March 5, 2024

Increased Syphilis Rates And Amoxicillin Shortage Fueled Crisis


Bicillin—a common form of penicillin manufactured by Pfizer and used to treat syphilis—is the newest antibiotic to face a shortage, causing the drugmaker to recommend the use of an alternative, less convenient drug for patients who aren’t pregnant.

Key Facts

In June, Pfizer announced the shortage of penicillin Bicillin A-L and Bicillin C-R, due to an increase in syphilis cases and “competitive shortages.”

The Food and Drug Administration’s drug shortage list has Bicillin A-L (generic name penicillin G benzathine) listed as “currently in shortage” and Bicillin C-R (generic name penicillin G benzathine and penicillin G procaine) as “discontinuation.”

Syphilis cases have been increasing in the U.S. since 2000, with a 75% increase between 2017 and 2021, the last year case data is available, according to the Centers for Disease Control and Prevention.

Cases were on the rise in parts of the U.S., like Houston, which last month reported a 2021 syphilis outbreak that was responsible for a 128% increase in cases among women and another spike in congenital syphilis—when a mother passes the disease to her unborn child.

Other parts of the country have also faced spikes: San Luis Obispo County in California released a statement saying syphilis cases rose from 66 in 2019 to 99 in 2022, and in April, the North Carolina Department of Health and Human Services warned residents that syphilis cases increased by 28% from 2021 to 2022, with cases among women and congenital cases seeing the most impact.

Bicillin A-L is the only approved treatment for infected pregnant women and is effective at preventing the disease from spreading to the unborn infant, according to the Virginia Department of Health.

To combat the shortage, the CDC recommends doctors give priority to pregnant patients and infants who are either infected or have been exposed, and prescribe doxycycline for other patients.

However, Bloomberg reports doctors fear patients won’t keep up with treatment as doxycycline must be taken twice a day for at least two weeks, whereas Bicillin is a shot that’s typically only administered once.

Big Number

176,713. That’s how many cases of syphilis were reported in the U.S. in 2021, according to CDC data, a 32% increase from 2020. Other sexually transmitted infections (STIs) increased during this time frame, too. Chlamydia, gonorrhea and syphilis cases all rose to a combined number of 2.5 million in 2021 from 2.4 million in 2020, though the rate at which syphilis and congenital syphilis cases spiked was “particularly jarring” to researchers.

Key Background

There are four stages of syphilis: primary syphilis, secondary syphilis, latent syphilis and late, or tertiary, syphilis. Symptoms and health issues progressively get worse with each stage, but the disease only progresses if left untreated. Syphilis is especially dangerous in pregnant people, who can pass off the disease to the fetus, potentially resulting in miscarriage or severe disabilities. According to the CDC, congenital syphilis cases have tripled over recent years, with 2021 seeing the highest number of cases since 1994. However, it’s easily preventable and treatable if testing and treatment is conducted early on.


Drug shortages increased by almost 30% from 2021 to 2022, according to a March report by the Senate Homeland Security and Governmental Affairs Committee. Bicilin is one of the newest additions to the long running list of drug shortages. Amoxicillin, a common antibiotic used to treat bacterial infections, has been in a shortage since October 2022. According to the American Academy of Pediatrics, doctors began prescribing Bicillin as an alternative medication to treat things like strep throat during the amoxicillin shortage. In its Bicillin shortage letter, Pfizer said this played a part in the Bicillin shortage in the form of “competitive shortages.” Popular weight loss and diabetes drugs Ozempic and Wegovy are also in a shortage due to popular demand. Adderall, used to treat disorders like narcolepsy and attention-deficit hyperactivity disorder (ADHD), has been in a shortage since last October. On Tuesday, the FDA and Drug Enforcement Administration put out a letter urging stakeholders to resolve the adderall shortage “as quickly as possible.”

Further Reading

Syphilis Cases In Women And Congenital Syphilis Skyrocket In Houston: Symptoms And How To Stay Safe (Forbes)

Wegovy Shortage: Drug Maker Limits Distribution—Here’s When Supplies Should Improve (Forbes)

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