{"id":2303,"date":"2024-07-23T15:30:50","date_gmt":"2024-07-23T15:30:50","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/clinicians\/?page_id=2303"},"modified":"2026-01-21T14:03:37","modified_gmt":"2026-01-21T14:03:37","slug":"syphilis-treatment-and-clinical-manifestations-updates-for-providers","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\/","title":{"rendered":"Syphilis Treatment and Clinical Manifestations Updates for Providers"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-2681 \" src=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton-1024x381.png\" alt=\"VDH Letterhead: Karen Shelton, MD State Health Commissioner Commonwealth of Virginia Department of Health PO Box 2448 Richmond, VA 23218 800-828-1120 or TTY 7-1-1\" width=\"761\" height=\"283\" srcset=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton-1024x381.png 1024w, https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton-300x112.png 300w, https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton-768x286.png 768w, https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton-1536x572.png 1536w, https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton-2048x763.png 2048w\" sizes=\"auto, (max-width: 761px) 100vw, 761px\" \/><\/p>\n<p style=\"text-align: center;\">July 23, 2024<\/p>\n<p>Dear Colleague:<\/p>\n<p>I am writing to share an update on the national shortage of Penicillin G benzathine (Bicillin L-A<sup>\u00ae<\/sup>), as well as updates on syphilis trends and clinical manifestations in Virginia.<\/p>\n<p>The Centers for Disease Control and Prevention <a href=\"https:\/\/www.cdc.gov\/sti\/php\/from-the-director\/2023-07-20-mena-bicillin.html\">shared an update from Pfizer on June 10, 2024<\/a>, noting that the manufacturer has available supply of 2.4 million Units\/4 milliliter Bicillin L-A<sup>\u00ae<\/sup>.\u00a0 In light of this update, please treat all patients with Bicillin L-A,<sup>\u00ae <\/sup>in keeping with <a href=\"https:\/\/www.cdc.gov\/std\/treatment-guidelines\/syphilis.htm\">CDC guidance<\/a>.\u00a0 If you are still unable to access Bicillin L-A, from your wholesaler or the manufacturer, please refer patients to their local health department for treatment.\u00a0 Alternative treatment options are also described in my <a href=\"https:\/\/www.vdh.virginia.gov\/clinicians\/shortage-of-penicillin-g-benzathine-bicillin-l-a\/\">letter<\/a> from June 2023.<\/p>\n<p>Data from 2023 reflect that syphilis continues to present a growing concern in Virginia.\u00a0 Compared to 2022, cases of early syphilis increased 16%, and there was a 30% increase in syphilis cases of late or unknown duration.\u00a0 These data, preliminary data from 2024, and healthcare provider resources are all available on <a href=\"https:\/\/www.vdh.virginia.gov\/syphilis\/data-in-virginia\/\">our syphilis webpage<\/a>.\u00a0 As syphilis cases have increased,<strong> the number of cases with ocular, otic and\/or neurological manifestations have also increased<\/strong>.\u00a0 In 2023 in Virginia there were 65 syphilis cases with ocular, 15 with otic and 66 with neurological clinical manifestations.\u00a0 These counts likely reflect underreporting of these manifestations.<\/p>\n<p>Virginia\u2019s congenital syphilis cases also continued to increase in 2023, with a total of 21 cases diagnosed.\u00a0 In 2022, 20 cases were diagnosed.\u00a0 To date in 2024, 12 cases have been diagnosed putting Virginia on pace to again exceed the previous year\u2019s total.<\/p>\n<p>About 11% of all patients diagnosed with early syphilis self-reported use of opioids, methamphetamine, or cocaine. \u00a0About half of patients (48%) who gave birth to an infant with congenital syphilis reported using one of these substances.<\/p>\n<p>Clinicians and allied health professionals represent our first line of defense in detecting syphilis.\u00a0 Please help us identify and reduce the spread of syphilis in Virginia.<\/p>\n<ul>\n<li>Conduct a full <a href=\"https:\/\/www.cdc.gov\/std\/treatment\/sexualhistory.htm\">sexual health history<\/a> for all patients.<\/li>\n<li>Screen for syphilis in all patients aged 15-44 years who are sexually active and living in <a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/220\/2023\/11\/Virginia-Syphilis-Screening-Guidelines-and-Map-Nov2023.pdf\">a <\/a><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/220\/2023\/11\/Virginia-Syphilis-Screening-Guidelines-and-Map-Nov2023.pdf\">county with high incidence of syphilis<\/a>, in keeping with <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/72\/wr\/mm7246e1.htm\">CDC recommendations<\/a> to prevent cases of congenital syphilis.\u00a0 For all other counties, continue to assess risk factors to recommend testing.\u00a0 <strong>Test all symptomatic patients for syphilis, regardless of their risk factors or where they live.