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Syphilis Toolkit for Healthcare Providers

Bicillin L-A® Shortage

The only medication available to treat pregnant people with syphilis and babies with congenital syphilis is in short supply. Healthcare providers are encouraged to prioritize Bicillin L-A® for these populations. Pfizer anticipates this shortage until early- to mid-2024. The Food and Drug Administration is now allowing the temporary importation of Extencilline (benzathine benzylpenicillin) which is an equivalent injectable medication until supplies of Bicillin are replenished. It is only available by prescription in the United States.

Learn More

You may already be aware that syphilis rates have been increasing since 2001, and that the Centers for Disease Control and Prevention (CDC) is concerned about these and other increasing sexually transmitted diseases (STD) or sexually transmitted infections (STI) rates.

In the past 10 years, primary and secondary syphilis cases have more than doubled, from 91 in 2011 to 277 in 2021. From 2019 to 2021, primary and secondary syphilis cases increased 60%. Like you, we are concerned.

We need your help.

Health care providers can play a critically important role in helping to reduce syphilis in suburban Cook County by taking the following actions:

Report. It’s the law.

Report syphilis to the health department as soon as possible but within 7 days so we can help you, your patients and their partners.

Ways to report:

  • Sign into the Illinois Disease Surveillance System (IDSS) online web portal.
    • Providers who have logged into I-NEDSS between December 2022 and April 2024 have received communications from [email protected] and have been automatically uploaded as users into the new system.
    • Providers who have not received an email will need to request access by emailing [email protected] .
  • Fax Completed Morbidity Report Form To: (708) 836-5450.

Test and Diagnose. Stage and Treat.

Syphilis is called ‘the great imitator’ because it can mimic so many other conditions. For this reason, and because talking about sex can sometimes be difficult, we know the process of testing, diagnosing, staging and treating syphilis can be challenging.

The below staging and treatment algorithms from IDPH can help. IDPH has also prepared a staging and treatment document . The University of Washington STD Prevention Training Center recorded a podcast on Monitoring and Interpretation of Syphilis Serological Tests .

Syphilis Staging & Treatment Algorithms

For each patient, select based on history, exam, and labs.

Stage Timing (After Exposure) Key Symptoms/Findings Treatment (CDC 2021)
Primary Syphilis ~10–90 days (avg. 3 weeks) Painless genital ulcer (chancre), localized lymphadenopathy Benzathine Penicillin G 2.4 million units IM × 1 dose
Secondary Syphilis ~6 weeks to 6 months Rash (palms/soles), mucous patches, condyloma lata, fever, malaise, lymphadenopathy Benzathine Penicillin G 2.4 million units IM × 1 dose
Early non-primary non-secondary syphilis /Formerly Early Latent Syphilis <12 months Asymptomatic, but recent infection documented Benzathine Penicillin G 2.4 million units IM × 1 dose
Syphilis Late or Unknown Duration/ Formerly Late Latent Syphilis >12 months or unknown Asymptomatic, no known recent exposure Benzathine Penicillin G 2.4 million units IM weekly × 3 doses
Neurosyphili, Ocular Syphilis, or Otic Syphilis (specific manifestation — not a separate stage) Can occur at any stage Neurologic (headache, cranial nerve palsies, vision changes, hearing loss, altered mental status) Aqueous Crystalline Penicillin G 18–24 million units/day IV (q4h) × 10–14 days
Penicillin Allergy (Non-pregnant, Non-Neuro) Based on stage Use if penicillin contraindicated

Early stages: Doxycycline 100 mg PO BID × 14 days

Late latent: Doxycycline 100 mg PO BID × 28 days

Alternative: Tetracycline 500 mg PO QID for 14 days for early stages only (if doxycycline unavailable)
Pregnant Patients (Any Stage) Any stage Pregnancy with syphilis Penicillin is the only recommended treatment. If allergic, patient should undergo penicillin desensitization followed by standard penicillin therapy. Desensitization should be performed in a monitored setting.

