Syphilis epidemiology in 1994–2013, molecular epidemiological strain typing and determination of macrolide resistance in <i>Treponema pallidum</i> in 2013–2014 in Tuva Republic, Russia

<jats:p>The incidence of syphilis in the Tuva Republic (geographical centre of Asia), Russia has been exceedingly high historically. No detailed examinations and no molecular investigations of <jats:italic>Treponema pallidum</jats:italic> strains transmitted in the Tuva Republic, or in general, in Russia, were published internationally. We examined the syphilis epidemiology in 1994–2013, and the molecular epidemiology and macrolide resistance in <jats:italic>T. pallidum</jats:italic> strains in 2013–2014 in the Tuva Republic. Among 95 mainly primary or secondary syphilis patients, the <jats:italic>arp</jats:italic>,<jats:italic> tpr</jats:italic>,<jats:italic> tp0548</jats:italic> and 23S <jats:styled-content style="fixed-case">rRNA</jats:styled-content> genes in 85 <jats:italic>polA</jats:italic> gene‐positive genital ulcer specimens were characterized. The syphilis incidence in Tuva Republic peaked in 1998 (1562), however declined to 177 in 2013. Among the 70 (82%) completely genotyped specimens, six molecular strain types were found. Strain type 14d/f accounted for 91%, but also 14c/f, 14d/g, 14b/f, 14i/f, 9d/f, and 4d/f were identified. Two (2.4%) specimens contained the 23S <jats:styled-content style="fixed-case">rRNA</jats:styled-content> A2058G macrolide resistance mutation. This is the first internationally published typing study regarding <jats:italic>T. pallidum</jats:italic> in Russia, performed in the Tuva Republic with the highest syphilis incidence in Russia. The two molecular strain types 4d/f and 9d/f have previously been described only in Eastern and Northern China and for the first time, macrolide‐resistant syphilis was described in Russia.</jats:p>