{"id":476,"date":"2026-06-15T16:37:23","date_gmt":"2026-06-15T16:37:23","guid":{"rendered":"https:\/\/smartmovinghome.com\/?p=476"},"modified":"2026-06-15T16:37:23","modified_gmt":"2026-06-15T16:37:23","slug":"congenital-syphilis-skyrockets-as-us-has-shortage-of-drug-that-treats-it","status":"publish","type":"post","link":"https:\/\/smartmovinghome.com\/?p=476","title":{"rendered":"Congenital Syphilis Skyrockets as US Has Shortage of Drug That Treats It"},"content":{"rendered":"
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The United States has a shortage of the only first-line medication recommended for pregnant women with syphilis to prevent passing it to their baby, even as congenital syphilis rates have been skyrocketing.<\/p>\n

Last July, drug manufacturer Pfizer issued a voluntary recall of brand name Bicillin L-A, or penicillin G benzathine \u2014 a long-acting injectable of the antibiotic \u2014 warning of particulates, or foreign material, in some batches. The U.S. Food and Drug Administration says supplies won\u2019t return to normal until December 2027.<\/p>\n

In the United States, there\u2019s only one manufacturing plant that makes this injectable penicillin, run by Pfizer\u2019s subsidiary, King Pharmaceuticals, in Michigan. The FDA has allowed the temporary importation of an alternative, Lentocilin, from Portugal.<\/p>\n

But because Lentocilin isn\u2019t a permanent solution, and penicillin is difficult and complex to manufacture, experts are concerned that the shortage will worsen infection rates and the disparities associated with congenital syphilis, which occurs when the infection is passed on to developing fetuses and newborns. State health departments told Stateline<\/em> they are guiding providers to prioritize the medication for pregnant patients with syphilis and their babies, and are connecting patients with the drugs if clinics lack them.<\/p>\n

Bicillin L-A has seen intermittent shortages throughout the past decade, said Elizabeth Finley, interim executive director of the National Coalition of STD Directors. In one survey of health departments across 13 states during a 2023 shortage, the group found widespread challenges in getting the drug in order to treat pregnant patients.<\/p>\n

But last year\u2019s recall has created \u201ca shortage that is more significant than we\u2019ve experienced in the past,\u201d Finley said.<\/p>\n

Some health centers lost their entire stock of Bicillin in the recall, Finley and others told Stateline<\/em>. The drug has no generic alternative.<\/p>\n

Congenital syphilis can have devastating, irreversible effects. Babies born to women with syphilis can be stillborn or die as a newborn. The infection also can cause serious complications in babies, such as bone deformities, deafness or blindness.<\/p>\n

\u201cThe biggest fear with the Bicillin shortages has always been that somebody could not get treatment before delivery,\u201d Finley said. \u201cThere\u2019s really no length of exposure to syphilis that is safe for a fetus.\u201d<\/p>\n

Indigenous babies have had the highest rates in recent years, disproportionate to their share of the population, followed by Black babies.<\/p>\n

\u201cIt\u2019s really a tragedy, because it\u2019s totally preventable,\u201d said infectious disease physician Dr. Kelly Johnson, medical director of the California Prevention Training Center at the University of California, San Francisco. The center offers training and consultation to medical providers in Arizona, Hawaii, New Mexico and Nevada, as well as in California, where congenital syphilis cases rose almost fivefold over the past decade. Under the recall, California had to return nearly 20% of its Bicillin L-A stock.<\/p>\n

In recent years, congenital syphilis cases have more than tripled, with nearly 4,000 cases nationwide in 2024 alone \u2014 the highest number reported in a single year in three decades.<\/p>\n

A federal report showed lack of timely testing or proper treatment contributed to 90% of the nation\u2019s cases. Black and Indigenous women disproportionately lack access to prenatal care, where they could get tested and treated for syphilis. Almost 90% of South Dakota congenital syphilis cases between 2020 and 2023 were in Native American babies, despite Native Americans making up just 11% of the state\u2019s population.<\/p>\n

