May 12, 2023
The California Department of Public Health (CDPH) has noted a concerning increase in cases of syphilis in the Central Coast region of California. Central coast region cases increased by 31% for congenital syphilis and 49% for syphilis among people who could become pregnant from 2020 through 2021.
These trends echo concerning statewide findings, with reported congenital cases in California increasing 1360% from 33 cases in 2012 to 483 cases in 2020. Many such cases in California have occurred among infants whose birthing parents report: receiving late or no prenatal care, using methamphetamine and injection drugs, experiencing homelessness or unstable housing, and/or having been incarcerated within the prior 12 months.
CDPH issued a health alert for providers, making recommendations to address this alarming trend. The recommendations include screening all pregnant patients for syphilis at least twice during pregnancy, as well as at delivery. Since syphilis can be challenging to recognize or adequately treat, CDPH is also urging providers to reinforce their knowledge of the clinical presentation and treatment of syphilis.
CDPH Recommends Post-Exposure Prophylaxis for those at High Risk of STIs
CDPH also recently issued a provider letter about a compelling new biomedical intervention to prevent bacterial sexually transmitted infections (STIs), including syphilis, gonorrhea and chlamydia.
Emerging evidence from a study among men who have sex with men and transgender women suggests doxycycline, when taken as a 200mg oral dose within 72 hours of condomless sex, significantly reduces acquisition bacterial STIs.
Given the high rates of these STIs in California, CDPH recommends that doxycycline post-exposure prophylaxis (doxy-PEP) be offered to men who have sex with men or transgender women who have had a bacterial STI in the past 12 months.
CDPH also recommends that doxy-PEP be offered to all non-pregnant individuals at increased risk for bacterial STIs, and to those requesting doxy-PEP, even if these individuals have not been previously diagnosed with an STI or have not disclosed their risk status.
More details on doxy-PEP and these recommendations can be found in the letter on the CDPH website.
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