et al. (2009) | Madagascar | NR | Randomized clinical trial | 186 | 23S rRNA | 0 | 0.0% | NA | DNA of T. pallidum was detected in 141 samples; 61% of patients were male; 98% were heterosexual | [49] |
| Unspecified low-risk populations | ||||||||||
| Mϋller et al. (2012) | South Africa Lesotho |
2005–2010 | Surveillance | 100 | A2058G A2059G | 1 0 | 1.0% 0.0% | 0.0–5.4% | 117 ulcer specimens collected of which 100 were positive for T. pallidum | [134] |
| A2058G Prevalence Workgroup (2012) | USA | 2007–2009 | Surveillance | 141 | A2058G | 75 | 53.1% | 45.0–61.2% | From patients with primary of secondary syphilis attending STI clinics; MSM were nearly 6 times more likely to have resistant syphilis compared with heterosexual women and men | [135] |
| Matejková et al. (2009) | Czech Republic | 2005–2008 | Passive case detection | 22 | 23S rRNA A2058G A2059G | 8 4 4 | 36.4% 18.2% 18.2% | 19.7–57.3% 7.5–38.8% 7.5–38.8% |
|
[136] |
| Martin et al. (2009) | China | 2007–2008 | Passive case detection | 38 | A2058G | 38 | 100% | NA | Patients presenting to STI clinic with symptoms compatible with primary syphilis | [137] |
| Lukehart et al. (2004) |
USA | PCR to detect 23S rRNA gene mutations; confirmation of azithromycin resistance was conducted through intradermal rabbit inoculation | [44] | |||||||
| San Francisco San Francisco Seattle Baltimore |
1999–2002 2003 2001–2003 1998–2000 |
Surveillance |
25 30 23 19 |
23S rRNA | 1 11 3 2 |
4.0% 36.7% 13.0% 10.5% |
1.0–19.6% 21.9–54.6% 4.7–32.3% 3.2–31.7% |
|||
| Ireland | ||||||||||
| Dublin | 2002 | Surveillance | 17 | 23S rRNA | 15 | 88.2% | 65.3–96.4% | |||
| Multiple locations | 1912–1987 | Historical | 18 | 23S rRNA | 1 | 5.6% | 1.3–2.6% | |||
DNA: Deoxyribonucleic acid; MSM: Men who has sex with men; NA: Not applicable; NR: Not reported; STI: Sexually transmitted infection.