NATIONAL HEALTH ALERT
Roger-Luc Chayer (Image : AI / Gay Globe)
Alert on the Shortage of Syphilis Treatments
Yesterday, January 19, 2025, on his Instagram account, Dr. Réjean Thomas, founding president of Clinique l’Actuel in Montreal, issued an alert regarding syphilis treatment shortages.
Introduction to Clinique l’Actuel, a Reference Center in Sexual Health
Clinique l’Actuel is a medical clinic located in the Village neighborhood of Montreal, recognized for its expertise in sexual health, STBBI (sexually transmitted and blood-borne infections) prevention, and general medicine. Founded in 1984, it initially established itself as an innovative care center for the prevention and treatment of HIV and sexually transmitted infections (STIs), before gradually expanding its mission. Today, l’Actuel operates as a family medicine group open to the entire population while remaining a key player for LGBTQ+ communities.
The clinic offers family medicine consultations, screening, treatment, and follow-up services for STBBIs, as well as prevention programs such as PrEP and PEP. It also provides support for people living with HIV and psychosocial services. Its approach is distinguished by comprehensive, inclusive, and respectful care, focused on accessibility, confidentiality, and clinical expertise.
Shortage of Bicillin L-A: A Key Medication Against Syphilis
The message published by Dr. Thomas, a long-time contributor to the gay magazine Globe, read: “WARNING: shortage of the first-line treatment against syphilis. Fortunately, other options exist, but the situation remains concerning. Moreover, there is a significant increase in syphilis cases in Quebec and Canada, affecting women of childbearing age, leading to a resurgence of congenital syphilis, transmitted to the fetus with serious consequences, as well as the LGBTQ+ community.”
Bicillin L-A (benzathine penicillin G) is a prescription medication used to treat certain infections. It is the primary antibiotic used to treat syphilis that does not affect the central nervous system.
In Canada, Bicillin L-A is marketed by Pfizer Canada SRI. Pfizer reports a shortage expected to last until the end of January 2026 due to a manufacturing interruption.
What is Bicillin L-A?
Bicillin L-A is an injectable antibiotic based on benzathine penicillin G, long used to treat certain bacterial infections. It acts slowly and for a prolonged duration in the body, allowing for lasting effectiveness with one or a few injections only. It is especially recognized as the reference treatment for syphilis when it does not involve the central nervous system, as well as for other penicillin-sensitive infections such as certain streptococcal throat infections or acute rheumatic fever for prevention.
Administered via intramuscular injection, Bicillin L-A maintains stable therapeutic concentrations over a long period, which is essential to fully eliminate the bacterium responsible for syphilis. Due to its central role in public health, particularly in preventing congenital syphilis, it is considered an essential medication, and any shortage raises serious concerns among healthcare professionals.
What is Syphilis?
Syphilis is a sexually transmitted infection and blood-borne disease caused by the bacterium Treponema pallidum. It is mainly transmitted during unprotected sexual contact, through direct contact with an infected lesion, and can also be transmitted from a pregnant person to their fetus, causing congenital syphilis with sometimes severe consequences. The disease progresses through successive stages. It often begins with a painless sore called a chancre, which may go unnoticed, then evolves into skin rashes and various general symptoms.
Without treatment, syphilis can remain silent for years and eventually affect the heart, brain, nervous system, and other organs, leading to severe complications. Syphilis is effectively treated with antibiotics, especially when diagnosed early, making screening and prevention essential in public health.
Managing the Bicillin L-A Shortage
During the Bicillin L-A shortage, management relies on medical adaptation supervised by health authorities and clinicians. When possible, the medication is prioritized for situations where it is absolutely indispensable, notably in pregnant women to prevent congenital syphilis.
For others, alternative antibiotics may be prescribed depending on the stage of syphilis, patient profile, and absence of allergies, while ensuring closer clinical and biological monitoring, as some alternatives require strict adherence. Screening remains essential to rapidly diagnose cases and limit transmission, while prevention measures including condom use and partner notification become even more important.
Alternative Medications to Bicillin L-A
In case of Bicillin L-A shortage, alternative medications can be used depending on the syphilis stage and clinical situation, always under medical supervision. Doxycycline is the most frequently chosen oral option for non-pregnant individuals, requiring strict adherence and close serological follow-up. Ceftriaxone, administered by injection, may also be used in certain contexts, particularly when doxycycline is inappropriate. Azithromycin has been used but is now generally avoided due to documented resistance.
Prevention Measures to Limit Syphilis Transmission
In times of Bicillin L-A shortage and rising syphilis cases, the public can protect themselves by adopting essential behaviors. Systematic use of condoms during sexual activity is paramount to limit transmission. Reducing the number of sexual partners also decreases risk.
Regular screening is advised, especially for people in high-risk groups such as sexually active youth or men who have sex with men. Informing partners in case of infection is critical so they can also get tested and treated. Presence of symptoms like ulcers or rashes should lead to avoiding sexual contact and prompt consultation with a healthcare professional. Avoid self-medication and carefully follow prescribed treatment.
Finally, participating in local information campaigns and awareness programs about sexually transmitted infections helps better understand risks and prevention methods. These precautions are particularly crucial when first-line treatments are lacking.
Free Resources for Syphilis Screening and Care
Here is an overview of free resources for syphilis screening and care available in Quebec, Canada, the United States, and Europe. These include public, community, and online services providing access to tests and care at no or low cost:
Quebec (Canada)
In Quebec, screening for sexually transmitted and blood-borne infections (STBBIs), including syphilis, is free for anyone insured by RAMQ at multiple public service points such as CLSCs, sexual health clinics, and youth services. Youth aged 14 and over can get tested without parental consent.
Community resources such as Integrated STBBI Screening and Prevention Services (SIDEP), located in several CLSCs, offer testing often with confidential reception, sometimes without requiring a health insurance card for certain groups.
There are also initiatives like GetaKit in Ontario that provide access to syphilis and other STI tests by mail after an online assessment (free service depending on coverage areas).
Canada (outside Quebec)
Across Canada, sexual health clinics, public health units, and walk-in clinics offer free or low-cost STI screening, including syphilis, as part of public health services. Community clinics or local health agencies can be contacted to find nearby screening points.
United States
In the U.S., many public health clinics (Healthy Sexual Health Clinics) and municipal programs offer free or low-cost STI screening and treatment, including syphilis, without appointment and confidentially. For example, some cities like Philadelphia have clinics offering free STI testing and treatment for anyone over 13 years old.
Programs such as TakeMeHome have also provided home testing kits for multiple infections, including syphilis, in certain states.
Local public health departments sometimes organize free community screening events with rapid tests and medical follow-up.
Europe
In many European countries, public health services include free or anonymous STI testing centers. For example, in the UK, services like SH.UK (in partnership with the NHS) allow ordering free home STI testing kits (including syphilis) and provide support for accessing treatment if needed.
There is also a European Test Finder that helps locate STI screening centers across Europe.
In some countries like France, CeGIDD centers offer free and anonymous STI testing and treatment, often accessible directly at testing centers without cost to patients.
In Ireland, the national public health service offers free home STI testing for individuals aged 17 and over.
These resources help make syphilis screening and care accessible at no or low cost, especially important during treatment shortages or for uninsured people. Contact local public health services or community clinics in your area to confirm practical details such as hours, access conditions, and confidentiality.
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