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Although penicillin has been effective in treating syphilis for more than 6 decades, the need to administer this agent parenterally has led physicians to seek oral alternatives, including tetracyclines and macrolides. Unfortunately, an international team of investigators has found evidence that significant resistance to azithromycin is emerging in several cities.
After several apparent failures of azithromycin therapy for syphilis were noted in San Francisco, the researchers examined clinical isolates of Treponema pallidum collected from patients in San Francisco, Baltimore, Seattle, and Dublin. Sequencing of the 23S ribosomal RNA genes in eight of the isolates revealed a point mutation in these genes that previously had been identified only…