# 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

## TL;DR

This study reports the first case of genetic resistance to azithromycin in syphilis-causing bacteria in Mexico, among men who have sex with men and people living with HIV.

## Contribution

First identification of the A2058G mutation in Treponema pallidum in Mexico, indicating azithromycin resistance.

## Key findings

- Molecular detection of TPA in blood samples from asymptomatic syphilis cases.
- Identification of the A2058G mutation linked to azithromycin resistance in TPA in Mexico.

## Abstract

Syphilis is a re-emerging sexually transmitted disease caused by Treponema pallidum subsp. pallidum (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 T. pallidum (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.