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When Stephen Miller left his primary care practice to work in public health a little under two years ago, he said, he was shocked by how many cases of syphilis the clinic was treating.

This story also ran on WPLN. It can be republished for free.

For decades, rates of the sexually transmitted infection were low. But the Hamilton County Health Department in Chattanooga a midsize city surrounded by national forests and nestled into the Appalachian foothills of Tennessee was seeing several syphilis patients a day, Miller said. A nurse who had worked at the clinic for decades told Miller the wave of patients was a radical change from the norm.

What Miller observed in Chattanooga is reflective of a trend that is raising alarm bells for health departments across the country.

Nationwide, syphilis rates are at a 70-year high. The Centers for Disease Control and Prevention said Jan. 30 that 207,255 cases were reported in 2022, continuing a steep increase over five years. Between 2018 and 2022, syphilis rates rose about 80%. The epidemic of sexually transmitted infections especially syphilis is out of control, said the National Coalition of STD Directors.

The surge has been even more pronounced in Tennessee, where infection rates for the first two stages of syphilis grew 86% between 2017 and 2021.

But this already difficult situation was complicated last spring by a shortage of a specific penicillin injection that is the go-to treatment for syphilis. The ongoing shortage is so severe that public health agencies have recommended that providers ration the drug prioritizing pregnant patients, since it is the only syphilis treatment considered safe for them. Congenital syphilis, which happens when the mom spreads the disease to the fetus, can cause birth defects, miscarriages, and stillbirths. Email Sign-Up

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Across the country, 3,755 cases of congenital syphilis were reported to the CDC in 2022 thats 10 times as high as the number a decade before, the recent data shows. Of those cases, 231 resulted in stillbirth and 51 led to infant death. The number of cases in babies swelled by 183% between 2018 and 2022.

Lack of timely testing and adequate treatment during pregnancy contributed to 88% of cases of congenital syphilis, said a report from the CDC released in November. Testing and treatment gaps were present in the majority of cases across all races, ethnicities, and U.S. Census Bureau regions.

Hamilton Countys syphilis rates have mirrored the national trend, with an increase in cases for all groups, including infants.

In November, the maternal and infant health advocacy organization March of Dimes released its annual report on states health outcomes. It found that, nationwide, about 15.5% of pregnant people received care beginning in the fifth month of pregnancy or later or attended fewer than half the recommended prenatal visits. In Tennessee, the rate was even worse, 17.4%.

But Miller said even those who attend every recommended appointment can run into problems because providers are required to test for syphilis only at the beginning of a pregnancy. The idea is that if you test a few weeks before birth, there is time to treat the infection.

However, that recommendation hinges on whether the provider suspects the patient was exposed to the bacterium that causes syphilis, which may not be obvious for people who say their relationships are monogamous.

What we found is, a lot of times their partner was not as monogamous, and they were bringing it into the relationship, Miller said.

Even if the patient tested negative initially, they may have contracted syphilis later in pregnancy, when testing for the disease is not routine, he said.

Two antibiotics are used to treat syphilis, the injectable penicillin and an oral drug called doxycycline.

Patients allergic to penicillin are often prescribed the oral antibiotic. But the World Health Organization strongly advises pregnant patients to avoid doxycycline because it can cause severe bone and teeth deformities in the infant.

As a result, pregnant syphilis patients are often given penicillin, even when theyre allergic, using a technique called desensitization, said Mark Turrentine, a Houston OB-GYN. Patients are given low doses in a hospital setting to help their bodies get used to the drug and to check for a severe reaction. The penicillin shot is a one-and-done technique, unlike an antibiotic, which requires sticking to a two-week regimen.

It’s tough to take a medication for a long period of time, Turrentine said. The single injection can provide patients and their clinicians peace of mind. If they don’t come back for whatever reason, you’re not worried about it, he said.

The Metro Public Health Department in Nashville, Tennessee, began giving all nonpregnant adults with syphilis the oral antibiotic in July, said Laura Varnier, nursing and clinical director.

Turrentine said he started seeing advisories about the injectable penicillin shortage in April, around the time the antibiotic amoxicillin became difficult to find and physicians were using penicillin as a substitute, potentially precipitating the shortage, he said.

The rise in syphilis has created demand for the injection that manufacturer Pfizer cant keep up with, according to the American Society of Health-System Pharmacists. There is insufficient supply for usual ordering, the ASHP said in a memo.

Even though penicillin has been around a long time, manufacturing it is difficult, largely because so many people are allergic, said Erin Fox, associate chief pharmacy officer for the University of Utah health system and an adjunct professor at the university, who studies drug shortages.

