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Prevalence of the 23S rRNA A2058G Point Mutation and Molecular Subtypes in Treponema pallidum in the United States, 2007 to 2009

The A2058G Prevalence Workgroup

doi: 10.1097/OLQ.0b013e31826f36de
Original Study

Background The 23S rRNA A2058G point mutation in Treponema pallidum is associated with macrolide antibiotic treatment failure. Its prevalence and potential association with a molecular subtype within the United States are unknown.

Methods During 2007 to 2009, 11 clinics across the United States sent samples from genital ulcers to the Centers for Disease Control and Prevention. Molecular techniques were used to identify T. pallidum DNA sequences, the A2058G mutation, and subtype of T. pallidum. Accompanying epidemiologic information was abstracted from medical records.

Results A total of 141 samples with T. pallidum were collected from individuals whose median age was 33 years (range, 13–68 years): 118 were male (69% reported as men having sex with men [MSM]). The A2058G mutation was carried in 75 samples (53%) with T. pallidum, with samples from MSM (versus women and other men) more likely carrying the A2058G mutation (65/82 samples versus 8/57 samples; prevalence ratio, 5.7; 95% confidence interval, 2.9–10.8). Of 98 strain-typed samples, 61 (62%) were the 14d9 subtype of T. pallidum, which was also associated with samples with T. pallidum from MSM (prevalence ratio, 3.5; 95% confidence interval, 1.9–6.5). However, among T. pallidum from MSM, the A2058G mutation was not associated with the 14d9 subtype.

Conclusions The A2058G mutation and 14d9 subtype of T. pallidum were present throughout the United States. Both were more commonly found in T. pallidum from MSM compared with women or other men but were not associated with each other. Treating syphilis with azithromycin should be done cautiously and only when treatment with penicillin or doxycycline is not feasible.

The A2058G mutation is present in T. pallidum throughout the U.S., but not associated with the predominant 14d9 subtype. To treat syphilis, azithromycin should be a last resort.

The A2058G Prevalence Workgroup, John R. Su, MD, PhD, MPH,* Allan Pillay, PhD,* Edward W. Hook, MD,† Khalil G. Ghanem, MD, PhD,‡ William Wong, MD,§ Dawn Jackson, BSW,¶ Lewis D. Smith, MA, *∥ Elaine Pierce, MD, MPH,** Susan S. Philip, MD, MPH,†† Steven Wilson, MD, MPH,‡‡ Matthew R. Golden, MD, MPH,§§ Kimberly A. Workowski, MD,*¶¶ Kai-Hua Chi,* Deidra D. Parrish, MD, MPH, TM,∥∥ Cheng Y. Chen, PhD,* Hillard S. Weinstock, MD, MPH*

From the *Centers for Disease Control and Prevention, Atlanta, GA; †University of Alabama at Birmingham and Jefferson County Department of Health, Birmingham, AL; ‡Johns Hopkins University School of Medicine, Baltimore, MD; §Chicago Department of Public Health, Chicago, IL; ¶Detroit Department of Health and Wellness Promotion, Detroit, MI; ∥New Mexico Department of Health, Albuquerque, NM; **County of San Diego Health and Human Services Agency, San Diego; ††San Francisco Department of Public Health, San Francisco, CA; ‡‡Dallas County Health and Human Services, Dallas, TX; §§University of Washington, Seattle, WA; ¶¶Emory University, Atlanta, GA; and ∥∥Vanderbilt University School of Medicine, Nashville, TN

The authors thank Adam Aragon, Edward R. Bannister, Emily J. Erbelding, Michael V. Grabenstein, Hanne S. Harbison, Jeffrey D. Klausner, Kenneth Katz, Vincent C. Marsiglia, and Sue Szabo for their contributions to this work.

Supported by the Centers for Disease Control and Prevention. D.D.P. was supported by the Oak Ridge Institute for Science and Education.

The authors report no conflicts of interest.

Correspondence: John R. Su, MD, PhD, MPH, Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-E02, Atlanta, GA 30333. E-mail:

Received for publication February 13, 2012, and accepted July 20, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association