Follow-Up & Test of Cure

  • RPR titers: Repeat at 6, 12, and 24 months.
  • Neurosyphilis: Repeat CSF exam every 6 months until normalization.
  • Pregnant patients: Close follow-up and serologic monitoring required.

Reference: CDC 2021 STI Treatment Guidelines

Always follow CDC’s Treatment Guidelines . The 2021 STD Treatment Guidelines app is available for download on iPhone  and Android  devices.

Prevent

Encourage frequent syphilis/STI testing in any patients who may be at high risk, including:

  • Gay, bisexual or other men who have sex with men (MSM)
  • Pregnant women – By law , pregnant women must be tested at first visit and at 28 weeks of pregnancy and at delivery. Download Pregnancy Syphilis Screening and Treatment Guide.
  • Patients who use ‘dating’ or ‘hookup’ apps like Jack’d, Grindr, Adam4Adam, etc. for sex may be at higher risk for STIs.

Please inform patients with syphilis that staff from the health department will be reaching out to them and encourage them to speak with us – we can help with partner notification, education, and support.

Remember, anyone who is sexually active can get syphilis. Promote safer sex by:

  • Encouraging consistent and correct condom use during every sexual encounter.
  • For eligible patients (e.g., MSM and transgender women with a recent history of bacterial STIs), consider discussing Doxy-PEP (doxycycline post-exposure prophylaxis), which may reduce the risk of acquiring chlamydia, syphilis, and gonorrhea when taken within 72 hours after condomless sex.

Early diagnosis, treatment, and prevention counseling are essential to protect both individual and public health.

What healthcare providers can do

Healthcare providers can help ensure patients have a positive experience by following these best practices. As a patient, here’s what you can typically expect:

Compassionate, non-judgmental, trauma-informed care:
You will be treated with respect, empathy, and dignity—regardless of your sexual history, identity, or behaviors. Appointments are conducted in a safe space where open, honest conversations are encouraged and free from stigma.

Personalized risk assessment and screening:
Your provider will review individual risk factors—such as pregnancy, MSM status, HIV status, recent or multiple partners, or a partner with syphilis—to determine the most appropriate screenings based on CDC guidelines.

Complete, confidential sexual health history:
You may be asked about specific sexual practices to ensure all potentially exposed areas (genital, oral, rectal) are tested. Questions are designed to be inclusive, open-ended, and respectful of your comfort and privacy.

Accurate staging and diagnosis:
Providers use your symptoms, medical history, and lab results to determine the correct stage of syphilis, helping to ensure you receive the most appropriate care.

Timely, evidence-based treatment:
Treatment is provided according to CDC guidelines, using the correct medication and dosage for your stage of infection. If you have a penicillin allergy or other contraindication, safe alternatives will be discussed.

Education and prevention support:
Expect guidance on how to reduce risk, prevent reinfection, and protect yourself and your partners. This may include information about condom use, HIV prevention options like PrEP, and Doxy-PEP to prevent certain bacterial STIs.

Ongoing follow-up:
Follow-up testing will be scheduled to monitor your response to treatment and ensure successful recovery, including repeat RPR titer checks when recommended.

What CCDPH is doing to help reduce syphilis cases

  • Serving as a technical consultant for test ordering, staging, and current treatment guidelines
  • Talking with cases, help them to notify partners, and help individuals reduce risk
  • Providing condoms
  • Educating the public, providers and ourselves
  • Monitoring trends and intervene where we can
  • Helping folks get into primary care

Contact Us

We want to hear from you. If you have questions about syphilis, reporting, staging, or treatment, we can help. If you think there’s something we can do better or if you have ideas about how to reduce syphilis in our area, let us know: (708) 836-8637.

Demian Christiansen, DSc, MPH
Unit Director Communicable Disease Control and Prevention
Cook County Department of Public Health

Rachel Rubin, MD, MPH, FAAP
Senior Public Health Officer
Cook County Department of Public Health

Updated July 17, 2025, 4:17 PM