First Report of Genetic Resistance to Azithromycin in Treponema pallidum from Blood Samples Among Men Who Have Sex with Men and People Living with HIV from Mexico

Syphilis is a re-emerging sexually transmitted disease caused by <i>Treponema pallidum</i> subsp. <i>pallidum</i> (TPA). It especially affects vulnerable populations such as men who have sex with men (MSM) and people living with HIV. Despite being treatable with benzathine penicillin G, a substantial increase in TPA resistance to azithromycin has been reported in many countries. The objective of this study was to detect the resistance of <i>T. pallidum</i> (TPA) to macrolides in blood samples from men who have sex with men and people living with HIV using molecular methods in a cross-sectional study. The detection of both TPA and the resistance to azithromycin was achieved through molecular methodologies (nested PCR), which were applied to blood samples of people with asymptomatic syphilis. We report the first data on the molecular prevalence of TPA and the first identification of genetic resistance to azithromycin (punctual mutation A2058G) in Mexico. Resistance testing for syphilis is not routinely performed in Mexico, but azithromycin continues to be prescribed despite syphilis being treatable with benzathine penicillin G. Therefore, the surveillance of cases of syphilis treatment failure, especially in vulnerable populations, which are the population group that maintains the active transmission of TPA, is recommended.