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The Health Care Authority (HCA) is sending this message on behalf of the Department of Health (DOH).
The nation is currently in a Bicillin L-A® shortage. Please use our latest Bicillin L-A® guidance for syphilis treatment in Washington.
Please continue:
- Testing all pregnant people for syphilis at the first prenatal visit, in the third trimester, and at delivery if risk factors are present or suspected. Sexual partners should also be treated.
- Providing empiric treatment (at the time of syphilis testing) for patients who report sexual exposure to someone with syphilis and patients with symptoms and signs of syphilis. Sexual partners should also be treated.
- Closely monitoring Bicillin L-A® inventory and consider alternative treatment when supplies are low.
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Bicillin L-A® is the first-line recommended treatment for syphilis and the only recommended treatment option for pregnant persons and babies who are diagnosed or have been exposed to syphilis.
The following groups should also be prioritized for Bicillin L-A® if possible:
- Sexual partners of pregnant people
- Pregnancy capable people of childbearing age without consistent birth control
- People with an allergy to doxycycline
- People with early syphilis (primary, secondary, early latent)
- People living with HIV
- People for whom doxycycline adherence or follow-up testing and care might be an issue
- People who have already initiated a 3-week course of Bicillin L-A® to treat syphilis.
When medication supply is limited, providers may use Doxycycline per the CDC STI treatment guidelines for syphilis. This medication is acceptable for treatment of non-pregnant people when Bicillin L-A® is not available due to the shortage and for known penicillin allergy.
Doxycycline is acceptable for syphilis treatment for the following groups when Bicillin L-A® is not available due to the shortage.
Use doxycycline for patients who:
- Are not pregnant
- Do not have a known allergy
- Can adhere to the dosing, duration, and follow-up recommendations
- Have not been diagnosed with HIV
- Report their partner is not currently pregnant
Considerations for syphilis treatment with doxycycline:
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Doxycycline for early syphilis (primary, secondary, or early latent): 100mg by mouth twice daily for 14 days.
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Doxycycline for late latent or unknown duration: 100mg by mouth twice daily for 28 days.
- Per CDC treatment guidelines, patients treated with doxycycline should have close serologic and clinical follow-up, especially individuals with HIV infection. Follow RPR titers to ensure a 4-fold decrease is achieved in 6 to 12 months.
- Patients receiving alternative treatment with doxycycline should receive education on the importance of adherence.
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The FDA and Pfizer have announced the shortage should be resolved by the end of the year. This shortage is due to the increase in demand in the US.
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Report the stock-outs and shortages to the following avenues:
- To help CDC continue to monitor the situation, notify DSTDP (stdshortages@cdc.gov) of the following:
- Shortages or stock-outs of Bicillin L-A® in the jurisdiction
- Situations in which patients diagnosed with syphilis are not being treated due to the inability to procure Bicillin L-A® in the jurisdiction
- Report any shortages to the Pfizer Supply Continuity Team.
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Phone: 844-646-4398 (select 1 and then select 3)
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Coordinate and link patients with DIS, case managers, navigators, and others to support patients with medication adherence and education. These public health educators and patient support resources are available to reinforce health care interventions.
Need assistance connecting to these patient support resources? Follow these links to learn more and locate resources available in your community.
For questions about this guidance, contact DOH Sexual Health and Prevention Manager Zandt Bryan.
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