LGBTQ Agenda: SF health officials respond to national syphilis drug shortage

  • by John Ferrannini, Assistant Editor
  • Tuesday August 1, 2023
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Pfizer has cautioned public health departments and others that Bicillin L-A, its treatment for syphilis, is in short supply, likely for about the next year. Photo: From Vaccine Shop
Pfizer has cautioned public health departments and others that Bicillin L-A, its treatment for syphilis, is in short supply, likely for about the next year. Photo: From Vaccine Shop

The San Francisco Department of Public Health is requesting that prescribing the most common treatment for syphilis be prioritized for groups at the highest risk of adverse outcomes from infection, due to a nationwide shortage of the antibiotic benzathine penicillin G.

Local health officials first publicized the shortage this spring.

"On May 18, SFDPH issued a Health Advisory requesting clinicians in San Francisco prioritize Bicillin L-A [the trade name for benzathine penicillin G] for pregnant people and people capable of pregnancy with syphilis infection or exposure, and for non-pregnant persons with early syphilis — syphilis within the first year after infection, which is when it is most transmissible through sex — who are less likely to complete a course of doxycycline or cannot take doxycycline," a statement to the Bay Area Reporter reads. "SFDPH will update guidance as needed."

In June, Pfizer — the company that makes the powerful antibiotic — sent a letter to its medical customers warning that there's a limited supply and "impending stock out situation" of the drug.

"The supply interruption is the result of a complex combination of factors including significant increases in demand, due to an increase in syphilis infection rates as well as competitive shortages," Pfizer Hospital U.S. stated in the letter.

Bicillin is the only recommended treatment for pregnant people with syphilis, and can prevent congenital syphilis, which is when the bacteria that causes syphilis is transmitted to a fetus, which can easily cause birth defects or death.

Syphilis is caused by the bacteria Treponema pallidum, and is spread by contact with infected lesions or sores. The primary stage of syphilis is the presence of such a chancre, followed by a secondary stage that often involves rashes and swollen lymph nodes. It's in the third stage — after a latency period that could last over a decade — that syphilis can be fatal, sometimes involving damage to the central nervous system or the brain.

And syphilis often was fatal until 1943, when the antibiotic penicillin became the first effective treatment. Syphilis rates declined to a low at the turn of the millennium, but in recent years the sexually transmitted infection has been making a comeback. According to national Centers for Disease Control and Prevention data syphilis rates increased 32% from 2020 to 2021, to 176,713 total cases per year. That made 2021 the worst year since 1950, which saw 217,558 cases, according to CDC data.

More recently, though, syphilis was among the STIs that have seen a decline both in San Francisco and nationwide since mid-2022. As the B.A.R. previously reported rates of syphilis in the city declined by about 7% (1,879 reported in 2021 compared to 1,684 reported in 2022). In 2023, there were 483 cases of syphilis reported in San Francisco as of April 30, compared to 612 last year during the same period.

As of the city's most recent STI report, there were 122 cases of syphilis reported in the city as of May 31, 2023, compared to 135 as of that date the year prior. That includes 27 primary and secondary cases (compared to 123 in 2022), 47 early latent cases (compared to 249 in 2022), 11 latent cases of unknown length (compared to 76 in 2022), 37 late latent cases (compared to 153 in 2022), zero cases of neurosyphilis (compared to eight in 2022), zero cases of congenital syphilis (compared to two in 2022), and 15 cases of syphilis in women (compared to 91 in 2022).

As the B.A.R. previously reported, experts aren't yet sure why STI rates have gone down. Perhaps mpox fears led to sexually active people having fewer unprotected sexual partners; or the use of doxycycline as post-exposure prophylaxis for chlamydia and gonorrhea last fall, referred to as doxy-PEP, has made a dent in STI rates. Though doxy-PEP has shown some effectiveness against syphilis infections, studies have not conclusively determined how much.

Because prescribing Bicillin-L-A for other infections was one reason for the current shortage, DPH recommends other infections be treated with alternative antibiotics.

"SFDPH also recommends that clinicians who have been using Bicillin-L-A for conditions other than syphilis — strep throat, prophylaxis for rheumatic fever — to use alternate antibiotics such as penicillin V, amoxicillin, or azithromycin," the statement continued.

DPH stated it's "monitoring the situation" closely.

Jorge Roman, the senior director of medical services for the San Francisco AIDS Foundation, advises those who frequent SFAF's Magnet clinic at its Strut health center in the city's LGBTQ Castro neighborhood not to be alarmed.

"We have been aware of a nationwide shortage of Penicillin G Benzathine (Bicillin), used to treat syphilis since the spring of this year," Roman stated to the B.A.R. "At SFAF, we have been able to secure enough supply of Bicillin to support our clinical operations through the end of the year and beyond, and will continue to monitor our supply for any impact in response to the supply of our community partners.

"As a community of sexual health providers, we also have contingency plans in place to respond to this supply shortage and are prepared to make additional adjustments should the issue last longer than expected," Roman added.

Pfizer expects the shortage to be ameliorated in the third and fourth quarters of 2024, or between summer and winter.

DPH stated that future updates can be found at SF City Clinic website. Providers having difficulty accessing Bicillin L-A for patients who cannot take doxycycline can refer patients to SF City Clinic for treatment at 628-217-6600.

LGBTQ Agenda is an online column that appears weekly. Got a tip on queer news? Contact John Ferrannini at [email protected]

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