That means you can’t make other drugs on that manufacturing line, she said. Only major manufacturers like Pfizer have the resources to build and operate such a specialized, cordoned-off facility. It’s not necessarily efficient or necessarily profitable, Fox said.

In a statement, Pfizer confirmed the amoxicillin shortage and surge in syphilis increased demand for injectable penicillin by about 70%. Representatives said the company invested $38 million in the facility that produces this form of penicillin, hiring more staff and expanding the production line.

This ramp up will take some time to be felt in the market, as product cycle time is 3-6 months from when product is manufactured to when it is available to be released to customers, the statement reads. The company estimated the shortage would be significantly alleviated by spring.

In the meantime, Miller said, his clinic in Chattanooga is continuing to strategize. Each dose of injectable penicillin can cost hundreds of dollars. Plus, it has to be placed in cold storage, and it expires after 48 months.

Even with the dramatic increase in cases, syphilis is still relatively rare. More than 7 million people live in Tennessee, and in 2019, providers statewide reported 683 cases of syphilis.

Health departments like Millers treat the bulk of syphilis patients. Many patients are sent by their provider to the health department, which works with contact tracers to identify and notify sexual partners who might be affected and tests patients for other sexually transmitted infections, including HIV.

When you diagnose in the office, think of it as just seeing the tip of the iceberg, Miller said. You need a team of individuals to be able to explore and look at the rest of the iceberg.

This story is part of a partnership that includes WPLN, NPR, and KFF Health News.

Catherine Sweeney, WPLN: csweeney@wpln.org, @CathJSweeney Related Topics Pharmaceuticals Public Health States CDC Sxual Health Tennessee Contact Us Submit a Story Tip

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The anniversary of George Floyd’s murder is a reminder of America’s racial divides

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The anniversary of George Floyd's murder is a reminder of America's racial divides

In Minneapolis, the spot where George Floyd was murdered has been turned into a mural.

His face is depicted in street art on a pavement covered in flowers, rosaries, and other trinkets left by people who have come to pay their respects in the last five years.

His final moments, struggling for breath with white police officer Derek Chauvin’s knee on his neck, were captured in a viral video that provoked anger, upset, and outrage.

Derek Chauvin kneeling on George Floyd's neck
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Derek Chauvin kneeling on George Floyd’s neck

In Minneapolis and other parts of America, there were protests that at points boiled over into unrest.

The events to mark the fifth anniversary of his death took on a very different tone – one of celebration and joy.

Behind a wooden statue of a clenched fist on one end of a junction now renamed George Perry Floyd Square, people gathered in the morning.

There was a moment of prayer before a brass band began to play and the group marched, while singing and chanting.

George Perry Floyd Square, a makeshift memorial area
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George Perry Floyd Square, a makeshift memorial area

‘It made us want to fight harder’

Among those gathered in front of a makeshift stage built in the square were two of Floyd’s family members – his cousin Paris and aunt Mahalia.

To them, the man whose death sparked a racial reckoning in America and further afield, was simply “Perry,” a larger-than-life figure whose presence is missed at family gatherings.

Speaking to me while the speakers behind them thumped and people danced, they didn’t just reflect with sadness though.

There was also pride at a legacy they felt has led to change.

“It made us want to fight harder,” said Mahalia, “and it’s a feeling you cannot explain. When the whole world just stood up.”

George Floyd's aunt Mahalia and cousin Paris
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George Floyd’s aunt Mahalia and cousin Paris

Referring to Chauvin’s eventual murder charge, Paris added: “I think that from here on out, at least officers know that you’re not going to slide through the cracks. Our voices are heard more.”

The tapestry of items outside the Cup Foods convenience store, now renamed Unity Foods, is not the only makeshift memorial in the area.

A short walk away is the “Say Their Names” cemetery, an art installation honouring black people killed by the police.

Meeting me there later in the day, activist Nikema Levy says the installation and George Floyd Square are called “sacred spaces” in the community.

As someone who took to the streets at the time of Floyd’s death and a community organiser for years before that, she’s constantly stopped by people who want to speak to her.

Activist Nikema Levy speaking to Sky News
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Activist Nikema Levy speaking to Sky News

‘White supremacy on steroids’

Once we do manage to speak, Levy reminds me of a wider political picture. One that goes beyond Minneapolis and is a fraught one.

In the week of the anniversary, the US Department of Justice rolled back investigations into some of the largest police forces in the country, including in Minneapolis – a move she calls “diabolical.”

“That type of cruelty is what we have seen since Donald Trump took office on January 20th of this year,” she continued.

