Record-high rates of syphilis and an accompanying shortage of the preferred antibiotic to treat the disease will make it one of the most pressing public health concerns in 2024, an association of public health leaders said.
Syphilis is a sexually transmitted infection that was once rare, but has made a “tragic” return in an era of reduced funding for public health. The 27-year high in cases has also strained manufacturing of the preferred antibiotic to treat syphilis, a penicillin formulation called Bicillin L-A.
The infection is especially dangerous for pregnant women who can pass the disease to the fetus in utero, called congenital syphilis. Congenital syphilis can lead to profound disability or death. Bicillin L-A is the only antibiotic known to safely treat syphilis in pregnancy.
Already, syphilis outbreaks across the country have doctors Uber-ing patients across town and begging colleagues to use alternative medications to treat the disease.
“I just want to lay out how scary this is for me as an obstetrician – if this medicine goes away I have no way to help these affected women as no other medication is recommended for the condition,” said Dr Hector Chapa, assistant clinical professor of obstetrics and gynecology at Texas A&M School of Medicine.
“In the past, we have provided transportation assistance to patients – if they want to – to go to the local health department” to get the medication, said Chapa. “The big take home of this is both the rate of syphilis and the concern about med supply are real.”
Bicillin has been in “limited supply” since June 2023, according to Pfizer, the only manufacturer of the antibiotic in the US. A spokesperson for the company said the sheer volume of new cases strained the supply. In just one example of the regional extremes, cases of congenital syphilis in Houston, Texas, surged from 16 in 2016 to 151 in 2021.
“Even in small-town America it has been – amazing is probably not the word – tragic,” said Dr Pat Cheney, an obstetrician and gynecologist in rural Amory, Mississippi. “There were a couple of decades where it was just a rarity,” Cheney said about syphilis cases.
When Cheney began practicing in Mississippi in 1989, he said he only occasionally treated a patient with syphilis. Back then, a health department official used to lug a dark field microscope into his office for a definitive diagnosis.
Syphilis was nearly eradicated in the US in the 1990s because of heightened funding for and awareness of sexually transmitted infections, a side-effect of the HIV crisis. Men who have sex with men are at heightened risk for syphilis.
“I had to go back in and review syphilis treatment and staging and pregnancy because it had been that long,” said Cheney. “It’s a different world today.”
In addition to increasing syphilis outbreaks, Bicillin is a challenging drug to scale up. The antibiotic is a formulation of penicillin, which must be made in a penicillin-only facility.
A spokesperson for Pfizer told the Guardian that the company’s plant in Rochester, New York, was producing at levels in line with historical norms. The spokesperson also said they had cut manufacturing time from 110 days to 50 and that the company was focused on producing adult-only doses of Bicillin. Still, Pfizer believes it will take until spring 2024 to both meet demand and build up a strategic reserve.
The Biden administration has attempted to aid public health workers in the fight against syphilis with a taskforce on syphilis, one that has sent strategic help to 14 hard-hit states across the country. Federal government efforts hope to help avert “5% of congenital syphilis cases” by September 2024.
The administration has also sent US health and human services officials on site visits to survey the damage of the outbreak first hand, such as at an Atlanta-area clinic. There, a Biden administration official was told the clinic delivered 500 babies in 2022, and saw 10 cases of congenital syphilis.
“Most doctors would not expect to see a single case of congenital syphilis in a baby during their career,” a read-out of the visit reported.
As a result of the challenges facing public health officials, syphilis and sexually transmitted infections are likely to be one of the most important health issues to tackle in 2024, according to the Association of State and Territorial Health Officials. Lawmakers in some states have mandated testing at multiple stages of pregnancy, in an effort to bring down rates of congenital syphilis.
As providers go into the New Year, Chapa said the important thing was to protect the Bicillin supplies that are available.
“Right now, it is definitely time to prioritize Bicillin,” said Chapa, “to ration it diligently, to seriously think about what we are using it for excluding syphilis.”
