'A great concern': How the shortage of a drug to treat syphilis is affecting Arizona

A shortage of the only drug recommended to treat syphilis in pregnant people is a serious concern for Arizona, which has the country's highest rate of syphilis in newborns.

The U.S. Food and Drug Administration listed a shortage of injectable benzathine penicillin, also known as benzathine penicillin G, on April 26 and it's unclear when the supply will recover.

In some parts of the state, syphilis patients are already receiving a less preferable treatment to make sure supplies of benzathine penicillin are conserved for the infected pregnant people who need it most.

"Benzathine is the only option for pregnant people. It is really, really important we have enough doses for people who are pregnant," said Rebecca Scranton, deputy bureau chief of infectious diseases and services at the Arizona Department of Health Services. "The health of babies, and the health of Arizonans is impacted by these shortages. It's serious. And syphilis is very, very serious for newborns."

Pregnant people in Arizona are still able to get the drug because public health departments are prioritizing it for that population. State guidance calls for counties that are below a 90-day supply of benzathine penicillin for treating all of the syphilis cases in their jurisdiction to switch to an alternative medication called doxycycline for non-pregnant cases.

One of doxycycline's biggest drawbacks is that it cannot be used to treat pregnant individuals. And it comes in a pill form only, which puts some patients at higher risk because they may accidentally skip doses.

Public health officials say that it's more imperative than ever that people continue to get tested because syphilis is preventable, and further spread could exacerbate the existing drug shortage and also put more lives in danger.

New York-based Pfizer, which produces benzathine penicillin under the name Bicillin, says the shortage has been driven in part by a rise in syphilis cases across the country. A total of 2,855 babies were born with syphilis in the U.S. in 2021, up by more than 300% since 2016, federal data says. The drug is not out of stock, and Pfizer officials say they have prioritized replenishing the supply.

"It is affecting and it will affect our ability to adequately treat patients diagnosed with syphilis. And it is a great concern," Dr. Melanie Taylor, a medical epidemiologist with the Maricopa County Department of Public Health, said of the shortage. "We don't know how long our stock will last because we can't predict the number of syphilis cases that are coming into us."

Preliminary data: 32 Arizona babies died from syphilis in 2022

Syphilis is a bacteria that can cross the placenta and infect unborn babies. Cases that are passed on to unborn babies during pregnancy are often called congenital syphilis.

High rates of syphilis in Arizona are a major public health problem because of the devastating health outcomes syphilis can cause if left untreated. The effects can include muscle weakness, changes to one's mental state, blindness, hearing loss and death.

Newborn babies are at particularly high risk. Preliminary state data shows that syphilis caused the deaths of 32 Arizona newborns last year, which is more than twice the number who died from syphilis in 2021.

Numerous factors are believed to contribute to Arizona's high rate, including a high number of pregnant people who aren't getting prenatal care.

Arizona's ranking as having the highest rate of congenital syphilis in the nation ― nearly three times the national average rate ― is based on 2021 data from the U.S. Centers for Disease Control and Prevention, and preliminary state data suggests the problem got much worse last year, not only in terms of deaths but also in the number of newborns infected.

State data shows that 182 Arizona babies were born with syphilis in 2021 and the number went up to 219 last year.

Even if babies don't die from syphilis, they may still suffer serious health consequences, including bone damage, severe anemia, jaundice, skin rashes, meningitis, blindness and hearing loss. Syphilis can also cause miscarriages, which are not reflected in the state data.

Getting worse: Arizona leads the nation for its rate of syphilis in newborns. Here's why

Getting tested for syphilis is critical because it can be hard to detect. The average time between acquiring the bacteria and the start of the first symptom is 21 days, according to the CDC, but the range is 10 to 90 days. The first symptom may be difficult to identify as it's often a firm, round, and painless sore known as a chancre that appears at the location where syphilis enters the body.

The chancre lasts three to six weeks and heals regardless of whether a person receives treatment, the CDC says, but the infection will progress to secondary syphilis if the person does not receive treatment.

There is a high rate of sexually transmitted infections in Arizona, data indicates. In addition to leading the country for its rate of congenital syphilis, based on 2021 CDC data, Arizona is 10th in the nation for its rate of chlamydia, 14th for its rate of gonorrhea and seventh in the nation for its rate of primary and secondary syphilis.

"If you're sexually active, even with one person, get tested, know your status. It doesn't happen to a certain population. It can happen to anyone," said Taylor Piontek, director of clinical services at The Southwest Center, a health clinic in downtown Phoenix that has a mission of serving the LGBTQIA+ community and those affected by HIV.

'There are a lot of unknowns'

The Southwest Center has already started sending pregnant individuals with syphilis to Maricopa County clinics for treatment with benzathine penicillin.

"We haven't been able to place any new orders for it," Piontek said. "It's been a big struggle. ... Because of the shortage, we are using doxycycline. However, that is starting to get put on back order as well."

The Southwest Center is treating non-pregnant individuals who have syphilis with doxycycline, which needs to be taken twice per day in pill form, typically for two to four weeks. As a result, patient compliance with taking the medication can be a problem.

"It's a long treatment, and doxycycline is a lot of times hard on the stomach, and people don't like to take it," Piontek said. "With syphilis, you don't always have symptoms, so it may cause the patient to not want to complete the full course of medication."

Public health officials emphasize that they still have benzathine penicillin for pregnant people, and state health officials are keeping in regular contact with their federal health partners to report supply levels.

"I don't think we're going to see this impacting our newborn population in the immediate future based on current supply projections," Scranton said.

"But the fact that we're already conserving doses for pregnant persons, I mean, it's hard to say ... There are a lot of unknowns."

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on X, formerly Twitter: @stephanieinnes.

This article originally appeared on Arizona Republic: Shortage of benzathine penicillin affects AZ efforts to curb syphilis