<\/strong><\/li>\n<li>In keeping with updated recommendations from the <a href=\"https:\/\/www.acog.org\/clinical\/clinical-guidance\/practice-advisory\/articles\/2024\/04\/screening-for-syphilis-in-pregnancy\">American College of Obstetricians and Gynecologists (ACOG)<\/a>, serologically screen all pregnant persons at their first prenatal care visit, followed by universal rescreening early in the third trimester (28-32 weeks) and again at delivery, regardless of risk.<\/li>\n<li>Order both treponemal and nontreponemal <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/73\/rr\/rr7301a1.htm\">serologic tests<\/a> to detect active syphilis infection (ex: reflex RPR and TPPA, or EIA reflex to RPR reflex to TPPA). The results of these tests can be used in combination with signs and symptoms in the last 12 months to differentiate between early or late syphilis infection.\u00a0 Ordering only one of these tests may delay identification and treatment of an active infection.<\/li>\n<li>Stage cases of syphilis and consider syphilis for your differential diagnosis, as it can mimic many other conditions. Syphilis has four stages: <a href=\"https:\/\/www.cdc.gov\/std\/treatment-guidelines\/p-and-s-syphilis.htm\">primary, secondary<\/a>, <a href=\"https:\/\/www.cdc.gov\/std\/treatment-guidelines\/latent-syphilis.htm\">latent<\/a>, and <a href=\"https:\/\/www.cdc.gov\/std\/treatment-guidelines\/tertiary-syphilis.htm\">tertiary<\/a>.\u00a0 Each stage has <a href=\"https:\/\/www.cdc.gov\/syphilis\/about\/index.html\">different signs and symptoms<\/a>.\u00a0 The earlier stages are considered the most infectious.\u00a0 <a href=\"https:\/\/www.cdc.gov\/std\/treatment-guidelines\/neurosyphilis.htm\"><strong>Ocular, otic and neurological manifestations<\/strong><\/a><strong> of syphilis can occur at any stage. <\/strong><\/li>\n<li>Everyone who tests positive for syphilis should also receive an HIV test unless their HIV positive status is already documented. All syphilis patients who are HIV negative should be offered <a href=\"https:\/\/www.cdc.gov\/hiv\/guidelines\/preventing.html\">Pre-Exposure Prophylaxis for HIV (PrEP)<\/a>.<\/li>\n<li>Consider <a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/220\/2024\/02\/DoxyPEP-Factsheet-for-Providers.pdf\">prescribing Doxycycline as post-exposure prophylaxis (DoxyPEP)<\/a> for syphilis for patients who are clinically indicated.<\/li>\n<\/ul>\n<p>Thank you for your continued partnership in sexually transmitted infection prevention.<\/p>\n<p>&nbsp;<\/p>\n<p>Sincerely,<\/p>\n<p>&nbsp;<\/p>\n<p>Karen Shelton, MD<\/p>\n<p>State Health Commissioner<\/p>\n","protected":false},"excerpt":{"rendered":"<p>July 23, 2024 Dear Colleague: I am writing to share an update on the national shortage of Penicillin G benzathine (Bicillin L-A\u00ae), as well as updates on syphilis trends and clinical manifestations in Virginia. The Centers for Disease Control and Prevention shared an update from Pfizer on June 10, 2024, noting that the manufacturer has [&hellip;]<\/p>\n","protected":false},"author":576,"featured_media":0,"parent":25,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"tags":[],"class_list":["post-2303","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Syphilis Treatment and Clinical Manifestations Updates for Providers - Clinicians<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Syphilis Treatment and Clinical Manifestations Updates for Providers - Clinicians\" \/>\n<meta property=\"og:description\" content=\"July 23, 2024 Dear Colleague: I am writing to share an update on the national shortage of Penicillin G benzathine (Bicillin L-A\u00ae), as well as updates on syphilis trends and clinical manifestations in Virginia. The Centers for Disease Control and Prevention shared an update from Pfizer on June 10, 2024, noting that the manufacturer has [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\/\" \/>\n<meta property=\"og:site_name\" content=\"Clinicians\" \/>\n<meta property=\"article:modified_time\" content=\"2026-01-21T14:03:37+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton.png\" \/>\n\t<meta property=\"og:image:width\" content=\"2344\" \/>\n\t<meta property=\"og:image:height\" content=\"873\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/clinician-letters\\\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\\\/\",\"url\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/clinician-letters\\\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\\\/\",\"name\":\"Syphilis Treatment and Clinical Manifestations Updates for Providers - Clinicians\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/clinician-letters\\\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/clinician-letters\\\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/content\\\/uploads\\\/sites\\\/134\\\/Letterhead_Shelton-1024x381.png\",\"datePublished\":\"2024-07-23T15:30:50+00:00\",\"dateModified\":\"2026-01-21T14:03:37+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/clinician-letters\\\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/clinician-letters\\\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/clinician-letters\\\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\\\/#primaryimage\",\"url\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/content\\\/uploads\\\/sites\\\/134\\\/Letterhead_Shelton-1024x381.png\",\"contentUrl\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/content\\\/uploads\\\/sites\\\/134\\\/Letterhead_Shelton-1024x381.png\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/clinician-letters\\\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Clinician Letters\",\"item\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/clinician-letters\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Syphilis Treatment and Clinical Manifestations Updates for Providers\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/#website\",\"url\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/\",\"name\":\"Clinicians\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Syphilis Treatment and Clinical Manifestations Updates for Providers - Clinicians","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\/","og_locale":"en_US","og_type":"article","og_title":"Syphilis Treatment and Clinical Manifestations Updates for Providers - Clinicians","og_description":"July 23, 2024 Dear Colleague: I am writing to share an update on the national shortage of Penicillin G benzathine (Bicillin L-A\u00ae), as well as updates on syphilis trends and clinical manifestations in Virginia. The Centers for Disease Control and Prevention shared an update from Pfizer on June 10, 2024, noting that the manufacturer has [&hellip;]","og_url":"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\/","og_site_name":"Clinicians","article_modified_time":"2026-01-21T14:03:37+00:00","og_image":[{"width":2344,"height":873,"url":"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton.png","type":"image\/png"}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\/","url":"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\/","name":"Syphilis Treatment and Clinical Manifestations Updates for Providers - Clinicians","isPartOf":{"@id":"https:\/\/www.vdh.virginia.gov\/clinicians\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\/#primaryimage"},"image":{"@id":"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\/#primaryimage"},"thumbnailUrl":"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton-1024x381.png","datePublished":"2024-07-23T15:30:50+00:00","dateModified":"2026-01-21T14:03:37+00:00","breadcrumb":{"@id":"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\/#primaryimage","url":"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton-1024x381.png","contentUrl":"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton-1024x381.png"},{"@type":"BreadcrumbList","@id":"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/syphilis-treatment-and-clinical-manifestations-updates-for-providers\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.vdh.virginia.gov\/clinicians\/"},{"@type":"ListItem","position":2,"name":"Clinician Letters","item":"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/"},{"@type":"ListItem","position":3,"name":"Syphilis Treatment and Clinical Manifestations Updates for Providers"}]},{"@type":"WebSite","@id":"https:\/\/www.vdh.virginia.gov\/clinicians\/#website","url":"https:\/\/www.vdh.virginia.gov\/clinicians\/","name":"Clinicians","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.vdh.virginia.gov\/clinicians\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/www.vdh.virginia.gov\/clinicians\/wp-json\/wp\/v2\/pages\/2303","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.vdh.virginia.gov\/clinicians\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.vdh.virginia.gov\/clinicians\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.vdh.virginia.gov\/clinicians\/wp-json\/wp\/v2\/users\/576"}],"replies":[{"embeddable":true,"href":"https:\/\/www.vdh.virginia.gov\/clinicians\/wp-json\/wp\/v2\/comments?post=2303"}],"version-history":[{"count":3,"href":"https:\/\/www.vdh.virginia.gov\/clinicians\/wp-json\/wp\/v2\/pages\/2303\/revisions"}],"predecessor-version":[{"id":2710,"href":"https:\/\/www.vdh.virginia.gov\/clinicians\/wp-json\/wp\/v2\/pages\/2303\/revisions\/2710"}],"up":[{"embeddable":true,"href":"https:\/\/www.vdh.virginia.gov\/clinicians\/wp-json\/wp\/v2\/pages\/25"}],"wp:attachment":[{"href":"https:\/\/www.vdh.virginia.gov\/clinicians\/wp-json\/wp\/v2\/media?parent=2303"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.vdh.virginia.gov\/clinicians\/wp-json\/wp\/v2\/tags?post=2303"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}