Significant exposures may include:
(1) sexual activity
(2) skin contact with someone with secondary syphilis
(3) offspring of a mother with syphilis
Adequate therapy with azithromycin or other macrolide:
(1) The dose and duration of therapy was adequate.
(2) The patient was fully compliant.
(3) Malabsorption of the drug was not an issue.
(4) There was no evidence of increased drug metabolism or excretion.
Reasons to consider macrolide resistance:
(1) Significant exposure in a region where macrolide resistance has been identified.
(2) Significant exposure to someone who has lived or visited a region where macrolide resistance has been identified.
(3) Failure to show a serologic response following apparent adequate therapy with azithromycin or other macrolide.
(4) Transmission of syphilis to someone following apparent adequate therapy with azithromycin or other macrolide with no other source.
(5) Persistent clinical findings following apparent adequate therapy with azithromycin or other macrolide not explained by re-exposure.
