Syphilis resources for SF providers

There is currently a shortage of Bicillin.

During the shortage, healthcare providers and health systems have ways to procure Bicillin or its alternative Lentocilin, for patients who cannot take doxycycline:

1. Continue to try to purchase Bicillin L-A through your existing vendor

• Pfizer has noted they will continue to have releases of medication as it becomes available, including an anticipated limited supply release in Fourth Quarter 2026.

2. Purchase Lentocilin from Cost Plus Marketplace

• See the SFDPH Health Update on Bicillin Shortage for additional information on how to purchase Lentocilin from Cost Plus Marketplace.

3. Request Bicillin L-A from Pfizer

• A request is allowed if a healthcare facility treats patients with confirmed congenital syphilis or patients who are at risk of congenital syphilis and cannot procure Bicillin L-A due to the shortage.
• An authorized healthcare provider or pharmacy director must complete the Pfizer Medical Request Form.
• Requests can be made for 10-syringe packs and are not limited to one form per patient. A separate form is required for each additional 10-pack of Bicillin L-A.
• If expedited shipping is needed, select “Yes” on the form and approve the $25 handling fee; Pfizer has typically waived this fee.
• The authorized healthcare provider or pharmacy director identified in the authorization section must email the completed form from their own email address to PISupplyContinuity@pfizer.com.

4. Request Lentocilin from SFDPH starting fall 2026 (limited supply)

• SFDPH will have Lentocilin available for San Francisco health systems to request on a limited basis in the fall of 2026.
• Health systems may request Lentocilin if they are out or have very low supply of Bicillin L-A.
• For questions email sfprephcc@sfdph.org.

Shortage status updates

Update as of April 30, 2026:

• SFDPH Health Update: Penicillin G Benzathine (Bicillin L-A) Shortage Continues Through 4th Quarter of 2027
• Extencilline is no longer available for distribution. The Bicillin alternative currently available is Lentocilin.

Lentocilin administration

• Written guide
  • Lentocilin preparation and administration guide from the CDC
• Videos
  • NNPTC National Webinar: Bicillin L-A Shortage: Implementing Lentocilin
  • How to Reconstitute and Draw Up Lentocilin Safely
  • Bicillin-L-A Shortage - How to Reconstitute Lentocilin S

Related guidance

• CDC: STI Treatment Guidelines for Syphilis
• CDPH: Protocol for Adding Lidocaine to Bicillin L-A for Pain Management During Syphilis Treatment
• CDC: Guidance on priority actions following recall of specific lots of Bicillin L-A – July 2025
• CDPH: Guidance on alternative therapies for the treatment of syphilis in non-pregnant adults

California Department of Public Health (CDPH) Updates Syphilis Screening Recommendations

Published October 14, 2024 by the California Department of Public Health

Health Update: Expanded Syphilis Screening Recommendations and Resolution of Benzathine Penicillin G Shortage (PDF)

Published January 23, 2025 by the San Francisco Department of Public Health

Syphilis: A Review (JAMA)

2025 review of syphilis by experts at City Clinic and California Prevention and Training Center

CDC and CDPH Laboratory Recommendations for Syphilis Testing (PDF)

Includes how to interpret serologic test results

Prenatal Syphilis Screening, Staging, and Management for Congenital Syphilis Prevention (PDF)

Pocket card by the California Department of Public Health

Evaluating patients for primary syphilis (PDF)

Evaluation algorithm and guide by the California Prevention Training Center

Evaluating patients for secondary syphilis (PDF)

Evaluation algorithm and guide by the California Prevention Training Center

"That rash or sore might be syphilis" (PDF)

Printable poster created by the San Francisco Department of Public Health

Congenital syphilis FAQ: English (PDF)

Printable handout created by the San Francisco Department of Public Health

Congenital syphilis FAQ: Spanish (PDF)

Printable handout created by the San Francisco Department of Public Health

Congenital syphilis resources from the California Department of Public Health

Resources for providers and patients

Eliminating Congenital Syphilis in San Francisco, 2024-2027 Strategic Plan (PDF)

Highlights the strategies that the San Francisco Department of Public Health will employ between 2024 and 2027 to move toward elimination of congenital syphilis in San Francisco.