Erroneous treatment of syphilis with benzyl penicillin in an era with benzathine benzylpenicillin shortages

The WHO estimates there are 5.6 million new cases of syphilis annually.1 The recommended choice of treatment for syphilis is 2.4 million units of benzathine benzylpenicillin (BBP), also called benzathine penicillin G, with no documented risk of antibiotic resistance. In 2015, the WHO began to receive country reports of BBP stock-outs.2 As with many off-patent drugs, the price competition of BBP is stiff. As a result, many manufacturers have discontinued production, and the stock-out risk has increased.3 From 2015 onwards, the Netherlands has been confronted with BBP stock-outs. At the STI clinic in Amsterdam, we were recently confronted with a treatment failure in a patient with syphilis who was treated with benzylpenicillin (BP) intramuscular injections …