The mission of the STI Prevention Program is to intervene in the spread of sexually transmitted diseases (STIs) and reduce the complications of these diseases. The program provides technical and financial assistance to local STI programs for surveillance, case detection through screening, ensuring treatment of known cases, case follow-up, and education. Efforts are coordinated among health care providers to screen for syphilis, gonorrhea, and chlamydia. Other important aspects of this program include education and prevention counseling for persons impacted by STIs.
The STI Prevention Program seeks to engage community groups, partner agencies, and other stakeholders to decrease the disparity of STIs among vulnerable communities and populations. This includes improving health inequalities that exist among people with STIs, including categorial inequalities defined by the WHO as “demographically, economically, geographically, and socially disadvantaged.”
ALERT: Please review the following guidance regarding the Bicillin L-A Recall.
- Overview and Guidance
Overview:
- On July 10, King Pharmaceuticals LLC. (a subsidy of Pfizer), voluntarily recalled lots of Bicillin L-A (Penicillin G Benzathine Injectable Suspension), due to particulates identified during visual inspection. The impacted timeframe in which affected product lots were distributed was from Dec. 11, 2023, through June 24, 2025. To date, Pfizer has not received reports of any adverse events associated with this issue. Please refer to the above link for lot numbers, as well as product photos and labels for ease of identifying the impacted product.
- Pfizer issued a statement that same day regarding planning for patient care. Pfizer is anticipating a near-term stockout for Bicillin L-A due to this voluntary recall.
- The American Society of Health-System Pharmacists (ASHP) has updated its website with information regarding the products affected, reasons for the shortage, available products, estimated resupply dates, implications for patient care, and alternative agents and management.
The Indiana Department of Health (IDOH) is returning inventory that may be impacted by this voluntary recall. Please email Special Projects Manager Jeremy Roseberry if you have questions about this voluntary recall and anticipated near-term stockout.
What can you do?- Pfizer has provided guidance on how to check your current stock. If you have affected product lots, please discontinue use, stop distribution and quarantine the product immediately. Promptly return the product to Sedgwick; 2670 Executive Drive, Suite A; Indianapolis, IN 46241; Attn: Event 8637, or call Sedgwick at 800-805-3093. Affected product lots.
- Pfizer has implemented its Medical Request Process, effective immediately. The purpose of this process is to ensure that available inventory is distributed equitably to hospitals and clinics treating patients with the highest medical necessity, which, based on prior CDC guidance during Bicillin L-A shortages, is to prioritize product only for patients with confirmed congenital syphilis and risk of congenital syphilis. Please share this guidance with your provider networks.
- FOR IDOH PREVENTION PROGRAM GRANTEES ONLY: Please email Courtney Schaber, Jeremy Roseberry and Silva Tunio if you are running low on medication, and we will do our best to accommodate your needs. Please let us know how much medication you have on hand and your anticipated need, for consideration. Orders may be limited at this time.
Finally, the IDOH Prevention Program asks that providers do the following:
- Continue to follow the Centers for Disease Control and Prevention’s treatment recommendations for sexually-transmitted infections
- Prescribe Bicillin L-A as the only recommended treatment for pregnant women infected with or exposed to syphilis
- Consider prioritizing using Bicillin L-A to treat pregnant women and babies with congenital syphilis, if applicable. All other cases can be treated with doxycycline 100mg PO BID for two weeks (for early syphilis) or four weeks (for latent or syphilis of unknown duration)
Thank you for your continued partnership and dedication to the communities you serve. This page will be updated as we learn new information.
Fast Facts
- Many STIs are asymptomatic, meaning you can't tell you if have one without being tested. It's important to get tested regularly if you're sexually active.
- Latex condoms used the right way every time will greatly reduce your risk of getting an STI.
- If diagnosed with an STI, it's important to take all medication exactly as prescribed. You and any partners should wait 7 days after treatment before having sex again to avoid reinfection.
- Some STIs, like chlamydia and gonorrhea, can cause irreversible damage to the reproductive system if not treated.
Looking for a clinic near you? Check out our STI Clinics Map of agencies that partner with the IDOH STI Chlamydia/Gonorrhea (CT/GC) Prevention Program. Enter your zip code to find a testing facility close to you. A list of those CT/GC clinics can be found here. Additional agencies that do not participate in the CT/GC Prevention Program but provide STI services can be found here.
Your role in interrupting the chain of transmission for sexually transmitted diseases is vital to the health of Hoosiers. Many communities rely on urgent care or emergency room care for screening and treatment of STIs, and the Indiana Department of Health (IDOH) STI Prevention Program would like to provide your agency with the tools and materials to ensure exceptional sexual healthcare to Hoosiers in accordance with CDC’s recommendations. Your efforts in STI prevention and attention to detail are assisting clients with getting access to critical care in order to lower the disease burden among Indiana communities. Below are links to five resources for healthcare providers when managing the sexual healthcare of your patient:
- A Provider's Guide to Managing STIs
- Information for talking with Teens
- Additional Resources for Providers
- Role of Disease Intervention Specialists (DIS)
- STI/HIV Partner Services
Expedited Partner Therapy for Health Care Professionals in Indiana
Expedited Partner Therapy, or EPT, is the practice of treating sexual partners of patients diagnosed with an STI (specifically chlamydia and/or gonorrhea) without an intervening medical evaluation. This practice helps prevent re-infection of patients and is considered an effective partner management strategy. Prescribing treatment to partners is a protected activity under the Indiana Administrative Code. See the resources below for more information.
