Some cities and states have recently reported outbreaks, including Houston, which declared a syphilis outbreak on July 13. The Houston Health Department cited a 128% increase in cases among women and a nine-fold rise in congenital syphilis in Houston and Harris County. The Food and Drug Administration (FDA) has also announced that it expects a "limited supply and impending stock out situation" for select Bicillin medications.
According to the Centers for Disease Control and Prevention (CDC), cases of syphilis have been on the rise in the U.S. for several years. Since 2017, all stages of the disease have increased by 74%, with over 176,000 cases reported in 2021. Between 2020 and 2021 alone, syphilis cases increased by 32%.
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Cases of congenital syphilis, which occurs when a mother passes the infection on to her baby during pregnancy, also rose by 32%, resulting in 220 stillbirths and infant deaths. Texas has seen a particularly dramatic spike in congenital syphilis cases, with a 650% increase since 2016, according to the Texas Department of Health and Human Services.
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Dr. James Hodges, an internist in Waco, Texas, has observed a surge in positive syphilis cases among women in two Texas prisons. He reported that these cases have doubled compared to just 18 months ago, with most of the inmates coming from Houston, San Antonio, and Dallas-Ft. Worth. Hodges expressed concern that the inmates are not taking the disease seriously, often stating, "It's no big deal, there is a cure."
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He estimated that young White women and young Black women make up the largest share of cases in women's prisons. Hodges also noted that some county sheriffs he spoke with were unaware of the syphilis problems, as county jails do not typically test for the disease.
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The CDC provides guidance for all physicians performing medical screening examinations for immigrants and refugees entering the U.S. Syphilis is one of the diseases on the list of communicable diseases that can make immigrants ineligible to obtain a visa or enter the country. However, the CDC does not track diseases by immigration status.
Between 2014 and 2019, approximately 445 out of every 100,000 tested immigrants and refugees were positive for some form of syphilis, according to the CDC. However, Dr. Hodges expressed skepticism about whether immigrants are being tested for syphilis as they enter the country.
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The Texas-Mexico border region has the highest rate of congenital syphilis in Texas, according to the Texas Department of State Health Services. However, the department is unable to quantify the impact of immigration on reported syphilis cases in the state. The spokesperson explained that the data source used for geographical reporting of syphilis diseases within Texas is the client's home address reported by the provider.
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The department attempts to obtain information about sexual partners from newly diagnosed individuals to facilitate their testing and treatment, but they are unable to distinguish Mexico residents from Texas residents based on the information provided. Of the reported 25,469 syphilis cases in Texas during 2022, 143 cases were reported to acquire the infection from Mexico.
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Dr. Jason E. Zucker, an assistant professor of medicine at Columbia University Irving Medical Center, stated that while he does treat some immigrants with syphilis, the majority of his patients with syphilis are not recent immigrants. He noted that syphilis rates in the domestic population have been increasing for years.
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Pfizer is the only pharmaceutical company that manufactures Bicillin, producing the drug in its Rochester, Michigan, facility. A Pfizer spokesperson acknowledged that the drug is in constrained supply but denied that there is an official shortage. The spokesperson explained that in 2022, during the convergence of RSV, flu, and COVID, there was a shortage of the popular antibiotic amoxicillin. This led doctors to begin prescribing Bicillin as a backup to treat strep throat and other bacterial infections in children, which had not happened before. These factors, coupled with the spike in syphilis cases, led to the dwindling supply. Pfizer is working to produce more Bicillin and supply the market. The company made a decision to deprioritize the pediatric version of the drug and prioritize the adult version for pregnant women with syphilis, as it is vital for them to receive the drug to prevent fetal death or birth defects.
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Dr. Mark C. Poznansky, an infectious disease physician at Massachusetts General Hospital, explained that the potential shortage of Bicillin did not affect them much until the past few weeks. The hospital still has some Bicillin, and they are able to procure some from the state directly. The drug is currently being prioritized for pregnant people with syphilis and their contacts, as well as people who cannot receive doxycycline. At Columbia University, physicians are seeing an increase in syphilis cases across gay, bisexual, and other men who have sex with men (MSM), as well as people born female. The nationwide shortage of Bicillin has led them to develop protocols to reduce Bicillin usage whenever possible.
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Dr. Zachary Hoy, a pediatric infectious disease specialist in Nashville, Tennessee, mainly sees cases of congenital syphilis. He stated that his facility has not experienced a shortage of Bicillin, but some hospitals in Nashville are concerned about a shortage.
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Pfizer expects to reach "full recovery mode" by mid- to late-2024, with an ample backup supply of six to eight weeks' worth of excess supply on the shelves. The company spokesperson confirmed that there will not be a stock-out of the adult drug.
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Syphilis is a bacterial infection that is spread through sexual contact or from a mother to an unborn child. The first sign of syphilis is usually a painless sore on the mouth, genitals, or rectum. If left untreated, syphilis can cause a body rash, hair loss, muscle aches, sore throat, fever, swollen lymph nodes, and eventually damage to various organs. Congenital syphilis can lead to fetal death, premature birth, or birth defects.
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Those most at risk include people who engage in unprotected sex, have sex with multiple partners, are men who have sex with men, or are infected with HIV. It is important for individuals to seek screening and treatment for sexually transmitted infections, as many are treatable if diagnosed early.
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