“From my perspective, that is white supremacy on steroids. And it should come as no surprise that he would take these types of steps, because these are the things that he talked about on the campaign trail.”

Read more from Sky News:
US-EU trade war fears reignite
Arsenal secure historic Champions League crown
Scientists are on the hunt for dolphin poo

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Has US changed five years after George Floyd’s death?

‘True healing has never taken place’

Trump has argued his policing reforms will help make America’s communities safer.

Even on a day of optimism, with a community coming together, Levy’s words in front of headstones bearing the names of black people who have died at the hands of the police are a reminder of how deep the racial divides in America still are – a sentiment she leaves me with.

“From the days of slavery and Jim Crow in this country, we’ve just had the perception of healing, but true healing has never taken place,” she says.

“So the aftermath of George Floyd is yet another example of what we already know.”

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Panthers one game away from another Cup Final: Grades, biggest takeaways from Game 3

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Panthers one game away from another Cup Final: Grades, biggest takeaways from Game 3

One team is a win away from advancing to a third straight Stanley Cup Final. The other is about to once again come up short in a conference final. As drastic as that sounds, that is the reality facing the Florida Panthers and Carolina Hurricanes following the Panthers’ 6-2 win Saturday in Game 3 of the Eastern Conference finals.

The defending Stanley Cup champion Panthers opened the series by scoring five goals in each of the first two games and exposing the Hurricanes in a way that hadn’t been done by another team this postseason. On Saturday, it appeared that the Canes may have found a solution as they entered the third period tied at 1-1 … before the Panthers exploded for five straight goals to close out Game 3 in emphatic fashion.

How did both teams perform? Who is worth watching in Game 4? And given that there’s a sweep in play, what could Monday mean for both teams, knowing that one of them could see their season come to an end? Ryan S. Clark and Kristen Shilton answer those questions while reviewing what has been a lopsided Eastern Conference finals.

The Panthers withstood an expected early push from Carolina and settled swiftly into their own game. They failed to capitalize on their first-period power-play chance but made up for it by opening the scoring with a goal credited to Niko Mikkola (that actually went off Carolina’s Dmitry Orlov) midway through the first. It was a deflating marker for Carolina goalie Pyotr Kochetkov to cede right after a solid Hurricanes penalty kill and appeared to diminish Carolina’s confidence.

There was potential to shift Carolina’s momentum, though. Before the first period ended, Panthers forward Eetu Luostarinen finished a check sending Jackson Blake awkwardly into the boards. That earned Luostarinen a five-minute penalty and game misconduct, putting the Panthers down two of their top forwards in Luostarinen and an injured Sam Reinhart. But Florida didn’t let the lengthy man advantage hurt its momentum. The Panthers killed it off and matched Carolina’s shot total while shorthanded.

While the score was tied at 1-1 going into the third, Florida regained its lead with Jesper Boqvist undressing (to put it mildly) Orlov in shocking fashion. Boqvist entered the lineup to replace Reinhart, and it was the type of contribution Florida could only hope to see from its depth skater.

It was all Panthers from there, with goals from Mikkola, Aleksander Barkov (capitalizing on a turnover by Orlov), Evan Rodrigues and Brad Marchand giving Florida a 6-1 lead halfway through the third and putting Carolina against the ropes going into an elimination Game 4. Florida will wonder about Mikkola’s status ahead of that tilt. (He left in the third period Saturday after slamming into the end boards.) But the Cats can’t be too frustrated given their win. — Kristen Shilton

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0:53

Jesper Boqvist puts Panthers back ahead

Jesper Boqvist goes through the goaltender’s legs to restore the Panthers’ lead vs. the Hurricanes.

Unofficial Canadian poet laureate Avril Lavigne once posed one of more philosophical questions of her generation: Why’d you have to go and make things so complicated?

Everything the Hurricanes did through the first two periods of Game 3 created the belief that they could potentially stick with the Panthers. Only to then fall apart in the third period. Again.

There are numerous reasons why losing Game 3 is so damning for the Hurricanes. What might be the most prominent and prevalent is there might not be anything else they can do at this stage. We have seen the Panthers take a 3-0 series lead only to be pushed to a Game 7 in a playoff series. That was the case in last year’s Stanley Cup Final against the Edmonton Oilers.

But through three games of this series? The Hurricanes have switched goaltenders, adjusted their lineups and sought out other alterations within their structure — and still lost by a large margin while once again falling prey to being on the other end of a big period. — Ryan S. Clark


Three Stars of Game 3

Mikkola has had quite a series. The defensemen has broken up plays, taken command off the rush and created quality scoring chances. He had two goals in Game 3 for his first career multigoal playoff game and the fourth multigoal playoff game in Panthers franchise history.

