Two Treponema pallidum strains account for the majority of syphilis infections, including among females, in Queensland, Australia

Authors

  • Emma L Sweeney University of Queensland Centre for Clinical Research (UQ-CCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  • Kym Lowry University of Queensland Centre for Clinical Research (UQ-CCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  • Mandy Seel Metro North Public Health Unit, Brisbane, Queensland, Australia
  • Frashta Rahimi University of Queensland Centre for Clinical Research (UQ-CCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  • Julian Langton-Lockton Biala Community Health Centre, Brisbane, Queensland, Australia
  • Cheryl Bletchly Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia
  • Graeme R Nimmo Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia; Griffith University, School of Medicine, Queensland, Australia
  • David M Whiley University of Queensland Centre for Clinical Research (UQ-CCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia

DOI:

https://doi.org/10.33321/cdi.2022.46.26

Keywords:

Treponema pallidum, sexually-transmitted infection, molecular diversity, multi-locus sequence typing, Queensland, Australia

Abstract

An ongoing outbreak of syphilis in Australia, first reported in the state of Queensland in 2011, has led to increasing cases of congenital syphilis, including several deaths. Here, we applied multi-locus sequence typing (MLST) on available Treponema pallidum PCR-positive samples from the state of Queensland from the beginning of the outbreak to July 2020. In total, 393 samples from 337 males and 56 females were genotyped. Of 36 different Treponema pallidum sequence types (ST) observed, the two most common STs, ST 1 (also reported to be a dominant strain in various other countries) and ST 100 (the latter differing from ST 1 by only one single nucleotide polymorphism (SNP) based on the MLST scheme), together comprised 69% (271/393) of all samples, including the majority of samples in females (79%; 44/56). ST 1 was prevalent throughout the entire study period. Both strains remained the most common STs during the year 2020 where social distancing and other measures were implemented due to the COVID-19 pandemic. Both STs had high male-to-female ratios and included male rectal infections, therefore suggestive of occurrence primarily among men-who-have-sex-with-men (MSM). Hence, bridging from MSM to heterosexual networks may potentially contribute to infections among females, but further studies are needed to confirm this. Overall, there was considerable diversity of Treponema pallidum genotypes observed throughout the study period, but the fact that two key strains accounted for the majority of infections, including among females, stresses the need for further investigations into the transmission of these strains, and potentially a need for targeted public health interventions to better control the spread of syphilis in Queensland.

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References

Queensland Health. Notifications of Syphilis in Queensland. 2019 Report. Brisbane: Queensland Government, Queensland Health; April 2020. Available from: https://www.health.qld.gov.au/__data/assets/pdf_file/0040/959809/syphilis-in-queensland-2019.pdf.

Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2018. Sydney: University of New South Wales, Kirby Institute; 2018. Available from: https://kirby.unsw.edu.au/sites/default/files/kirby/report/KI_Annual-Surveillance-Report-2018.pdf.

Multi-jurisdictional Syphilis Outbreak Working Group. Multijurisdictional syphilis outbreak surveillance report: October 2020. Canberra: Australian Government Department of Health; October 2020. Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-infectious-syphilis-outbreak.htm#historical.

Grillova L, Jolley K, Šmajs D, Picardeau M. A public database for the new MLST scheme for Treponema pallidum subsp. pallidum: surveillance and epidemiology of the causative agent of syphilis. PeerJ. 2019;6:e6182. doi: https://doi.org/10.7717/peerj.6182.

Grillová L, Bawa T, Mikalová L, Gayet-Ageron A, Nieselt K, Strouhal M et al. Molecular characterization of Treponema pallidum subsp. pallidum in Switzerland and France with a new multilocus sequence typing scheme. PloS One. 2018;13(7):e0200773. doi: https://doi.org/10.1371/journal.pone.0200773.

Grillová L, Noda AA, Lienhard R, Blanco O, Rodríguez I, Šmajs D. Multilocus sequence typing of Treponema pallidum subsp. pallidum in Cuba From 2012 to 2017. J Infect Dis. 2019;219(7):1138–45.

