STI Resources for Healthcare Providers

The CDC provided updated recommendations for the CDC Laboratory Recommendations for Syphilis Testing. Laboratories have a critical role in the public health response to the syphilis epidemic. The responsibility of the laboratory is to test specimens and report results in a timely manner, allowing clinicians to efficiently make clinical diagnoses for patient management. Public health reporting by laboratories also allows local health departments and CDC to conduct surveillance and monitor disease trends. This report details CDC’s new recommendations for syphilis testing, including laboratory-based tests, point-of-care (POC) tests, processing of samples, and reporting of test results to aid laboratorians and clinicians in the diagnosis of syphilis. Future revisions to these recommendations will be based on new research or technologic advancements for syphilis clinical laboratory science.

CDC Laboratory Recommendations for Syphilis Testing, 2024

The National Syphilis and Congenital Syphilis Syndemic Federal Trask Force has shared the Implementation of Point of Care Tests for Syphilis document to address the challenges in diagnosis and treatment of syphilis. This document emphasizes the often-asymptomatic nature of the infection and discusses the implementation of Point of Care (POC) tests to facilitate rapid diagnosis and treatment during the same visit. 

POC tests for syphilis differs from the traditional laboratory-based serologic testing primarily in specimen collection, time to result, need for confirmation, and sensitivity/specificity. While POC tests offers rapid results using whole blood from a fingerstick, it lacks the comprehensive assessment provided by laboratory-based tests, requiring confirmation and follow-up. It also underscores that laboratory-based testing remains the preferred option, particularly for individuals with a history of syphilis and low-risk individuals. Despite lower sensitivity and specificity, POC tests can be valuable, especially in settings with high incidence rates or where access to healthcare is limited.

Considerations for the Implementation of Point of Care (POC) Tests for Syphilis

Please be aware of the updated post here: https://www.cdc.gov/sti/php/from-the-director/2023-07-20-mena-bicillin.html regarding the bicillin shortage and additional bicillin supply from Pfizer. 
 
Update from Pfizer - June 10, 2024‎
On June 10, 2024, Pfizer shared an update on their 2.4 million Units/4 milliliter Bicillin L-A^® supply, noting that they currently have available supply. If there is sufficient supply of Bicillin L-A^® in your jurisdiction, please consider using Bicillin L-A^® for all appropriate patients, per CDC's standard guidance.

If you are experiencing Bicillin L-A^® supply issues, please notify DSTDP (stdshortages@cdc.gov) of any shortages and contact Pfizer Hospital US directly at the number or email below:

Pfizer Hospital US:
Phone: 844-646-4398
Hours: M-F 7 am - 5 pm CST
Email: PISupplyContinuity@Pfizer.com (For assistance with orders/supply information)

Note Bicillin^® L-A supply is improving, but it will not be fully available until later this year, per Pfizer's Availability Report.

E-mail for assistance with orders/supply information.

In January, Centers for Disease Control and Prevention (CDC) made aware that the U.S. Food and Drug Administration’s (FDA) announced the availability of Extencilline (benzathine benzylpenicillin injection, powder, for suspension) to address the ongoing shortages of Bicillin L-A^®. At that time, CDC directed all to the FDA’s distribution and administration information in a letter to healthcare providers (see the “Dear Healthcare Provider Letter”). The preparation and administration of Extencilline, as well as the contraindications for prescribing, differ from those for Bicillin-LA^®. CDC has provided a clinical information resource to more clearly delineate some of those differences and offer appropriate guidance. Please share this resource widely with your networks. 

Extencilline Information for Clinicians