By Amy Yurkani

Earlier this year, Dr. Jodie Dionne, a specialist in infectious diseases at UAB, said the clinic where she works got down to a single dose of benzathine penicillin, the injectable antibiotic used to treat syphilis.

A nationwide shortage of the drug has reached Alabama and could have devastating effects on the state’s newborns. Cases of congenital syphilis, a potentially deadly condition that affects babies exposed during pregnancy or birth, have been on the rise in Alabama for a decade.

“We literally have zero other options when there’s no benzathine to treat the pregnant women with newly diagnosed syphilis,” Dionne said. “Nobody wants to not be able to offer treatment to someone who has an infectious disease that’s passed congenitally. It’s a very bad place to be.”

Dr. Karen Landers, chief medical officer for the Alabama Department of Public Health, said the agency has been holding some of its supply of benzathine penicillin in reserve for pregnant women. Although the medication is the most effective treatment for all types of syphilis, the agency has advised doctors to start treating some non-pregnant patients with doxycycline to preserve the supply of the benzathine injection. Doxycycline, administered as a pill, is not safe for use in pregnant women, Landers said.

“We still prefer [benzathine penicillin] for the treatment of syphilis,” Landers said. “Because even with the oral regimens, which do work in non-pregnant women or men, we have to ensure that people take it. And trying to ensure that people take something for two weeks, twice a day or four weeks twice a day can be a concern.”

Landers said the agency has been keeping a close eye on the supply and anticipating demand to maintain stock for high-priority patients. So far, they have not run out of benzathine penicillin for pregnant women, she said.

The shortage of benzathine penicillin has been driven in part by a surging number of syphilis cases. In Alabama from 2020 to 2022, the number of syphilis cases nearly doubled, according to the public health department.

The increase in congenital syphilis cases among newborns is particularly alarming. The state had only two cases in 2013, but that number shot up to 44 last year, Landers said.

Cases have been increasing across the nation, a trend that has alarmed public health officials. Congenital syphilis is completely preventable with treatment, but cases that go undetected can cause death and disability. Dionne said congenital syphilis is considered a “never event” that should not happen if women receive prenatal care.

“If you have this infection, either in utero or acquired at the time of birth, the long-term manifestations can be significant,” Dionne said. “Learning disabilities and growth abnormalities. Things that will impact the child for the rest of their life. So, we try to do everything we can to prevent that from happening, which really relies on early diagnosis and early treatment during pregnancy.”

Dionne said some babies have no symptoms from congenital syphilis. Serious cases can cause bone deformations, blindness, deafness and even stillbirth.

The Alabama Department of Public health has ramped up efforts to test and treat pregnant women for syphilis. Instead of just testing women at the beginning of pregnancy, guidelines now suggest women receive three syphilis tests before their babies are born to detect infections that start in the second or third trimester.

In adults, the most common symptom of early-stage syphilis is a chancre or circular lesion. Dionne said pregnant women may feel no symptoms.

“This is an asymptomatic infection in most women,” Dionne said. “They don’t know they have it. They feel totally fine. So, we need to do our part to make sure we’re looking frequently for it.”

In addition to testing pregnant women, Dionne said federal agencies need to do more to make sure effective treatments are available for all people with syphilis, including the partners of pregnant women. It should be unacceptable to have a shortage of benzathine penicillin, Dionne said. Pfizer is the only company that imports the components of the medication.

“This is really an unacceptable supply chain issue, and we need to look at some creative solutions,” Dionne said. “This shortage is not a theoretical issue. It really impacts patient care.”

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