Program Updates
FDA Temporarily Approves Extencilline to Help Address Bicillin L-A Shortage
CDC has released a Dear Colleague Letter regarding FDA’s approval of imports of Extencilline (benzathine benzylpenicillin) to help address the ongoing Bicillin L-A shortage. Extencilline is currently authorized and marketed in other countries and can be used to treat syphilis in pregnancy. Additional information regarding reconstitution and administration of Extencilline is available here.
Extencilline will only be available by prescription in the United States. To place an order, please contact Direct Success at Distribution@dsuccess.com or 1-877-404-3338. It is unclear at this time how much supply of Extencilline is available and given the ongoing Bicillin L-A shortage, please continue to use doxycycline for syphilis treatment in non-pregnant adults without contraindications to doxycycline, as stated in this Santa Clara County Health Advisory.
CAPTC Pilots Congenital Syphilis Hotline for Providers: January -March 2024
 Have an urgent congenital syphilis (CS) case and need same-day expert advice? The California Prevention Training Center (CAPTC), in collaboration with the National Network of Prevention Training Centers, is now piloting a hotline for urgent clinical consultations involving CS or syphilis in pregnancy. California clinicians with CS-related questions requiring immediate attention can visit www.stdccn.org, indicate that they have an urgent inquiry, and receive a same-day call back from a subject matter expert. The CS hotline will be available 24/7 (including nights and weekends), and will run from January through March 31st 2024.
CDC's Dear Colleague Letter: Mpox Guidance for Clinicians and Health Departments
Dear Colleague:
I am writing to you today with a reminder that mpox continues to circulate in the United States. Although case counts are lower than they were last year, severe manifestations, including deaths, continue to occur. Convinced by the benefits of the vaccine, the Advisory Committee on Immunization Practices now recommends persons with potential risk of exposure receive two doses of the JYNNEOS vaccine. Despite this, only one in four of the approximately two million people eligible to receive the vaccine in the United States have received both doses. In addition to the Clade II mpox virus (MPXV) cases that have been reported in the United States since May 2022, the Centers for Disease Control and Prevention (CDC) recently issued an advisory to raise awareness about a concerning increase of cases of Clade I MPXV in the Democratic Republic of Congo (DRC). Clade I is associated with increased transmission and more severe illness.
Mpox in the United States
Although reported cases of Clade II MPXV have significantly declined since the height of the outbreak in 2022, small clusters are still occurring in the United States. Within the past two months, some health departments have reported an increase in cases among men who report having sexual contact with men.1,2 Unfortunately, deaths continue to occur in individuals who are severely immunocompromised, including advanced HIV disease. Vaccination remains an important, but underutilized, tool in stopping the spread of MPXV. Modeling data suggest that if vaccine coverage in the United States does not increase, we may experience large outbreaks in the future.
What you can do:
- Remain alert for patients presenting with MPXV symptoms and test patients who have a rash illness consistent with MPXV regardless of whether other etiologies are more likely.
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Continue to recommend the two dose JYNNEOS vaccine to eligible patients.
- Encourage patients who have only received one dose to get the second dose to have the best protection.
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Conduct a comprehensive sexual history of your patients, which will help you determine what additional counseling or testing to provide. Additionally, test all sexually active people with suspected MPXV for HIV and other STIs and provide treatment to those with positive test results.
Mpox in the DRC
MPXV has two distinct genetic clades (or subtypes), I and II. CDC issued a Health Advisory to notify clinicians and health departments about the occurrence, geographic spread, and sexually associated human-to-human transmission of Clade I MPXV in the DRC. While Clade I MPXV has not been detected in the United States, clinicians should be aware of the possibility of Clade I MPXV in travelers returning from the DRC. Clade I spreads similarly to Clade II, the MPXV type associated with the 2022-23 global outbreak, but may be more transmissible and cause more severe infections. Vaccines and other medical countermeasures are available and expected to be effective for both Clade I and Clade II MPXV infections.
What you can do:
- Notify your state health department if you have a patient with mpox-like symptoms and recent travel to the DRC.
