Emerging Strain of Syphilis Resistant to Azithromycin, Study Finds
A growing percentage of people with syphilis are infected with a strain of the disease that is resistant to azithromycin, an oral antibiotic given to some patients as an alternative to painful penicillin shots, according to a study in the New England Journal of Medicine, the AP/Spokane Spokesman-Review reports. Sheila Lukehart, a research professor of infectious diseases at the University of Washington in Seattle, and colleagues tested 114 syphilis samples from patients at sexually transmitted disease clinics in Seattle, San Francisco, Baltimore and Dublin, Ireland. They found that at least 28% of the samples had a strain resistant to azithromycin. Among the samples from the Dublin clinics, 88% were resistant. In San Francisco, the percentage of samples with the mutant strain jumped from 4% in 1999-2002 to 37% in 2003, with much of the increase taking place among men who have sex with men and who have multiple partners.
CDC officials said that much of the overall increase in strains of syphilis resistant to azithromycin is attributable to a twelvefold increase in cases among MSM. Lukehart said that the study "suggests that this mutation is pretty widely distributed geographically." According to the AP/Spokesman-Review, experts say doctors should switch patients to penicillin or other antibiotics if azithromycin does not treat the syphilis infection. Experts also recommend that patients treated with azithromycin receive follow-up tests to ensure that the syphilis was cured (Johnson, AP/Spokane Spokesman-Review, 7/8). An abstract of the study is available online.
Public-sector investment in research, drug development and prevention of sexually transmitted diseases is "nonexistent" and must be increased before the spread of drug-resistant infectious diseases "set[s] back decades of advances in public health and disease control," Dr. Jeffrey Klausner, the San Francisco Department of Public Heath director for sexually transmitted disease prevention and control services, writes in a San Francisco Chronicle opinion piece. According to Klausner, the identification of a resistant strain of syphilis to azithromycin, a "potentially effective antibiotic" for treatment of the disease, "is of particular concern" because there are no new drugs in development for the disease and no research activities in process.
According to Klausner, the lack of investment can be attributed to "the privatization of public health research and the wholesale shift in what Americans believe is the role of the government versus industry." Klausner writes that funding cuts to CDC programs result in delays in disease control, adding that "vocal advocacy decrying" such cuts are needed to affect change (Klausner, San Francisco Chronicle, 7/9).