Adrien Sanchez, Constance Mayslich, Isabelle Malet, Philippe Alain Grange, Michel Janier, Julie Saule, Pervenche Martinet, Jean-Luc Robert, Dominique Moulene, François Truchetet, Anne-Lise Pinault, Annie Vermersch-Langlin, Nadjet Benhaddou, Johan Chanal, Nicolas Dupin
DOI: 10.2340/00015555-3589

Benzathine penicillin G (BPG) is the reference treatment for early syphilis, but shortages have recently been reported, highlighting a need for the validation of alternative treatments. The aim of this study was to evaluate the genomic resistance of Treponema pallidum subspecies pallidum (TPA) to macrolides and doxycycline in France. Swabs from genital, anal, oral and cutaneous lesions were obtained from 146 patients with early syphilis in France. They were screened for mutations conferring resistance to macrolides and doxycycline by nested PCR and sequencing. Resistance to macrolides was detected in 85% of the isolates, but no point mutations conferring doxycycline resistance were detected. These findings confirm that, in France, resistance to macrolides is widespread. Moreover, we confirmed the absence of genomic resistance to doxycycline in the TPA strains. Therefore, doxycycline could be safely recommended as an alternative to BPG for the treatment of early syphilis.

Benzathine penicillin G is the reference treatment for early syphilis, but shortages have been reported recently, highlighting a need for the validation of alternative treatments. The aim of this study was to evaluate the genomic resistance of Treponema pallidum subspecies pallidum to macrolides and doxycycline in France. Swabs from mucosal and cutaneous lesions were obtained from 146 patients with early syphilis. Resistance to macrolides was detected in 85% of the isolates, but no mutations conferring doxycycline resistance were detected. These findings confirm that resistance to macrolides is widespread and no evidence for genomic resistance to doxycycline was detected.