It was two goals and a helper for the Cats’ captain. This was Barkov’s 20th career multipoint playoff game, the most in Panthers franchise history.

3. The Panthers’ third period

The Panthers unloaded in the final frame, scoring five goals to run away with Game 3 by a final score of 6-2. Five tucks is the most in any period in a playoff game in franchise history. The Hurricanes have now lost 15 straight conference final games since they won the Stanley Cup in 2006. — Arda Öcal

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0:44

Panthers pour it on with 2 more quick goals

The Panthers net two more goals in just over a minute to pad their lead vs. the Hurricanes.


Players to watch in Game 4

There’s no question Florida’s netminder has been building a Conn Smythe case with his excellent play in this postseason. However, Bobrovsky hasn’t been at his most dominant in (initial) closeout games during the playoffs. He made 26 saves for an .897 save percentage in Florida’s Game 5 win over Tampa Bay to send the Lightning home, and made just 15 stops (.882 SV%) in Florida’s Game 6 loss to Toronto in the second round, when the Panthers had a chance to advance.

Bobrovsky was practically impenetrable in Game 7 of that series as the Leafs imploded, but it’s fair to wonder what version of Bobrovsky the Panthers will get in Game 4.

When Florida had an opportunity to close out Edmonton in Game 4 of the Stanley Cup Final last spring, Bobrovsky turned in his worst showing of the playoffs, with five goals allowed on 11 shots that saw him chased from the net in an 8-1 thumping. Florida has put itself in a good position to send Carolina home, but wouldn’t it be nice to do it sooner than later? Bobrovsky at his best will help Florida do just that. — Shilton

Benching Frederik Andersen was done with the belief that Kochetkov could give the Hurricanes a stronger chance to win. Through two periods, it appeared that that could be the case, as Kochetkov received the necessary support from the Hurricanes’ defensive structure, something that had been an issue in the first two games.

But the Panthers’ five consecutive goals in the third period derailed things. The Hurricanes have now allowed 16 goals over three games. It’s a stark contrast to the first two rounds, when Carolina allowed 18 total in 10 games against the Devils and Capitals.

Kochetkov’s first two periods of Game 3 provided a level of consistency the Hurricanes have struggled to find at times. Is it possible they take something from the opening two-thirds of Game 3 and parlay it into a different outcome in Game 4? Or will it be game and season over instead? — Clark


Big questions for Game 4

Is Florida ready to end this series?

The cliché that the fourth win of a playoff series is the hardest to get exists for a reason. The Panthers experienced that firsthand last season when they took a 3-0 lead over Edmonton in the Stanley Cup Final, then crisscrossed the continent over the next week as the Oilers clawed back to force a Game 7.

Did the Panthers learn their lesson on how to close an opponent out quickly? Florida did it to these very Hurricanes in the Eastern Conference finals two years ago with a tidy four-game sweep featuring many of the same elements we’ve seen from the Panthers in this round. But Florida appeared to have Edmonton well in hand 11 months ago, too.

Game 3 was arguably the Hurricanes’ best of the series. If they can channel some significant desperation into their game Monday, how will Florida handle the pressure of an urgent club trying not to be embarrassed with a 16th consecutive loss in a conference final situation? The Panthers can’t afford to look past what will be a dramatic Game 4. — Shilton

Is this it for the Hurricanes — and what comes next if it is?

That in and of itself is a rather loaded question for several reasons, with the obvious being: Will Monday be Carolina’s last game of the 2025 playoffs? If it is, what could that mean for the franchise going forward?

The way the Hurricanes have been constructed has allowed them to become a perennial playoff team with a legitimate chance of reaching the conference finals. But that comes with the caveat that the Canes might not go any further than that.

It was a dilemma the Panthers faced before making the changes that saw them not only win a Stanley Cup, but also be one win away from a third consecutive Stanley Cup Final. Maybe it doesn’t come to that point for the Hurricanes. But if they allow five or more goals for a fourth straight game while also struggling to score? It could lead to some difficult questions this offseason in Raleigh. — Clark

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Up 3-0, Panthers will not ‘start looking ahead’

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Up 3-0, Panthers will not 'start looking ahead'

SUNRISE, Fla. — The Florida Panthers are one win away from an Eastern Conference finals sweep. They’ve outscored the Carolina Hurricanes, a team that’s lost 15 straight conference final games, by a count of 16-4. Yet Panthers forward Brad Marchand is still ready for this series to go the distance.

