Single-Source Headache

"It is very, very concerning to us to have supply of this drug run out, because we are in a period of resurgence of syphilis in many parts of Canada."
Dr. Ameeta Singh, infectious-disease specialist, national syphilis expert, Edmonton

"It's actually a really big deal. Right now, we're really concentrating on conserving our supplies."
Dr. Lynora Saxinger, infectious-disease specialist, University of Alberta

"The problematic element for me is that at a time when syphilis rates are increasing, having a more complicated treatment regime could make it harder to control."
"Now our hands are tied a bit more."
Dr. Vanessa Allen, Public Health Ontario

Syphilis: A sexually transmitted disease caused by Treponema pallidum, a microscopic organism called a spirochete. This worm-like, spiral-shaped organism infects people by burrowing into the moist mucous membranes of the mouth or genitals. From there, the spirochete produces a non-painful ulcer known as a chancre. There are three stages of syphilis:

• The first (primary) stage: This involves the formation of the chancre. At this stage, syphilis is highly contagious. The primary stage can last one to five weeks. The disease can be transmitted from any contact with one of the ulcers, which are teeming with spirochetes. If the ulcer is outside of the vagina or on the scrotum, the use of condoms may not help in preventing transmission. Likewise, if the ulcer is in the mouth, merely kissing the infected individual can spread syphilis. Even without treatment, the early infection resolves on its own in most women.

• The second (secondary) stage: However, 25 percent of cases will proceed to the secondary stage of syphilis, which lasts four to six weeks. This phase can include hair loss; a sore throat; white patches in the nose, mouth, and vagina; fever; headaches; and a skin rash. There can be lesions on the genitals that look like genital warts, but are caused by spirochetes rather than the wart virus. These wart-like lesions, as well as the skin rash, are highly contagious. The rash can occur on the palms of the hands, and the infection can be transmitted by casual contact.

• The third (tertiary) stage: This final stage of the disease involves the brain and heart, and is usually no longer contagious. At this point, however, the infection can cause extensive damage to the internal organs and the brain, and can lead to death.

While syphilis is no longer the major killer it was in the 1800s there has been a major resurgence of the disease beginning in 2001, after it had all but disappeared by the 1990s. Currently the per-capita rate has doubled in a ten-year span with the number of new cases spiralling to over three thousand annually in Canada.

The Public Health Agency recently posted guidelines on how to ration Bicillin, the major drug commonly utilized to treat the potentially deadly infection. It is a dreadful infection that impacted the lives of many people, including monarchs and musicians and all who fall between. Abraham Lincoln, William Shakespeare, Henry VIII, Ludwig van Beethoven, Napoleon Bonaparte, Leo Tolstoy and Christopher Columbus are all said to have suffered from syphilis.

Penicillin proved to be a godsend in saving peoples' lives, a solution that none of these famous figures from the past could take advantage of since it was discovered in the late 1920s and only made available in 1940. Now that syphilis is spreading in Canada it leaves physicians to struggle with a shortage of the drug Bicillin.

But it isn't just Bicillin that's in short supply, but over 800 drugs that have been difficult to obtain in the supply chain. According to Dr. Supriya Sharma, a senior medical advisor with Health Canada, a few "tier-three" shortages erupt annually, where shortages of specific drugs affect people's health. In Canada, perhaps short-sightedness is as much at fault as anything when Health Canada and the provinces have agreements with sole suppliers.

Just as a sexual revolution has taken place leading the public to become less fastidious about sex partners, unsafe sex is recognized as the major culprit. As is technology which has given us social-media sites where people can 'meet' on line, then meet again in person, and often meeting people whose sexual history is unknown. That, and men having sex with men.

There have also been instances reported where mothers have transmitted the bacteria to their newborns. The form of penicillin represented by Bicillin is administered by direct injection into the muscle. It has a long-lasting effect, generally needing only one shot, and the patient is cured. The alternative is an oral antibiotic to be taken twice daily for two weeks, but pregnant women cannot use them due to risk of birth defects.

Patients stay contagious longer with the oral doxycycline, and sex must be avoided for three weeks once the course of the oral antibiotic is complete.  For pregnant women unable to use Bicillin, the alternative is intravenous penicillin, administered every four to ten hours in a hospital setting. Before the Bicillin shortage, it was the epilepsy drug Epival.

A diminishing number of pharmaceutical companies globally commit to producing the active ingredients that go into these medications. And there is a growing reliance on countries like India and China for pharmaceutical supplies. Older, low-cost medicines are made by just a handful of generic producers. All these factors leave governments, trying to keep their drug costs as low as possible, susceptible to making decisions that rebound deleteriously.

penicillin g benzathine/penicillin g procaine - injection, Bicillin C-R

SIDE EFFECTS: Pain at the injection site, nausea, or vomiting may occur. If these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: severe pain/peeling skin at injection site, joint/muscle pain, headache, shortness of breath, dizziness, vision changes, fast/slow/pounding heartbeat, numbness/tingling of arms/legs, pain/redness/swelling of arms/legs, change in skin color near injection site or on arms/legs, uncontrolled movements, inability to move, change in the amount of urine, new signs of infection (e.g., fever, persistent sore throat), easy bruising/bleeding, extreme tiredness, dark/cloudy urine, seizures, mental/mood changes (e.g., depression, agitation).Get medical help right away if you have any very serious side effects, including: trouble breathing, chest pain, slurred speech, confusion, fainting.This medication may rarely cause a severe intestinal condition (Clostridium difficile-associated diarrhea) due to a type of resistant bacteria. This condition may occur during treatment or weeks to months after treatment has stopped. Do not use anti-diarrhea products or narcotic pain medications if you have any of the following symptoms because these products may make them worse. Tell your doctor right away if you develop: persistent diarrhea, abdominal or stomach pain/cramping, blood/mucus in your stool.Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.