The study by Oriol Mitja and colleagues in The Lancet shows that a single round of mass administration of azithromycin is insufficient to achieve yaws eradication. It also represents the first report of a mutation in both 23S rRNA genes of the yaws-causing spirochaete, Treponema pallidum subspecies pertenue (T p pertenue), causing macrolide resistance in five epidemiologically linked patients. The mutation, A2059G, was previously reported in a patient with syphilis (caused by T p pallidum) with spiramycin treatment failure;2 it is one of two macrolide-resistant mutations previously detected in T p pallidum (the other is A2058G). Since its discovery, the A2059G mutation has been detected in T p pallidum isolates from patients with syphilis from Argentina,China, Czech Republic,the UK, Madagascar and the USA.