title: Evaluation of macrolide resistance and enhanced molecular typing of Treponema pallidum in patients with syphilis in Taiwan: a prospective multicenter study.
abstract: Studies of macrolide resistance mutations and molecular typing using the newly proposed enhanced typing system for Treponema pallidum isolates obtained from HIV-infected patients in the Asia-Pacific region are scarce. Between September 2009 and December 2011, we conducted a survey to detect T. pallidum using a PCR assay using clinical specimens from patients with syphilis at six major designated hospitals for HIV care in Taiwan. The T. pallidum strains were genotyped by following the enhanced molecular typing methodology, which analyzed the number of 60-bp repeats in the acidic repeat protein (arp) gene, T. pallidum repeat (tpr) polymorphism, and the sequence of base pairs 131 to 215 in the tp0548 open reading frame of T. pallidum. Detection of A2058G and A2059G point mutations in the T. pallidum 23S rRNA was performed with the use of restriction fragment length polymorphism (RFLP). During the 2-year study period, 211 clinical specimens were obtained from 136 patients with syphilis. T. pallidum DNA was isolated from 105 (49.8%) of the specimens, with swab specimens obtained from chancres having the highest yield rate (63.2%), followed by plasma (49.4%), serum (35.7%), and cerebrospinal fluid or vitreous fluid (18.2%) specimens. Among the 40 fully typed specimens, 11 subtypes of T. pallidum were identified. Subtype 14f/f (18 isolates) was the most common isolates, followed by 14f/c (3), 14b/c (3), and 14k/f (3). Among the isolates examined for macrolide resistance, none had the A2058G or A2059G mutation. In conclusion, we found that type 14 f/f was the most common T. pallidum strain in this multicenter study on syphilis in Taiwan and that none of the isolates exhibited 23S rRNA mutations causing resistance to macrolides.
authors.affiliation: Centers for Disease Control, Taipei, Taiwan.
authors.forename: Hsiu
authors.initials: H
authors.lastname: Wu
authors.forename: Sui-Yuan
authors.initials: SY
authors.lastname: Chang
authors.forename: Nan-Yao
authors.initials: NY
authors.lastname: Lee
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Huang
authors.forename: Bing-Ru
authors.initials: BR
authors.lastname: Wu
authors.forename: Chia-Jui
authors.initials: CJ
authors.lastname: Yang
authors.forename: Shiou-Haur
authors.initials: SH
authors.lastname: Liang
authors.forename: Chen-Hsiang
authors.initials: CH
authors.lastname: Lee
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
authors.forename: Hsi-Hsun
authors.initials: HH
authors.lastname: Lin
authors.forename: Yen-Hsu
authors.initials: YH
authors.lastname: Chen
authors.forename: Wen-Chun
authors.initials: WC
authors.lastname: Liu
authors.forename: Yi-Ching
authors.initials: YC
authors.lastname: Su
authors.forename: Chia-Yin
authors.initials: CY
authors.lastname: Hsieh
authors.forename: Pei-Ying
authors.initials: PY
authors.lastname: Wu
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016000:Cluster Analysis; D004269:DNA, Bacterial / Q000235:genetics; D024881:Drug Resistance, Bacterial; D005838:Genotype; D015658:HIV Infections / Q000150:complications; D006801:Humans; D018942:Macrolides / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D058889:Molecular Typing; D016366:Open Reading Frames; D017354:Point Mutation; D011110:Polymorphism, Genetic; D012150:Polymorphism, Restriction Fragment Length; D011446:Prospective Studies; D012338:RNA, Ribosomal, 23S / Q000235:genetics; D013587:Syphilis / Q000382:microbiology*; D013624:Taiwan; D014210:Treponema pallidum / Q000145:classification* / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D018942:Macrolides; D012338:RNA, Ribosomal, 23S