Several important updates on therapeutics for the prevention and treatment of COVID-19

Summary:
Central District Health continues to respond to a rise in syphilis infections in our communities. In the past six months, between Public Health Districts 3 and 4, more than 60 early syphilis infections (primary, secondary, and early latent) have been identified. This represents a significant increase compared to 32 infections during the same timeframe two years ago. Patients’ ages range from 19 to 60 years old. Persons report a variety of sexual partner preferences. Methamphetamines or other substance use has been reported by males and females. Another common risk factor is having multiple sex partners met locally via various dating apps.

Please consider testing for syphilis and HIV if a person presents with any of the risk factors mentioned above, and/or:

• Any anogenital or oral lesions, especially indurated and minimally painful ulcers
• Any unexplained rash, especially with palmar or plantar involvement
• Unexplained lymphadenopathy

Syphilis treatment considerations:
Syphilis treatment is determined by the stage of infection coupled with a person’s medication
allergies and pregnancy status.

• Primary, secondary, and early latent syphilis are treated with 2.4 million units IM of
  Bicillin L-A.
• Late latent syphilis is treated with 2.4 million units IM of Bicillin L-A once per week times
  three weeks.
• If there is not enough evidence to confirm initial infection was within the previous 12
  months, treat as if the person has late latent syphilis.
• Individuals who have had sexual contact with a person who receives a diagnosis of
  primary, secondary, or early latent syphilis <90 days before the diagnosis should be
  treated presumptively for early syphilis, even if serologic test results are negative.
• Doxycycline can be used to treat syphilis in the case of a severe penicillin allergy if the
  patient is not pregnant. For individuals who are pregnant, no proven alternatives to
  penicillin are available for treatment. Patients should be desensitized and treated
  with penicillin G per their stage of infection.
• Neurosyphilis, ocular syphilis, and otosyphilis can occur during any stage of a syphilis
  infection and require IV or IM treatment.

Resources:
For questions, or to report a syphilis infection or another reportable STI, call Central District Health’s Communicable Disease Control program at 208-327-8625.
Providers can access STI clinical consultation services through the latest STD Clinical Consultation Network.
Instructions to access the CDC’s 2021 STI Treatment (Tx) Guide mobile app, plus wall charts and pocket guides can be found here: https://www.cdc.gov/std/treatment-guidelines/provider-resources.htm
CDC’s STI Screening Recommendations: https://www.cdc.gov/std/treatment-guidelines/screening-recommendations.htm
For more details on syphilis screening and treatment during pregnancy, visit: https://www.cdc.gov/std/treatment-guidelines/syphilis-pregnancy.htm
For management and treatment considerations for neurosyphilis, visit: https://www.cdc.gov/std/treatment-guidelines/neurosyphilis.htm

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