{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:23:27Z","timestamp":1747196607871,"version":"3.40.5"},"reference-count":80,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T00:00:00Z","timestamp":1718928000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Syphilis, caused by <jats:italic>Treponema pallidum<\/jats:italic>, is resurging globally. Molecular typing allows for the investigation of its epidemiology. In Pakistan and other nations, <jats:italic>T. pallidum<\/jats:italic> subsp. <jats:italic>pallidum<\/jats:italic> has developed widespread macrolide resistance in the past decade. A study at the Peshawar Regional Blood Centre from June 2020\u2013June 2021 analyzed serum samples from 32,812 blood donors in Khyber Pakhtunkhwa, Pakistan, to assess circulating <jats:italic>T. pallidum<\/jats:italic> strains and antibiotic resistance. Blood samples were initially screened for <jats:italic>T. pallidum<\/jats:italic> antibodies using a chemiluminescent microparticle immunoassay (CMIA). CMIA-reactive samples underwent polymerase chain reaction (PCR) targeted the <jats:italic>polA<\/jats:italic>, <jats:italic>tpp47<\/jats:italic>, <jats:italic>bmp<\/jats:italic>, and <jats:italic>tp0319<\/jats:italic> genes. PCR-positive samples were further analyzed for molecular subtyping using a CDC-developed procedure and <jats:italic>tp0548<\/jats:italic> gene examination. All PCR-positive samples were analyzed for the presence of point mutations A2058G and A2059G in 23S rRNA, as well as the G1058C mutation in 16S rRNA. These mutations are known to impart antimicrobial resistance to macrolides and doxycycline, respectively. Out of 32,812 serum samples, 272 (0.83%) were CMIA-reactive, with 46 being PCR-positive. Nine <jats:italic>T. pallidum<\/jats:italic> subtypes were identified, predominantly 14d\/f. The A2058G mutation in 23S rRNA was found in 78% of cases, while G1058C in 16S rRNA and A2059G in 23S rRNA were absent. The research found donor blood useful for assessing <jats:italic>T. pallidum<\/jats:italic> molecular subtypes and antibiotic resistance, especially when chancres are not present. The prevalent subtype was 14d\/f (51.85%), and the high macrolide resistance of 36 (78%) indicates caution in using macrolides for syphilis treatment in Khyber Pakhtunkhwa, Pakistan.<\/jats:p>","DOI":"10.1371\/journal.pone.0305720","type":"journal-article","created":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T17:45:54Z","timestamp":1718991954000},"page":"e0305720","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Analysis of molecular subtypes and antibiotic resistance in Treponema pallidum isolates from blood donors in Khyber Pakhtunkhwa, Pakistan"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5466-844X","authenticated-orcid":true,"given":"Iqbal","family":"Muhammad","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eman H.","family":"Khalifa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magdi M.","family":"Salih","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waheed","family":"Ullah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manal S. 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