Introduction. Syphilis is an infectious disease caused by Treponema pallidum spirochete and is mainly transmitted by sexual contact. Syphilis has the potential to cause serious complications and is closely related to human immunodeficiency virus (HIV) infection thus making syphilis still a major public health problem. In Indonesia, surveys of high-risk populations in 2007 and 2011 reported an increase in the prevalence of syphilis, especially in men who have sexual relationships with other men (MSM). Moreover, studies have described risk factors for HIV transmission including MSM, heterosexual contacts, Intravenous (IV) drug use, and infected partners. Objectives. To assess the epidemiological aspects and risk factors for syphilis in Makassar, as well as the correlation with a coinfection of other sexually transmitted infections. Material and Methods. This study is a multi-centre cross-sectional descriptive study with consecutive sampling. We evaluated cases for eligibility by confirming the diagnosis based on the serological result using rapid plasma reagin assay (RPR), Treponema pallidum haemagglutination (TPHA), and HIV screening kit. The cases were analyzed based on epidemiological features, risk factors and clinical findings, co-infection with other sexually transmitted infection (ST), and stadium of the disease. Results. A total of 79 serologically confirmed syphilis cases were collected between January 2017 and December 2018 in Makassar, the capital city of South Sulawesi province in Indonesia. Of the 63 male subjects (79.7%), 38 (48.1%) were homosexual/MSM, and in 41 cases of HIV-infected subjects, 25 (60.9%) of them were also MSM. Conclusion. Our study showed there was a significant correlation between syphilis and an increased risk of HIV transmission in MSM groups. The higher number of cases of syphilis and HIV co-infection among MSM can increase transmission of both infections and should be considered a major risk factor for syphilis in Makassar.

Azithromycin is one of the antibiotics used to treat syphilis, especially in the context of penicillin allergy. Resistance to azithromycin is widely reported associated with one and/or two point mutations on the 23S rRNA gene but has yet to be described in Indonesia.Specimens were collected from 220 patients diagnosed with secondary syphilis. A multiplex nested PCR testing system using the 23S rRNA target gene of Treponema pallidum was designed using three pairs of primers. The first step used PCR pairs of primers to detect T. pallidum. In the second step of PCR using 2 pairs of primers were achieved to identify azithromycin resistant T. pallidum based on A2058G and A2059G point mutations. There was no T.pallidum identified resistant to azithromycin in Jakarta and Bandung. T. pallidum resistance to azithromycin were found in Makassar, Medan, and Bali. The majority of azithromycin resistance was found among heterosexual males and in patients living with HIV. This study has demonstrated T. pallidum resistance to azithromycin in Indonesia appears to be a novel variant of resistance, containing both the A2058G and A2059G mutations that was found in Medan and Makassar.