Salazar JC, Vargas-Cely F, García-Luna JA, Ramirez LG, Bettin EB, Romero-Rosas N, Amórtegui MF, Silva S, Oviedo O, Vigil J, La Vake CJ, Galindo X, Ramirez JD, Martínez-Valencia AJ, Caimano MJ, Hennelly CM, Aghakhanian F, Moody MA, Seña AC, Parr JB, Hawley KL, López-Medina E, and Radolf JD
Background: Venereal syphilis, caused by the spirochete Treponema pallidum subsp. pallidum (TPA), is surging worldwide, underscoring the need for a vaccine with global efficacy. Vaccine development requires an understanding of syphilis epidemiology and clinical presentation as well as genomic characterization of TPA strains circulating within at-risk populations. The aim of this study was to describe the clinical, demographic, and molecular features of early syphilis cases in Cali, Colombia., Methods and Findings: We conducted a cross-sectional study to identify individuals with early syphilis (ES) in Cali, Colombia through a city-wide network of public health centers, private sector HIV clinics and laboratory databases from public health institutions. Whole blood (WB), skin biopsies (SB), and genital and oral lesion swabs were obtained for measurement of treponemal burdens by polA quantitative polymerase chain reaction (qPCR) and for whole-genome sequencing (WGS). Among 1,966 individuals screened, 128 participants met enrollment criteria: 112 (87%) with secondary (SS), 15 (12%) with primary (PS) and one with early latent syphilis; 66/128 (52%) self-reported as heterosexual, while 48 (38%) were men who have sex with men (MSM). Genital ulcer swabs had the highest polA copy numbers (67 copies/μl) by qPCR with a positivity rate (PR) of 73%, while SS lesions had 42 polA copies/μl with PR of 62%. WB polA positivity was more frequent in SS than PS (42% vs 7%, respectively; p = 0.009). Isolation of TPA from WB by rabbit infectivity testing (RIT) was achieved in 5 (56%) of 9 ES WB samples tested. WGS from 33 Cali patient samples, along with 10 other genomic sequences from South America (9 from Peru, 1 from Argentina) used as comparators, confirmed that SS14 was the predominant clade, and that half of all samples had mutations associated with macrolide (i.e., azithromycin) resistance. Variability in the outer membrane protein (OMP) and vaccine candidate BamA (TP0326) was mapped onto the protein's predicted structure from AlphaFold. Despite the presence of mutations in several extracellular loops (ECLs), ECL4, an immunodominant loop and proven opsonic target, was highly conserved in this group of Colombian and South American TPA isolates., Conclusions: This study offers new insights into the sociodemographic and clinical features of venereal syphilis in a highly endemic area of Colombia and illustrates how genomic sequencing of regionally prevalent TPA strains can inform vaccine development., Competing Interests: Outside the submitted work, ACS reports royalties from UptoDate Inc, ELM reports research grants from Sanofi Pasteur, Janssen, Moderna and GSK, grants and consulting fees from Takeda and MSD, and honoraria from Pfizer, JAGL reports support for attending meetings/travel from Janssen, MAM reports membership in an advisory board for GSK, JDR receives royalties from Biokit SA, Chembio, and Span Diagnostics for syphilis serodiagnostic reagents outside the scope of the current work, JBP reports research support from Gilead Sciences, non-financial support from Abbott Diagnostics, and consulting for Zymeron Corporation. All other authors report no competing interests. The commercial funders indicated above provided support in the form of royalties for stated authors but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript., (Copyright: © 2024 Salazar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)