Syphilis cases rising as drug to treat them in short supply. Local docs asked to ration

TACOMA – A national shortage of medication used to treat syphilis is leading to ration recommendations in Pierce County, and a recent update from the drugmaker did not bring better news.

On July 5, the Tacoma-Pierce County Health Department posted a health advisory for the local medical community regarding the current shortage of Penicillin G benzathine (Bicillin L-A). It called on prescribing physicians to “Reserve Bicillin L-A for pregnant people with or exposed to syphilis, or babies with congenital syphilis.”

It added that the Centers for Disease Control and Prevention recommends two different doxycycline treatment protocols during the shortage for early diagnosed latent cases and cases involving or those diagnosed as late latent or of unknown duration.

Syphilis is a bacterial infection typically spread through sexual contact. According to the Mayo Clinic, “The disease starts as a painless sore – typically on the genitals, rectum or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores.”

Syphilis infection is diagnosed as latent when symptoms are not present. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms, according to Washington state Department of Health online guide.

Untreated syphilis can spread to the brain and nervous system, eyes or ears and can be life-threatening. Blood tests are used to diagnose infection.

Early latent and late latent are determined based on whether the infection or exposure happened within a year of diagnosis (early) or is unknown or more than year out from diagnosis (late).

TPCHD told providers in its advisory that it “may be able to assist” if a site did not have enough for a patient needing treatment.

The news is particularly hard hitting for Pierce County, which the health department noted has seen the number of syphilis cases quadrupling locally from 2016 (58 cases) to 2021 (243 cases).

“Congenital syphilis cases increased from 2 in 2020 to 14 in 2021,” it added.

Congenital syphilis appears when the infection is passed to a fetus during pregnancy. Babies born to mothers with untreated syphilis can suffer serious health complications or result in a stillborn birth or death shortly after birth.

In April the U.S. Food and Drug Administration reported a shortage of injectible Penicillin G Benzathine with an “estimated recovery” from the shortage in the second quarter of next year.

The drug is also used as a treatment for other bacterial infections such as strep throat. Strep throat also can be treated with amoxicillin. Amoxicillin fell into short supply last fall.

The FDA blamed an increase in demand for both drug shortages.

NBC News reported in April that the penicillin’s drug’s maker, Pfizer, “pointed to the amoxicillin shortage as the main issue, because it prompted doctors to recommend penicillin instead. The rise in syphilis cases most likely further accelerated demand.”

On June 12, Pfizer issued an update to hospitals that supplies of the go-to syphilis drug were edging closer to depletion.

“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,” the update said.

The company said it was prioritizing “manufacturing capacity.”

Tacoma is the latest among public health departments spanning the nation to issue shortage advisories about the drug. Others include California Department of Health and Virginia Department of Health.

More information on local STD testing and treatment is listed at tpchd.org/std