Azithromycin versus Penicillin for Early Syphilis

To the Editor: In their study on the treatment of early syphilis, Riedner et al. (Sept. 22 issue) 1 concluded that the wider use of oral azithromycin should be encouraged as part of syphilis-control programs in developing countries. Whereas this conclusion would appear to be rational on the basis of the authors' results, we believe that there are other factors that should be considered before opting for such a strategy. Although the authors acknowledged the potential for the emergence of azithromycin-resistant Treponema pallidum, ongoing monitoring for such resistance, as they suggested, requires molecular-sequencing techniques, 2 which are unavailable in most developing countries. . . .