Global challenge of antibiotic-resistant Treponema pallidum

Antimicrob Agents Chemother. 2010 Feb;54(2):583-9. doi: 10.1128/AAC.01095-09. Epub 2009 Oct 5.


Syphilis is a multistage infectious disease that is usually transmitted through contact with active lesions of a sexual partner or from an infected pregnant woman to her fetus. Despite elimination efforts, syphilis remains endemic in many developing countries and has reemerged in several developed countries, including China, where a widespread epidemic recently occurred. In the absence of a vaccine, syphilis control is largely dependent upon identification of infected individuals and treatment of these individuals and their contacts with antibiotics. Although penicillin is still effective, clinically significant resistance to macrolides, a second-line alternative to penicillin, has emerged. Macrolide-resistant strains of Treponema pallidum are now prevalent in several developed countries. An understanding of the genetic basis of T. pallidum antibiotic resistance is essential to enable molecular surveillance. This review discusses the genetic basis of T. pallidum macrolide resistance and the potential of this spirochete to develop additional antibiotic resistance that could seriously compromise syphilis treatment and control.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use*
  • Drug Resistance, Multiple, Bacterial*
  • Female
  • Humans
  • Macrolides / pharmacology
  • Macrolides / therapeutic use
  • Male
  • Pregnancy
  • Syphilis / drug therapy
  • Syphilis / epidemiology
  • Syphilis / microbiology
  • Treponema pallidum / drug effects*
  • Treponema pallidum / physiology


  • Anti-Bacterial Agents
  • Macrolides