Funded sites will receive training and technical assistance to increase their capacity to provide treatment, linkage, and follow-up referrals. While the topics of syphilis/HIV/HCV will be covered in the webinars and Community of Practice, some initial resources on treatment requirements and best practice are located here: STI Treatment Guidelines (cdc.gov), Health & Human Services (HHS) Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV, and Recommendations for Testing, Managing, and Treating Hepatitis C.

If preliminary positive results return while the patient is still in the ED, the ED provider should disclose the results and, when appropriate, initiate empiric treatment. The provider should also consult the patient navigator to meet with the patient to begin the linkage to care process by assisting in scheduling follow-up appointments and making referrals before the patient is discharged.

Clinicians can offer treatment based on preliminary positive results and patient history while confirmatory tests are pending. A “test to treat” approach ensures that EDs can start treatment while linking patients to care. See the EDSP ‘Test to Treat: Syphilis, HIV, & HCV’ webinar for more information on the test-to-treat model for syphilis, HIV, and HCV.

It is reasonable to start syphilis treatment based on history and/or physical findings while awaiting confirmatory titers. Either begin the first dose of Benzathine Penicillin G (or the newly available Extencilline) or empiric Doxycycline (if patient is not pregnant) and determine in follow up if the patient needs three doses of penicillin or 28 days vs. 14 days of doxycycline.

Yes, it is acceptable to have patients return to the ED for follow-up syphilis treatment. EDs should create standard operating procedures that ensure streamlined linkage to care. Among those who experience barriers accessing routine primary care, EDs often serve as the sole point of contact with the health care system. As such, patients may return to the ED to receive follow-up treatment.

See EDSP Clinical Resources, Patient Navigation Resources and EDSP Culturally Responsive and Trauma-Informed Care, working with people with significant barriers to care.

Penicillin is the only recommended treatment for syphilis during pregnancy. Pregnant patients who test positive for syphilis and have a history of a true allergic reaction to penicillin should be admitted to the hospital for penicillin desensitization¹.

Once desensitized, the patient can complete penicillin syphilis treatment. It is critical that patients who test positive for syphilis during their pregnancy complete syphilis treatment while pregnant to prevent maternal to child transmission and congenital syphilis.

For more information on prenatal syphilis screening, staging, treatment, and monitoring for congenital syphilis prevention please review this resource from CDPH. Additional details on the evaluation and diagnosis of penicillin allergies can be found in this resource from CDC.

EDs can reach out to their local Medical Health Operational Area Coordinator (MHOAC) to order TPOXX through the state warehouse. See CDC guidance on obtaining and using TPOXX for the required forms and documentation. For more information on prescribing or accessing tecovirimat for your patients, please contact your health department (LHD) or submit an inquiry to CDPH.

Mpox vaccination with JYNNEOS (2-dose series) reduces the risk of severe illness, hospitalization and death. The vaccine is available to anyone who requests it. However, people in high-risk groups for exposure should be offered mpox vaccination, including people with HIV. Recent mpox infections have occurred in people that were previously vaccinated, and it is important to note this is possible. However, studies have shown that persons who receive vaccination are less likely to be hospitalized with mpox. Second doses confer a strong benefit and efforts should be made to bring in individuals for their second dose. The second dose is ideally given 28 days after the first dose, but can be given any time after 28 days without restarting the series. 

Persons exposed to mpox can receive vaccination up to 14 days after exposure to reduce the risk of infection (i.e., post-exposure prophylaxis). Vaccine appointments can be scheduled through LHDs, via on-line locators such as My Turn, or through regular health care providers. Providers can request JYNNEOS vaccine in myCAvax. Providers who do not have a myCAvax account and want to administer vaccine should contact their LHD.

See EDSP Resources, Clinical Resources, MPOX section.