Amid increasing STD infection in Washington, proposed law expands access to treatment of syphilis, other sexually transmitted infections

As syphilis cases rise across Washington state, a proposed law would increase access to treatment of the sexually transmitted disease.

Recently heard in the state’s Senate Committee on Health & Long Term Care, the bill would also increase access to STI treatment for the sexual partner of someone diagnosed with syphilis or another sexually transmitted disease.

The two proposals of the bill stem from a 2022 Department of Health report that made policy recommendations to the state legislature in how the state can combat sexually transmitted infections.

If passed, medical assistants would be permitted to administer penicillin in treating syphilis while under the telehealth supervision of a licensed health care practitioner.

According to the state report, physicians and registered nurses often do not have the staffing capacity to perform these injections when an area is faced with a syphilis outbreak.

“The barrier is staffing. Relatively few local health departments have RNs available to do this work or funding needed to support staffing, programming, and administration of these services. Hiring RNs is often difficult for public health jurisdictions due to staffing shortages and competition with hospitals and clinics,” the 2022 Department of Health report reads.

Speaking at a Senate committee hearing earlier this month, University of Washington infectious disease professor and the report’s main author, Matthew Golden, said the bill is essential to ensure those who are homeless or engage in substance abuse have access to treatment.

“Almost half of those babies with congenital syphilis involve miscarriages, fetal demise, or babies born with complications that can potentially lead to lifelong problems,” Golden said. “We need this legislation to make it easier to treat patients, and the legislation to allow our staff to treat people outside of clinics when there is no alternative.”

Under the proposed law, medical assistants in a given area must have received temporary authority from the Department of Health or a local health officer. These entities will grant this authority when the total rate of infection in the area exceeds 25% of what is typically observed.

Syphilis cases in Washington have risen dramatically in recent years. Between 2019 and 2021, syphilis infections rose by 49% across Washington. The rise of syphilis in Spokane County predates that of the state as a whole, increasing from 59 Spokane County cases in 2015 to a peak of 287 cases in 2019.

The rise of syphilis has become especially pronounced among heterosexual couples, which increases the risk of congenital syphilis in which the disease is passed to a child in the womb.

Approximately 20% of congenital cases result in a stillbirth or miscarriage, and there is an additional 9% chance that the infant will die within the first month of their life. Children who do survive are at risk of long-lasting symptoms.

“This is a set of illnesses that we have longstanding treatments to prevent it. And it’s just because people aren’t getting access to that treatment that we see this spread and unnecessary suffering,” bill sponsor Sen. Marko Liias, D-Edmonds, said at the hearing. “This is one of those cases where an ounce of prevention will provide more than a pound of cure to our society.”

The bill also authorizes health care providers to prescribe treatment to the sexual partner of any person diagnosed with a sexually transmitted infection without examining the patient’s sexual partner.

To provide the expedited therapy to the sexual partner, the patient must have engaged in sexual activity with their partner within a 60-day period immediately before their STI diagnosis, and they must conform that their partner is unable or unlikely to seek clinical services in a timely manner.

If following this criteria, the second dose of medication would be prescribed to the diagnosed patient, who would deliver the medication to their sexual partner or partners.

While legal in Washington state, the practice of expedited partner therapy is not a standard of care at many health care providers because they are held liable if the patient misuses the prescription or does not give the prescription to their sexual partner. If passed, this bill would clarify expedited partner therapy’s legality and ensure practitioners are not held liable.

“Some health care providers report fear of liability as a reason they do not practice expedited partner therapy. Health care providers and patients would benefit from legal clarity and liability shielding,” the Department of Health recommendation reads.