We're #1! We're #1! Oh... in syphilis?

My friends and family (and well, complete strangers) have been subjected to my T. pallidum interest a lot so when this article came out on the Bold Italic (Not Bragging: SF is #1 in Syphilis), it was messaged, emailed and tweeted at me more than a few times. I love syphilis. 

I recently started a new class and the professor, having met me at an open house for the program, gleefully proclaimed "oh yes! Syphilis Girl" during introductions. I was delighted. I wrote my undergrad thesis on syphilis and HIV co-infection. I have always been interested in STI's and infectious bacteria in general but there's just something special about syphilis!

I'm also from the Bay Area where the Healthy Penis campaign was launched. I LOVE this campaign. Cartoon penises and "Phil" the angry, red syphilis sore appeared all over the city; smiling trios on the sides of buses, pyramids of plushie Clark, Byron and Pedro (yup, they have names!) grace Castro shop windows, person-sized costumes of all three arrived at events. I have a squishy Clark on my desk and it's one of my treasures. The bottom of it has the name of clinics where you can get STI/HIV testing and a request to get tested every six months. It's cheeky and fun and kind of ridiculous. Sadly, it doesn't seem to have had much of an effect. The new campaign that has just gone up looks more like an ad for Scientology. The video makes more sense but it doesn't seem as charming or engaging as adding Phil or Clark or Pedro as Facebook friends. 

One of the things about syphilis I find so fascinating is that it's still susceptible to classic antibiotics like penicillin. I'm guessing syphilis infections are actually underreported as it can be easily wiped out before diagnosis. So even though it's been on rise in the Bay Area (and elsewhere) thankfully syphilis hasn't changed much in a few thousand years and hasn't really developed antibiotic resistance. Which is so weird, as it's had plenty of time to update its skill set. Unlike its friends staph and gonorrhea (which is in SF and may have started here) which are ahead of the curve in antibiotic resistance, syphilis is pretty static. 

However, there has been confirmation of antibiotic resistance for syphilis. Four HIV patients had syphilitic infections that did not respond to a common antibiotic, azithromycin (Z-pak). Their infections did respond to other antibiotics. Sequencing of the T. pallidum genome of each patient indicated a single point mutation. HIV treatment often includes preventative doses of antibiotics and antibiotic resistant bacterial infections are common as any bacteria not cleared by the immune system hangs around and has the opportunity to evolve resistance. The good news is that daily antibiotics are much less necessary as modern anti-retroivirals have improved and can keep the virus at undetectable, untransmissable levels. These four cases seem pretty localized and specific to comorbidity with HIV.

I'll probably be writing a lot about my favorite spirocheteEspecially since this ancient little infectious goober has been making headlines, which gives me lots of opportunities to tell people all about it. In great detail. For hours. At parties. On the bus. Did I mention I loooooOoOoove syphilis? 

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