- Submit lesion specimens for clade-specific testing for these patients. Some non-CDC laboratories may also have options available for clade-specific testing. If clade-specific testing is not available in a jurisdiction, specimen submission to CDC is encouraged; specimen submission to CDC can be coordinated through your state or local health department.
- Test all sexually active people with suspected mpox for HIV and other STIs and provide treatment to those with positive test results. People with advanced HIV, or who are severely immunocompromised, are at increased risk of severe illness and death if they get the mpox virus.
I also encourage you to administer the JYNNEOS vaccine in your clinic, if possible. If the vaccine is not available in your clinic, share the vaccine finder and prevention information with your patients. Please also circulate this letter among your colleagues for broader awareness and action.
Thank you for your continued efforts to stop the spread of MPXV and protect individuals and communities across the nation and abroad.
Sincerely,
Jonathan H. Mermin, MD, MPH
Rear Admiral and Assistant Surgeon General, USPHS
Director
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
- https://www.cdph.ca.gov/Programs/OPA/Pages/CAHAN/Increase-in-Mpox-Cases-in-California-Updates-on-Identification,-Laboratory-Testing,-Management-Treatment-and-Vaccination.aspx
- Outbreak of Mpox in King County - King County, Washington
Provider Training Opportunities
CAPTC Injectable PrEP (CAB LA) Update 2024
The CAPTC is pleased to announce the first 2024 Injectable PrEP Update, Wednesday, February 21, 12-1:30pm PDT. You'll hear from providers, program leaders, and navigators about their efforts to provide injectable PrEP (CAB-LA) to their patients and clients. You'll also discuss successes and challenges in access, retention, and equity. The guest panelists will include:
Oakland LGBTQ Center
Childrens Hospital Los Angeles
CARE Center, Dignity/St Mary, Long Beach
Southern Nevada Health District
University of Miami, Miller School of Medicine
If you are interested in attending, click the link below to register on Zoom:
New Certificate Program in Treatment Innovation for HIV Care Providers
 The HealthHIV HIV Treatment Innovation Certificate Program is a free, CME/CE-certified multi-module educational certificate program that will prepare providers already providing HIV care/treatment to treat more complex patient cases. Upon completion of the self-paced program, providers will earn an HIV Treatment Innovation Certificate which demonstrates competency in innovative, multi-level treatment optimization strategies for providing care and treatment to people with HIV (PWH). All modules are certified and participants can earn up to 5.0 Credits/Contact Hours (CME, MOC, NCPD, AAPA) for completion of the program.
Participants who complete the certificate program will have an understanding of current antiretroviral (ARV) therapies for optimal HIV treatment, the provider’s role in managing common co-infections and opportunistic infections, treatment optimization strategies, clinical guidelines to treating PWH in key populations (including patients aging with HIV), and a framework for managing treatment-experienced patients with HIV.
Recent Publications
Use of Doxycycline to Prevent Sexually Transmitted Infections According to Provider Characteristics
Use of doxycycline to prevent sexually transmitted infections (STIs) may lead to antimicrobial resistance. Researchers analyzed attitudes toward this practice between US providers who commonly and less commonly treat STIs. Providers who more commonly treat STIs are more likely to prescribe prophylactic doxycycline and believe that benefits outweigh potential for increased antimicrobial resistance.
FDA Warns of False Positive HSV-2 Test Risks
In a recent statement, the FDA reminded health care providers and clinical laboratory staff about the risk of false positive genital herpes simplex virus type 2 (HSV-2) serological test results.
To reduce the risk of a false positive HSV-2 serological test result, the FDA provided information on risk factors and recommendations for health care providers and clinical laboratory staff. Additionally, the FDA has stated it will provide new information as it becomes available.
Request Clinical Training or Technical Assistance Today!
Santa Clara County Getting to Zero offers FREE training and technical assistance to providers individually or in a group-setting. Our level of assistance ranges anywhere from case-by-case, disease-specific or broader STI and HIV clinical trainings. Submit a Clinical Health Education Request Form by clicking the button below!
Visit our webpage for more information: www.gettingtozeroscc.org
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