As Syphilis Rises, Los Angeles LGBT Center Promotes New Treatments

Cases of syphilis have been rising across the country, just as the drug used to treat the disease is experiencing a dire shortage. That has led the Los Angeles LGBT Center to highlight another treatment option.

In L.A. County, case numbers have shot up among some groups of people, including men and transgender women who have sex with men, according to the L.A. County Department of Public Health.

Bicillin LA is the go-to treatment for syphilis, but the supply of the antibiotic has been low since spring. The shortage is expected to last until at least early 2024, said Dr. Kaiyti Duffy, chief medical officer at Los Angeles LGBT Center.

In light of the shortage, the center is promoting another treatment called DoxyPEP that can be taken up to 72 hours after an unprotected sexual encounter.

Think of it as kind of like the morning-after pill. Instead of pregnancy, the drug prevents syphilis infections by as much as 87%, according to Duffy.

“This would eliminate the need for people who are at high risk to eventually need Bicillin at all,” Duffy said.

Syphilis is mostly spread through direct contact with an infected person during sex. But there’s another form of the disease: congenital syphilis, passed from a mother to child that can lead to miscarriages, stillbirths, and health defects in children if the pregnancy comes to term.

But DoxyPep shouldn’t be taken by those who are pregnant or allergic to penicillin. So the center hopes that as more people turn to the use of DoxyPep, it will shore up availability of Bicillin to those who have no other option.

“We're in this new period of having to figure out how to ration these resources,” Duffy said.

Duffy partly attributes the rise of syphilis cases to the pandemic shutdown, which limited treatment and care on-site.

“But [the pandemic] didn't stop people from having sex. And so people were connecting, as people do, without the same venues to receive prevention care and treatment care,” Duffy said.

There are also funding challenges, she added. L.A. County has been pushing for those with health insurance to pay for testing for sexually transmitted diseases.

“People might get co-pays or have to pay out of pocket in a way they never had to before, and that can potentially be deterring people from coming in for care,” Duffy said. “These things trickle down, as soon as people stop getting tested, they don't know that they have an infection, they're spreading infection, and then we have a whole circle.”

As to the Bicillin LA shortage, Pfizer has cited the rise in syphilis cases and a sudden increase in demand as contributing factors.

Duffy offered another take.

“Pharmaceutical companies might not think of syphilis as being a concern for the general population and it being a niche need of the LGBT community,” she said. But, she added, “it ultimately affects the larger community, and there's no way around that.”