HIV and Syphilis Updates for Virginia Providers

Dear Colleague:

This letter provides updates on Virginia’s recent HIV trends, testing recommendations, prevention measures, care resources, and an update to Virginia’s syphilis screening recommendations.

HIV Trends, Testing Recommendations, and Informational Resources

Virginia’s HIV surveillance trends indicate increases in HIV diagnoses in 2024 among:

  • Youth (15–19 years – all races/ethnicities)
  • Hispanic/Latino populations (all age groups)

HIV infections are rebounding after the COVID-19 pandemic. Please help us ensure HIV testing and prevention recommendations are reaching all patients who may benefit.

Please be aware of CDC’s current HIV testing guidelines and recommendations. Some important recommendations from the CDC STI Treatment Guidelines include:

  • Screen all pregnant women, including those in labor with unknown HIV status.
  • Screen all adolescents and adults aged 15–65 years, screen younger adolescents and older adults at risk.
  • Test for HIV all persons seeking sexually transmitted infection (STI) evaluation who are not already known to have HIV infection. Testing should be routine/opt-out, regardless of reported risk.
  • Screen higher-risk groups (sexually active gay, bisexual, and other men who have sex with men) at least annually. Work collaboratively to assess their individual risk and the benefits of more frequent screening (every 3–6 months).
  • Discuss prevention options like HIV Pre-Exposure Prophylaxis (PrEP) and Comprehensive Harm Reduction (CHR) with all sexually active patients. Consider doxycycline as post-exposure prophylaxis (DoxyPEP) to prevent bacterial STIs that increase the risk of HIV.

If you have patients who test positive for HIV and need care resources, the Virginia MedicationAssistance Program (VA MAP) provides HIV/other medications, assistance with insurance premiums, or medication co-payments, for low-income patients who meet eligibility requirements. Please visit our website to view the Ryan White Part B: Unified Eligibility Assessment locations by region.

Updated Syphilis Screening Guidelines

Syphilis diagnoses in Virginia and across the nation have reached historic heights. Over the past decade, cases among women have risen significantly, leading to a sharp increase in babies born with congenital syphilis.

VDH recently revised its syphilis screening recommendations for sexually active people aged 15–44 based on recent Virginia data. The guidelines now use rates of all stages of syphilis among women 15–44, instead of only primary and secondary cases.

Why the Change?

Congenital syphilis can occur from infection at any stage during pregnancy. In Virginia, most women are diagnosed in later stages — only 21% of cases in 2024 were early stages. Including all stages gives a more accurate picture of high-risk areas and ensures counties with congenital syphilis cases are not overlooked.

What This Means for Providers:

  • Continue screening all pregnant women for syphilis at first trimester, third trimester, and delivery, regardless of location.
  • Using the updated screening recommendations map
    • In counties/cities where the rate of syphilis of all stages among women aged 15–44 years was greater than 4.6 per 100,000 in 2024, offer syphilis testing to all sexually active people aged 15–44 years.
    • In counties/cities where the rate of syphilis of all stages among women aged 15–44 years was less than or equal to 4.6 per 100,000 in 2024, providers should continue to assess individual risk factors to determine testing needs as outlined in the CDC screening guidelines.
  • Consider point-of-care (POC) syphilis testing in settings where immediate results can improve timely treatment and reduce congenital syphilis risk (emergency rooms, urgent care, correctional facilities, substance use treatment programs, comprehensive harm reduction sites, rural areas, shelters).
  • Discuss doxycycline for STI prevention (DoxyPEP) with male patients who have female sexual partners and have been previously diagnosed with HIV or a bacterial STI, or who report multiple sexual partners in the past year.
  • Refer to the Virginia Syphilis resource page for more information.

Thank you for your continued partnership in keeping Virginians healthy.

Sincerely,

B. Cameron Webb, MD, JD

State Health Commissioner