Syphilis drug shortage comes amid high infection rates across Canada

A shortage of the most effective drug for syphilis at the same time the infection is on the rise in Canada is raising concerns for doctors and public health officials.

The Public Health Agency of Canada has recommended that health-care providers conserve available stock of Bicillin L-A, a long-lasting and effective injectable form of the antibiotic penicillin that is used to treat syphilis.

"Already it's been a challenge to be able to get control over the spread of syphilis and this [shortage] just adds another layer," Dr. Vanessa Allen, chief of medical microbiology at Public Health Ontario, said Tuesday.

Allen called the ability to treat syphilis with a single, potent dose of Bicillin a cornerstone of treatment because it is so effective at killing the bacteria that cause the infection.

Shortage threat

Some people who are infected do not have symptoms and could pass on the bug if they don't practise safe sex. 

"We've had the luxury of being able to treat with a single dose," Allen said. The shortage of the drug threatens the success in containing the spread of syphilis. 

For doctors, the complexity comes in terms of delivering effective treatment.

For example, Bicillin is the only recommended therapy for syphilis in pregnant patients, who can transmit the infection to the fetus. That can lead to blindness and bone changes in the baby. 

Given how devastating the disease can be to a baby, when a case of congenital syphilis does occur, it means the public health system is not working, Allen said. 

Under the new federal guidelines, Bicillin is reserved for pregnant patients, those who may not complete at least 14 days of taking two pills of doxycycline twice a day and other high-risk individuals.

Pfizer is the only Canadian supplier of Bicillin L-A and the shortage is due to a manufacturing issue, the Public Health Agency of Canada said.

The national shortage is expected to last until July, the agency said.

"This situation is caused by a production issue at the manufacturing plant. Pfizer is currently completing an investigation and will remediate the situation as soon as possible," Vincent Lamoureux, director of corporate affairs for Pfizer Canada, said in an email. 

"We are currently working with Health Canada to facilitate the importation of approximately 800 Bicillin units from Pfizer Australia. Our current timeline indicates that we should have new stock available by the week of May 16."

​Dr. Supriya Sharma, senior medical adviser at Health Canada, said the interim guidelines are meant to ration the existing supplies of Bicillin as a bridge until another supply can be brought into Canada.  

"The challenge with syphilis is that it's been called the great imitator, so in different phases it can actually mimic a lot of other diseases," Sharma said.

That's why safe sex, greater awareness of symptoms and good strategies to detect the infection, test it and compliance with medication are all so important, she said. 

The U.S. is going through the same shortage, Sharma said. The U.S. Centers for Disease Control and Prevention issued similar guidance for the drug. 

Last week, health officials in Alberta  recently reported outbreak levels of syphilis and gonorrhea.

Alberta currently has a small supply of Bicillin but as of this morning, two provinces have none, said Dr. Ameeta Singh, a professor in the infectious disease division at the University of Alberta in Edmonton.

That's a concern because pregnant women are a priority group to receive Bicillin. The alternative treatment in pregnancy is intravenous penicillin every four hours for 10 days. Syphilis screening is part of prenatal care with retesting at the time of delivery, Singh said.  

Alberta's last case of syphilis infection passing between a mother and baby was in 2011.

"We have seen mothers once again being diagnosed with infectious syphilis just in the last few months and that does that raise the concern that we could see it in this group again," said Singh. 

During Alberta's syphilis outbreak, there's also been an increase in eye complications, including many cases in men who have sex with men, Singh said.  

B.C., Saskatchewan, Manitoba and Newfoundland have also reported increases in both sexually transmitted infections. Ontario had more than 1,000 cases of syphilis last year, compared with 350 in 2005, Allen said. 

In 2012, the Public Health Agency of Canada said there were 2,003 cases of infectious syphilis, compared with 908 in 2003.