{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T17:21:12Z","timestamp":1759339272174,"version":"3.37.3"},"reference-count":10,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2019,8,5]],"date-time":"2019-08-05T00:00:00Z","timestamp":1564963200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Public Health Laboratory, GGD Amsterdam, Amsterdam, Netherlands","award":["R&D 7572.2172"],"award-info":[{"award-number":["R&D 7572.2172"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2019,7,17]]},"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec>\n<jats:title>Objectives<\/jats:title>\n<jats:p>\nThe prevalence of syphilis, caused by the spirochete\n<jats:italic>Treponema pallidum<\/jats:italic>\nsubsp\n<jats:italic>. pallidum<\/jats:italic>\n(TPA), remains high despite the availability of effective antibiotics. In the Netherlands, most syphilis cases are found among men who have sex with men (MSM). We studied the distribution of TPA strain types by molecular characterisation and related this to available characteristics. In addition, resistance to macrolides was assessed.\n<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>\nTPA DNA was extracted from 136 genital ulcer swab or skin lesions samples deriving from 135 patients diagnosed with syphilis in 2016 and 2017 at the Public Health Service in Amsterdam, the Netherlands. Molecular typing was done according to the enhanced CDC method (E-CDC), in which three genetic regions of the\n<jats:italic>arp<\/jats:italic>\n,\n<jats:italic>tpr<\/jats:italic>\nand\n<jats:italic>tp0548<\/jats:italic>\ngenes are analysed by gel electrophoresis of the\n<jats:italic>arp<\/jats:italic>\nand\n<jats:italic>tpr<\/jats:italic>\nregions and by sequence analysis for the\n<jats:italic>tp0548<\/jats:italic>\nregion. Part of the 23S rDNA locus was sequenced to determine the presence of macrolide resistance-associated mutations.\n<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>\nFull E-CDC strain types could be determined for 99\/136 (73%) DNA samples, which tested positive in a diagnostic PCR targeting the\n<jats:italic>polA<\/jats:italic>\ngene. Types differed within one patient of whom two samples were available. No association was found between the demographic and clinical characteristics and the TPA types. The most prevalent type was 14d\/g, found in 23 of the 99 (23%) fully typed samples. Part of the 23S rDNA locus was successfully sequenced for 93\/136 (68%) samples and 83 (88%) contained the A2058G mutation. No A2059G mutation was found.\n<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>A broad strain distribution was found. Few subtypes were clonally expanded, and most other subtypes were rare. Detection of the most prevalent strain type, 14d\/g, is in concordance with other TPA typing studies. The high prevalence of genetic macrolide resistance indicates that azithromycin is not an alternative treatment option.<\/jats:p>\n<\/jats:sec>","DOI":"10.1136\/sextrans-2019-054044","type":"journal-article","created":{"date-parts":[[2019,8,5]],"date-time":"2019-08-05T21:15:38Z","timestamp":1565039738000},"page":"223-226","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Molecular diversity of\n<i>Treponema pallidum<\/i>\nsubspecies\n<i>pallidum<\/i>\nisolates in Amsterdam, the Netherlands"],"prefix":"10.1136","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9230-7488","authenticated-orcid":false,"given":"Helene C A","family":"Zondag","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akke R","family":"Cornelissen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alje P","family":"van Dam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvia M","family":"Bruisten","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,8,5]]},"reference":[{"key":"2024092304051568000_96.3.223.1","unstructured":"National Institute for Public Health and the Environment R . Sexually transmitted infections in the Netherlands in 2017. RIVM report number: 2018-0012 2018."},{"key":"2024092304051568000_96.3.223.2","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-199809000-00004"},{"key":"2024092304051568000_96.3.223.3","doi-asserted-by":"publisher","DOI":"10.1086\/656533"},{"key":"2024092304051568000_96.3.223.4","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.007542-0"},{"key":"2024092304051568000_96.3.223.5","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00720-09"},{"key":"2024092304051568000_96.3.223.6","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000741"},{"key":"2024092304051568000_96.3.223.7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0200773","article-title":"Molecular characterization of Treponema pallidum subsp. pallidum in Switzerland and France with a new multilocus sequence typing scheme","volume":"13","author":"Grillov\u00e1","year":"2018","journal-title":"PLoS One"},{"key":"2024092304051568000_96.3.223.8","doi-asserted-by":"crossref","unstructured":"Arora N , Schuenemann VJ , J\u00e4ger G , et al . Origin of modern syphilis and emergence of a pandemic Treponema pallidum cluster. Nat Microbiol 2017;2.doi:10.1038\/nmicrobiol.2016.245","DOI":"10.1038\/nmicrobiol.2016.245"},{"key":"2024092304051568000_96.3.223.9","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2180-13-178","article-title":"Comparison of CDC and sequence-based molecular typing of syphilis treponemes: TPR and Arp loci are variable in multiple samples from the same patient","volume":"13","author":"Mikalov\u00e1","year":"2013","journal-title":"BMC Microbiol"},{"key":"2024092304051568000_96.3.223.10","doi-asserted-by":"crossref","DOI":"10.1128\/mBio.01153-18","article-title":"Long-Term In Vitro Culture of the Syphilis Spirochete Treponema pallidum subsp. pallidum","volume":"9","author":"Edmondson","year":"2018","journal-title":"MBio"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2019-054044","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T17:56:55Z","timestamp":1727114215000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2019-054044"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,5]]},"references-count":10,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,4,17]]},"published-print":{"date-parts":[[2020,5]]}},"alternative-id":["10.1136\/sextrans-2019-054044"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2019-054044","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"type":"print","value":"1368-4973"},{"type":"electronic","value":"1472-3263"}],"subject":[],"published":{"date-parts":[[2019,8,5]]}}}