WDH Provider Update – STI’s in Wyoming

 Wyoming Medical Society Newsletter 

Jan 5, 2024 

The Wyoming Department of Health (WDH) appreciates the opportunity to share information with providers about concerning trends in certain sexually transmitted infections. 

Syphilis cases, including congenital syphilis, are increasing nationwide and within our state. Wyoming has seen a 54% increase in reported syphilis cases from 2018 to 2022. In 2022, 65% of cases were male and 35% female, with an age range for cases of 16-65 years. In 2022, 68% were diagnosed in later stages of syphilis and 6.1% of cases were among pregnant women. 

Amidst this significant increase in transmission, there is a shortage of Penicillin G Benzathine injectable suspension products (Bicillin L-A), which is the first line treatment for syphilis and the only available treatment for certain individuals, including pregnant women. The Bicillin L-A shortage is expected to last until at least the second quarter of 2024. WDH asks providers to consider using doxycycline as an alternative to Bicillin L-A for certain persons diagnosed with or exposed to syphilis to help conserve Bicillin L-A for persons with no other treatment options. Recommendations for prioritizing Bicillin L-A were released in October 2023, and can be found here. WDH also asks providers to consider using antibiotics other than Bicillin L-A for other conditions such as group A streptococcal pharyngitis. 

WDH recommends syphilis testing for all sexually active individuals and for all pregnant women at the first prenatal visit AND repeat testing throughout pregnancy if the pregnant woman or partner(s) have other sexual partners, use injection or intranasal drugs, have unprofessional or homemade tattoos or piercings, or have other ongoing risks for syphilis transmission. 

Provisional 2023 data indicate HIV diagnoses have also increased across Wyoming. While WDH has typically seen between 12-15 new HIV diagnoses reported per year, 22 new diagnoses were reported in 2023, an increase of 69% over the 13 diagnoses reported in 2022. Of these new diagnoses, ages ranged from 24-77 years old (average age 40); 82% were male and 18% were female. Of the 22 new diagnoses, 8 (36%) identified as heterosexual while the remainder identified as LGBTQ+. Concerningly, of those patients with assessments completed prior to this notice, approximately 50% were at stage 3 (AIDS, CD4 < 200) of their infection at the time of their positive test, indicating late diagnoses. 

WDH recommends providers follow CDC Guidelines for HIV screening, including testing individuals aged 13-64 years at least once as part of routine healthcare and testing sexually active individuals at least once a year, at every STI clinic visit, or more often based on risk factors and clinical judgment. All pregnant women should be tested for HIV as part of routine screening, and testing throughout pregnancy is recommended if there are ongoing risks for HIV exposure. Individuals at substantial risk of acquiring HIV infection should be offered Pre-Exposure Prophylaxis if clinical criteria are met. Persons with a HIV exposure require Post-Exposure Prophylaxis within 72 hours of the exposure; medications should be initiated without delay upon presentation. The National Clinician Consultation Center offers free consultation services for management of potential exposures. 

The WDH Communicable Disease Unit offers partner services, linkage to care, free or reduced-cost STI testing, condom distribution, and HIV, TB, and STI medications for some patients. The Communicable Disease Unit is able to consult with providers on syphilis staging and treatment recommendations and linkage to services for individuals diagnosed with HIV. Please see our website, https://knowyo.org/, and https://wyprepmatters.com/ for more information.