National and Statewide Increase in Syphilis Cases
Once on a trajectory for elimination in the United States, the rate of syphilis infection has been increasing every year since 2001. National rates of primary and secondary (P&S) stages of syphilis-- the most infectious stages-- have increased almost every year, increasing 28.6% during 2020–2021. Rates increased among both males and females, in all regions of the United States, and in all age groups. Rates of P&S syphilis increased in all racial/Hispanic ethnicity groups, with greatest increases among non-Hispanic American Indian or Alaska Native persons who also had the highest P&S syphilis rate in 2021.1 Indiana is at a record-high rate of P&S syphilis cases with 10.8 cases per 100,000 in 2021. Congenital syphilis cases have also increased at the state and national levels, which is a major public health concern. Indiana reported 20 cases of congenital syphilis (rate of 25.0 cases per 100,000 live births). The 2021 national congenital syphilis rate was 77.9 cases per 100,000 live birth, which was an 30.5% increase relative to 2020.1
Please use the documents at the links provided below for guidance on managing syphilis diagnosed in your patients.
- Syphilis Testing Reminders from the State Health Commissioner
- CDC Syphilis Pocket Guide for Providers
1. National Overview of STIs - https://www.cdc.gov/sti-statistics/about/index.html
The Centers for Disease Control and Prevention (CDC) provides guidelines for recommended courses of treatment for STIs. On July 23, 2021, the CDC released the newest treatment guidelines (2021). The links below include the most recently updated guidelines in a wall chart and a pocket guide, including the changes to the treatment of Neisseria gonorrhoeae infections in December 2020. The second link provides more details about the changes to the gonorrhea treatment guidelines.
Use the fact sheets provided here to learn more about STDs, how they are spread, and who is at risk. All resources are shown in English and Spanish. Resources in other languages are available on the CDC's website.
| Disease | English Version | Spanish Version |
|---|---|---|
| Chlamydia | English PDF | Spanish PDF |
| Gonorrhea | English PDF | Spanish PDF |
| Pelvic Inflammatory Disease (PID) | English PDF | Spanish PDF |
| Syphilis | English PDF | Spanish PDF |
| Congenital Syphilis | English PDF | Spanish PDF |
| Human Immunodeficiency Virus (HIV) | English PDF | Spanish PDF |
| Hepatitis B | English PDF | Spanish PDF |
| Hepatitis C | English PDF | Spanish PDF |
| Human Papillomavirus (HPV) | English PDF | Spanish PDF |
| STD Risk and Oral Sex | English link | Spanish link |
| Genital Herpes | English PDF | Spanish PDF |
| Trichomoniasis | English PDF | Spanish PDF |
| Bacterial Vaginosis | English PDF | Spanish PDF |
| STDs and HIV | English PDF | Spanish PDF |
| Gay, Bisexual, and Other Men who have Sex with Men (MSM) | English PDF | Spanish PDF |
| Shigellosis in MSM | English PDF | Spanish PDF |
- Sexually transmitted infections (STIs) caused by Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum are at an all-time high in the United States. Chlamydia, gonorrhea, and syphilis disproportionately affect gay, bisexual, and other men who have sex with men (MSM) and transgender women (TGW). DoxyPEP studies have been shown to reduce syphilis and chlamydia infections by >70% and gonococcal infections by approximately 50%.
- The Centers for Disease Control and Prevention (CDC) recommends DoxyPEP among MSM and TGW who have had a bacterial STI (specifically syphilis, chlamydia, or gonorrhea) diagnosed in the past 12 months.
- DoxyPEP should be combined with counseling that it may be used as PEP to prevent these infections. It should be implemented following shared decision-making between the patient and provider in the context of a comprehensive sexual health approach, including:
- Risk-reduction counseling
- STI screening and treatment
- CDC recommended vaccination(s)
- Linkage to HIV PrEP, HIV care, or other services as appropriate
- The Indiana Department of Health (IDOH) recommends that individuals prescribed DoxyPEP:
- Undergo bacterial STI testing at anatomic sites of exposure at baseline and every 3 to 6 months thereafter.
- Specifically, IDOH recommends that providers of recipients of DoxyPEP conduct syphilis screening using the reverse-sequence algorithm.
- Reassess ongoing need for DoxyPEP every 3 to 6 months.
- Additionally, IDOH recommends that HIV screening be performed for men who have sex with men and transgender women according to current recommendations.
- Undergo bacterial STI testing at anatomic sites of exposure at baseline and every 3 to 6 months thereafter.
For more information about DoxyPEP please click here.
Click here for IDOH’s adult and congenital syphilis toolkit.