Syphilis and penicillin shortage: surveillance, pharmaceutical services and federal response (2014-2023)

Abstract Syphilis remains a significant sexually transmitted infection in Brazil, with benzathine penicillin (BPG) as the first-line treatment. In 2014, the country faced a global penicillin shortage, prompting a coordinated federal response, especially in light of rising congenital syphilis cases. This study conducted a documentary analysis of 37 official documents (price registration minutes, technical notes, ordinances, and decrees) to characterize strategies for procurement, price negotiation, and national and international cooperation. The analysis revealed a progressive increase in public procurement of penicillin after 2014 and growing integration between pharmaceutical services, surveillance, and care within the Brazilian Unified Health System (SUS). Federal pharmaceutical services and medicines management was central in overcoming shortages, ensuring BPG supply, and articulating surveillance and comprehensive care. The findings highlight pharmaceutical services as a structural component of the Brazilian response to syphilis, impacting case detection, care, and epidemiological surveillance.