Bicillin shortage puts syphilis prevention back in focus

The U.S. supply problem around Bicillin L-A, the first-line penicillin shot used for syphilis, is not over. CDC’s latest product-availability page says Pfizer extended the next delivery of two Bicillin L-A prefilled syringe presentations to October 2026, with anticipated recovery pushed to late 2027.

That matters because syphilis is treatable, but timing and access matter — especially during pregnancy. CDC says penicillin is the only recommended treatment for pregnant patients with syphilis and for babies with congenital syphilis.

What changed now

CDC updated its STI product-availability guidance on April 21, noting the extended Bicillin L-A timeline and continuing to recommend that jurisdictions preserve benzathine penicillin G for pregnant patients. FDA has allowed temporary importation of Lentocilin because of the ongoing limited availability of Bicillin L-A, according to CDC’s March 10 Dear Colleague letter.

Here is the concrete number: CDC’s provisional 2024 STI surveillance counted 3,941 congenital syphilis cases, up 1.6% from 2023 and nearly 700% higher than a decade ago. The same report showed some better news — combined reported chlamydia, gonorrhea and syphilis cases fell 9% from 2023 — but congenital syphilis is still moving the wrong way.

What readers can do safely

This is not a reason to panic or ration care on your own. It is a reason to ask direct, practical questions if syphilis testing or treatment is relevant to you, your partner, or a pregnancy.

A short list to bring to a clinician or clinic:

• “Do I need syphilis testing based on where I live, pregnancy status, symptoms, or partners?”
• “If I test positive, what treatment is recommended for my situation?”
• “If I am pregnant or could become pregnant, how quickly should treatment happen?”
• “If medication supply is limited locally, who coordinates access?”

CDC’s testing guidance says many STIs have no symptoms, and that pregnant people should be tested for syphilis early in pregnancy; some may need repeat testing. For everyone else, screening depends on age, location, partners, sexual practices and symptoms.

The plain-language takeaway: the shortage is a systems problem, not a personal failure. Testing, respectful partner conversations and timely care still do the heavy lifting.

Sources: CDC STI product availability (https://www.cdc.gov/sti/hcp/clinical-guidance/availability-of-products.html); CDC Bicillin L-A shortage letter (https://www.cdc.gov/nchhstp/director-letters/bicillin-update.html); CDC provisional 2024 STI surveillance (https://www.cdc.gov/sti-statistics/annual/index.html); CDC STI testing guidance (https://www.cdc.gov/sti/testing/index.html).