Relationship between the high frequency of 23S rRNA point mutations in Treponema pallidum and low serological response rate to azithromycin treatment in China

作     者：Rui-Li Zhang Qian-Qiu Wang Zhi-Ju Zheng Guo-Jun Liang Li-Jia Yang Li-Gang Yang Dong-Nu Pei Shao-Chun Lin Zhang Rui-Li;Wang Qian-Qiu;Zheng Zhi-Ju;Liang Guo-Jun;Yang Li-Jia;Yang Li-Gang;Pei Dong-Nu;Lin Shao-Chun

作者机构：Department of DermatologyAffiliated Wuxi No.2 People's Hospital of Nanjing Medical UniversityWuxiJiangsu 214002China National Center for STD Control and PreventionChina Centers for Diseases Control and PreventionHospital for Skin Diseases(Institute of Dermatology)Chinese Academy of Medical Sciences and Peking Union Medical CollegeNanjingJiangsu 210042China Department of DermatologyDermatology Hospital of Southern Medical UniversityGuangzhouGuangdong 510091China Department of DermatologyHainan Provincial Dermatology HospitalHaikouHainan 570100China Department of DermatologyInstitute of DermatologySichuan Provincial People's HospitalChengduSichuan 611500China 

出 版 物：《International Journal of Dermatology and Venereology》 (国际皮肤性病学杂志（英文）)

年 卷 期：2019年第2卷第1期

页      面：6-14页

学科分类：1004[医学-公共卫生与预防医学(可授医学、理学学位)] 1002[医学-临床医学] 1001[医学-基础医学(可授医学、理学学位)] 100214[医学-肿瘤学] 10[医学] 

基　　金：the Mega Project of China National Science Research for the 11th Five-year Plan(2008ZX10001-005) Natural Science Foundation of Jiangsu Province of China(BK20150121) National Natural Science Foundation of China(81601804,8177220) the Union Innovation Team Project of Chinese Academy of Medical Sciences(No.2016-I2M-3021) 

主　　题：Syphilis Azithromycin Mutation Serological response Treponema pallidum 

摘      要：Objective Although azithromycin is effective against Treponema pallidum (***),the causative agent of syphilis,recent reports indicate that the prevalence of azithromycin resistance in China is very high,which may result in the failure of *** this study,we aimed to investigate the association between azithromycin resistance and therapeutic outcomes in early syphilis *** Between February 2010 and December 2014,patients aged 18-65 years with early syphilis were *** DNA were extracted to test the presence of A2058G and A2059G ***,eligible patients were randomly assigned to receive oral azithromycin (0.5 g,once daily for 15 days) or intramuscular BPG (2.4 million units,once weekly for 3 weeks).All patients were followed up in 2 weeks and 3,6,9,and 12 months after treatment to collect demographic and clinical characteristics and laboratory *** differences on serological response,serological failure and serofast rate were compared between the two groups by Chi-square *** Among the 187 ***-infected patients enrolled,172 (92.0%) cases had a mutation associated with azithromycin resistance (A2058G,153 cases;A2059G,19 cases).During the 5-year study period,the percentage of cases enrolled with these mutations steadily increased,from 90.9% in 2010 to 95.3% in *** the 172 patients presenting with these mutations,only 78 (45.3%;all benzathine penicillin G [BPG]-treated) obtained a serological response to treatment;32.6% and 22.1% of patients presented with serological failure and serofast results,*** azithromycin-treated cases,66.3% and 33.7% had serological failure and serofast results,respectively,in contrast with 1.1% and 11.3% of BPG-treated ***,among the A2058G-and A2059G-negative patients,the serological response rates between the two treatment groups were *** multivariate analyses,patients with lower rapid plasma reagin (RPR) titers (RPR,≤ 1 ∶ 8;odds ratio [OR],