National and state guidelines instruct providers and health departments to prioritize pregnant syphilis patients for their remaining stocks of Bicillin L-A. Non-pregnant syphilis patients can take the antibiotic doxycycline, although that drug\u2019s regimen \u2014 two pills a day for up to four weeks \u2014 can be harder for patients to adhere to, experts say.<\/p>\n

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\u201cIt\u2019s much more difficult as a clinician or as a public health person to know if people actually complete their (doxycycline) treatment,\u201d Johnson said.<\/p>\n

Experts say it\u2019s unclear whether the shortages have been contributing to the rise in congenital syphilis cases. \u201cBut I suspect it certainly could make it worse,\u201d Johnson said. \u201cThe longer this goes on, the harder that it\u2019s going to be.\u201d<\/p>\n

In South Dakota, which had the highest rates in the nation, cases decreased slightly last year, from 40 in 2024, to 37 in 2025. This year as of April, only one case has been reported, though data for congenital syphilis can lag.<\/p>\n

Mississippi has seen a gradual drop in cases over the past couple of years, said Dr. Tami Brooks, medical director of the state\u2019s health department. Mississippi and other state health departments told Stateline <\/em>they connect patients with Bicillin or Lentocilin when a health care center reports it has a pregnant patient but no supply.<\/p>\n

Bicillin L-A can also be used for other infections, such as strep throat. Dr. Tanya Fitts, immediate past president of the American Academy of Pediatrics\u2019 Mississippi chapter, said one of her patients had suffered a rare complication of strep throat. For the past five years, the now 18-year-old has had to take daily oral penicillin to keep symptoms at bay, instead of the recommended monthly Bicillin L-A injection, Fitts said.<\/p>\n

\u201cWe haven\u2019t been able to order it for many, many years,\u201d Fitts said, adding that the price of the drug outpaced what her clinic was getting paid from insurance companies.<\/p>\n

In a statement to Stateline<\/em>, Pfizer said demand for Bicillin L-A is exceeding supply, though it said health providers may request the drug for a pregnant syphilis patient. The company did not answer Stateline<\/em>\u2019s questions regarding details of the recall nor the manufacturing process, saying it doesn\u2019t disclose details about product supply chain.<\/p>\n

If a drug is expensive but has limited use, manufacturers don\u2019t have a lot of financial incentives to make it, said infectious diseases clinical pharmacist Katherine Yang, a professor at the University of California, San Francisco\u2019s School of Pharmacy.<\/p>\n

\u201cThe more niche a drug is, the less likely it is to have multiple manufacturers and generic products once it is off patent,\u201d Yang said. \u201cIt does speak to the vulnerability of our drug supply chain, when there are very limited manufacturers.\u201d<\/p>\n

Bicillin L-A is typically sold by the 10-dose box, even if a clinic only needs a few doses \u2014 costing thousands of dollars, said family medicine physician Dr. Megan O\u2019Connell, of the Cherokee Nation. She\u2019s the chief public health officer of the Great Plains Tribal Leaders Health Board, which offers epidemiological support, care and advocacy for 18 tribes across Iowa, North and South Dakota, and Nebraska.<\/p>\n

Patrick Fonge, pharmacy director at the Navajo Health Foundation\u2019s Sage Memorial Hospital in rural Arizona, told Stateline<\/em> wholesalers have increased prices.<\/p>\n

\u201c(Bicillin L-A) is not available in the market, but some vendors, some distributors, do have it in their warehouses and then now triple the price or quadruple the price to make profit,\u201d Fonge said. According to one wholesaler, the average wholesale price for Bicillin at the 1.2mu concentration showed about $4,870 for a 10-dose box, he said. \u201cWe don\u2019t have extra (in our) budget for Bicillin.\u201d<\/p>\n

Fonge puts in orders for the Lentocilin instead, through the federal Indian Health Service, which pays for the medication.<\/p>\n

\u201cIt\u2019s clear to us that a single U.S. manufacturer that makes this drug in a singular factory is a challenge,\u201d said Finley, of the National Coalition of STD Directors. \u201cWe\u2019re talking about the U.S. not being able to make the drug penicillin. Which is ridiculous.\u201d<\/p>\n

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\u201cWe\u2019re talking about the US not being able to make the drug penicillin. 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