Virginia syphilis cases are up 22% as officials warn of treatment shortage

VIRGINIA, USA — Health officials are noticing an increase in syphilis cases in Virginia, a problem that is even worse when you take into account a possible nationwide shortage of a key treatment for the disease. 

Bicillin is a long-acting form of penicillin that is used to treat syphilis. In a June 12 letter to customers, pharmaceutical company Pfizer Inc. warned of an "impending stock out situation" for select Bicillin syringes. 

"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 letter reads. 

Pfizer predicts some versions of the treatment will deplete between July and September of 2023. Pediatric versions of the treatment are expected to be gone by the end of June.

The stock is not expected to recover until sometime between April 1 and June 30, 2024.  

In a March release, Acting State Epidemiologist and Director Laurie Forlano, DO, MPH of the Office of Epidemiology said Virginia reported 20 congenital syphilis cases in 2022, the highest number in over three decades. 

"Congenital syphilis cases have risen among all Virginia populations, but the number of diagnoses among Black/African American and Hispanic infants are disproportionately high," wrote Forlano. "More than 34% of mothers of infants diagnosed with congenital syphilis had late or no prenatal care prior to delivery. Substance use during, or the year prior to, pregnancy was reported in 11% of cases."

Forlano added that the Virginia Department of Health has also received reports of seven stillbirths due to syphilis infections during pregnancy between 2012 and 2021.

In a June 22 release, Virginia State Health Commissioner Karen Shelton, MD, said there is no emergency stockpile of the medication and the product is being allocated with limited inventory released.

Shelton said the Commonwealth has seen more cases of syphilis among adults as well as more cases of the disease being passed onto infants from their mothers during pregnancy, which is called congenital syphilis.

"Reported cases of syphilis during the first four months of 2023 were 22% higher than during the same timeframe in 2022, and six cases of congenital syphilis have been reported so far this year," wrote Shelton in June. "The number of syphilis cases with ocular, otic or neurological manifestations has increased 118% from 2022 compared to the first four months of 2023."

Shelton added that many of the syphilis diagnoses are happening among people who inject or otherwise use drugs. 

The CDC recommends that health care providers prioritize the Bicillin L-A treatment for pregnant people and babies with congenital syphilis. During the shortage, doxycycline is an alternative therapy for non-pregnant patients diagnosed with or exposed to syphilis. Doxycycline is not recommended as an alternative treatment for those who are pregnant as it is classified as a Category D medication. 

Focused ultrasound is being used to treat essential tremor and now Parkinson's symptoms, and doctors say it may be a non-invasive way to treat other brain diseases.