(P109) COMPLETION OF SYPHILIS DOXYCYCLINE REGIMENS DURING THE BENZATHINE PENICILLIN G (BPG) SHORTAGE, BALTIMORE CITY, MARYLAND.

Wednesday, September 18, 2024

4:15 PM - 5:15 PM EST

Primary Author(s)

Christina M. Schumacher, PhD, MHS (she/her/hers)

Assistant Professor
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States

Co-Author(s)(s)

EG

Elizabeth Gilliams, MD, MSc

Medical Director for STI services
Baltimore City Health Department Sexual Health Clinics, United States
Matthew M. Hamill, MBChB, PhD

Assistant Professor of Medicine
Department of Medicine, The Johns Hopkins University
Baltimore, Maryland, United States

Background:
Since July 20, 2023, the CDC has recommended use of 14- and 28-day doxycycline regimens for syphilis treatment for non-pregnant people to preserve limited supplies of BPG. On July 26, 2023, the Baltimore sexual health clinics implemented protocols to prescribe doxycycline for syphilis management for non-pregnant people. The objectives were to determine syphilis treatment completion rates during vs. pre-BPG shortage and identify characteristics associated with doxycycline treatment completion.

Methods:
We reviewed sexual health clinic patients who underwent syphilis management between January 1 – December 31, 2023. Treatment completion was defined as documentation of one (for early syphilis/prophylactic treatment) or three (for late latent syphilis) 2.4 MU BPG injections or self-reported completion of prescribed doxycycline regimen. Chi-squared tests compared treatment completion rates across time periods (pre-shortage: January 1 – July 25, 2023; during-shortage: July 26 – December 31, 2023) and by demographic and clinical characteristics.

Results:
In 2023, 540 patients underwent syphilis management (pre-shortage: 294; during-shortage: 246). Across the two periods, patients did not differ significantly by demographics or syphilis stage. During-shortage, 81.3% (200/246) were prescribed doxycycline and 13.4% (33/246) BPG vs. 8.2% (24/294) prescribed doxycycline and 83.7% (246/294) BPG pre-shortage (p < 0.0001). Treatment completion was lower during- vs. pre-shortage (63.9% vs. 37.0%, p<0.0001). Among the 200 prescribed doxycycline during-shortage, treatment completion was confirmed for 35.0% (70/200), confirmed as not completed for 5.0% (10/200) and unknown for 60.0% (120/200). Confirmed doxycycline treatment completion was higher among those with early syphilis (53.4%, 31/58) compared to late syphilis (23.4%, 19/93) and those treated prophylactically (31.3%, 15/48) (p < 0.001), but did not differ by demographics, HIV status, or HIV/PrEP-care engagement.

Conclusion:
Documented syphilis treatment completion rates declined two-fold during vs. pre-BPG shortage period. Treatment completion was unknown for most patients prescribed doxycycline, necessitating additional follow-up. Monitoring for impacts of potential decreased syphilis treatment rates also is needed.