Syphilis Continues to be an Important Public Health Priority in San Francisco

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Syphilis Continues to be an Important Public Health Priority in San Francisco

March 2022Syphilis among people who are or could become pregnant is of particular concern as it poses a risk for congenital syphilis. Congenital syphilis can lead to significant morbidity and mortality including stillbirth and neonatal death. There was a staggering 224% increase in cases of syphilis among cis-females from 2017 to 2021, with two cases of congenital syphilis reported in 2021, and two congenital cases to date in 2022. The SFDPH recommends screening according to citywide STI guidelines and ensuring treatment of patients and partners:

  1. Test all individuals who report methamphetamine use or are experiencing homelessness for syphilis, HIV, and HCV at least annually.
  2. All sexually active people who could become pregnant should receive at least one lifetime screen for syphilis, regardless of risk, and at the time of each HIV test.
  3. Test all pregnant people for syphilis at least twice during pregnancy: 1) at the first clinical encounter (ideally during the first trimester) and 2) during third trimester (ideally between 28-32 weeks gestation). Pregnant people should be tested again at delivery unless they have a negative test in the third trimester and no risk factors for syphilis.
  4. Treat clinically suspected or diagnosed syphilis immediately with penicillin (benzathine penicillin G [Bicillin LA] 2.4 mu IM) which is also the only therapy proven to be effective in pregnancy. Prophylactically treat patients who report a recent exposure to a partner diagnosed with syphilis.
  5. Refer sex partners for testing and treatment.
  6. Report all syphilis cases by faxing a confidential morbidity report to 628-217-6603

Important STI Prevention Numbers and Resources

  • Syphilis titer and treatment history & DPH LINCS partner services referrals: 628-217-6639
  • San Francisco City Clinic (SFCC) provider line for clinical questions: 628-217-6677
  • For DPH Epic Users, SFCC is now available on e-consult:  Submit an E-Consult to Sexually Transmitted Infection (STI): San Francisco City Clinic to obtain a patient’s syphilis history or for clinical guidance on STI diagnosis and management
  • Refer pregnant people experiencing homelessness, with active substance use disorders, or other barriers to care to ZSFG-based Team Lily: 415-802-7615 or email

The San Francisco Monthly STI Report ( for March is now available for viewing here

For the full monthly report this editorial appeared in, please visit Department of Public Health - Research, Health Assessments & Data ( webpage and scroll down to San Francisco Monthly STI Reports.