Pospíšilová P, Grange PA, Grillová L, Mikalová L, Martinet P, Janier M et al. Multi-locus sequence typing of Treponema pallidum subsp. pallidum present in clinical samples from France: infecting treponemes are genetically diverse and belong to 18 allelic profiles. PloS One. 2018;13(7):e0201068. doi: https://doi.org/10.1371/journal.pone.0201068.

Palmer HM, Higgins SP, Herring AJ, Kingston MA. Use of PCR in the diagnosis of early syphilis in the United Kingdom. Sex Transm Infect. 2003;79(6):479–83.

Li Z, Hou J, Zheng R, Li Z, Wen J, Liu D et al. Two mutations associated with macrolide resistance in Treponema pallidum in Shandong, China. J Clin Microbiol. 2013;51(12):4270–1.

Wu BR, Liu WC, Wu PY, Su YC, Yang SP, Hung CC et al. Surveillance study of Treponema pallidum harbouring tetracycline resistance mutations in patients with syphilis. Int J Antimicrob Agents. 2014;44(4):370–2.

Vrbová E, Grillová L, Mikalová L, Pospíšilová P, Strnadel R, Dastychová E et al. MLST typing of Treponema pallidum subsp. pallidum in the Czech Republic during 2004–2017: clinical isolates belonged to 25 allelic profiles and harbored 8 novel allelic variants. PloS One. 2019;14(5):e0217611. doi: https://doi.org/10.1371/journal.pone.0217611.

Cunningham SD, Olthoff G, Burnett P, Rompalo AM, Ellen JM. Evidence of heterosexual bridging among syphilis-positive men who have sex with men. Sex Transm Infect. 2006;82(6):444–5.

Yun K, Xu JJ, Reilly KH, Zhang J, Jiang YJ, Wang N et al. Prevalence of bisexual behaviour among bridge population of men who have sex with men in China: a meta-analysis of observational studies. Sex Transm Infect. 2011;87(7):563–70.

Williamson DA, Chow EPF, Gorrie CL, Seemann T, Ingle DJ, Higgins N et al. Bridging of Neisseria gonorrhoeae lineages across sexual networks in the HIV pre-exposure prophylaxis era. Nat Commun. 2019;10(1):3988. doi: https://doi.org/10.1038/s41467-019-12053-4.

Read P, Tagg KA, Jeoffreys N, Guy RJ, Gilbert GL, Donovan B. Treponema pallidum strain types and association with macrolide resistance in Sydney, Australia: new TP0548 gene types identified. J Clin Microbiol. 2016;54(8):2172–4.

Gayet-Ageron A, Combescure C, Lautenschlager S, Ninet B, Perneger TV. Comparison of diagnostic accuracy of PCR targeting the 47-kilodalton protein membrane gene of Treponema pallidum and PCR targeting the DNA polymerase I gene: systematic review and meta-analysis. J Clin Microbiol. 2015;53(11):3522–9.

Liu H, Rodes B, Chen CY, Steiner B. New tests for syphilis: rational design of a PCR method for detection of Treponema pallidum in clinical specimens using unique regions of the DNA polymerase I gene. J Clin Microbiol. 2001;39(5):1941–6.

Noda AA, Rodríguez I, Grillová L, Bosshard PP, Lienhard R. Accuracy of PCR and serological testing for the diagnosis of primary syphilis: both tests are necessary. Int J STD AIDS. 2019;30(11):1087–94.

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Published

19/05/22

How to Cite

Sweeney, Emma L, Kym Lowry, Mandy Seel, Frashta Rahimi, Julian Langton-Lockton, Cheryl Bletchly, Graeme R Nimmo, and David M Whiley. 2022. “Two Treponema Pallidum Strains Account for the Majority of Syphilis Infections, Including Among Females, in Queensland, Australia”. Communicable Diseases Intelligence 46 (May). https://doi.org/10.33321/cdi.2022.46.26.

Issue

Vol. 46 (2022)

Section

Original article

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