“We’re prepared to go seven here,” he said after their 6-2 victory in Game 3 on Saturday night. “I mean, you can’t start looking ahead. That’s such a dangerous game to play.”

Contextually, that mindset might seem preposterous. The Panthers are trying to match the Tampa Bay Lightning as the only teams since the Edmonton Oilers’ 1980s dynasty to advance to the Stanley Cup Final in three straight seasons, having won the Cup last season. They’ve dominated the Hurricanes with their physicality, scoring depth and the goaltending of Sergei Bobrovsky, who now has a .947 save percentage and a 1.33 goals-against average in the conference finals.

It seems like a matter of when, not if, Florida will eliminate Carolina — and the “when” is trending to be Monday night at home in Game 4. Yet the Panthers are the last team to take a 3-0 lead for granted.

Coach Paul Maurice recalled their semifinals series against the Toronto Maple Leafs in 2023, when they went up 3-0 and dropped a Game 4 on home ice. “We wanted it so bad that we tried to win the game on every play,” he said.

Then came the ultimate lesson on how not to close out a series: The 2024 Stanley Cup Final, which saw the Panthers squander a 3-0 series lead to the Edmonton Oilers before finally winning Game 7 to hoist the Cup for the first time.

Maurice hopes his players understand the dynamics at play in Game 4.

“They have the desperation advantage. You have, potentially, the desire advantage. Both teams will fight that. Can we control the desire emotion and play the game? Can they control the desperation emotion and play the game? The common denominator is just playing the game,” he said.

Game 3 saw the Hurricanes play with more desperation than they’ve exhibited in this series. The game was tied 1-1 entering the third period after Carolina’s Logan Stankoven — who Bobrovsky robbed earlier in the second period with a lunging blocker save — managed to knock the puck past him for a power-play goal at 14:51 to even the score.

The Hurricanes were finally looking like the stingy, tight-checking team they’re known for being. Maurice wasn’t expecting a windfall of offense from the Panthers after the first 40 minutes of Game 3.

“We’re not going out to the third period saying, ‘Well, we can tell this is going to work out [for us]. I’ve got an extra piece of gum in my pocket for the second overtime. That’s how our experience with Carolina has been,” the coach said.

The gum stayed in his pocket. Florida scored five goals in the first 10:37 of the third period to put the game — and potentially the series — away.

“We knew we needed to be a little better than what we were in the second period, so we tried to keep things simple and I think we got rewarded for that,” said captain Aleksander Barkov, who had two of the goals in the onslaught.

Carolina coach Rod Brind’Amour was left dumbfounded.

“We’re playing better and then we just turn pucks over. It’s not what we do. I think everyone’s just pretty surprised, you know what I mean?” he said. “Just you can’t do that. In a preseason game it’s going to cost you. But against that team, and you turn it over for odd man rushes? Forget it.”

The key to the rally was a goal by forward Jesper Boqvist, who was put on Barkov’s line as an injury replacement for Sam Reinhart, the Panthers’ leading scorer in the regular season. He took a short pass from linemate Evan Rodrigues and then turned Carolina defenseman Dmitry Orlov (minus-4) inside out before scoring on the backhand against Pyotr Kochetkov (22 saves), who got the start over Frederik Andersen in Game 3 for Carolina.

Boqvist had just one goal and one assist in 9 playoff games this postseason, averaging 8:53 in ice time. In Game 3, he had three points (1 goal, 2 assists) and skated 15:08 for the Panthers.

“He’s an extremely gifted player. I love playing with him. He can kind of play anywhere in the lineup and he’s such an incredible skater. So strong with the puck, so smart. And that was a massive goal,” Marchand said.

The Panthers won Game 3 without Reinhart and without having forward Eetu Luostarinen for most of the game, after he was ejected for boarding Carolina forward Jackson Blake in the first period. Luostarinen was tied for the team lead with 13 points entering Game 3, with 4 goals and 9 assists.

The Panthers would kill off that 5-minute major in what Maurice called “a real inflection point in the game,” considering that Florida was missing key penalty killers in Luostarinen and Reinhart, who is day-to-day with a lower body injury. When they needed him, Bobrovsky (23 saves) was a great last line of defense.

Thanks to their third-period deluge, the Panthers are now poised to sweep the Hurricanes in the conference final for the second time in three postseasons. Yet even with Florida’s domination of the series, Marchand said his team is anything but overconfident.

“I don’t think the way the games have been played is really an indication of what the outcome’s been, score wise. They’ve been pretty tight. It just seems like we’ve gotten a couple bounces, a couple lucky breaks here and there that have given us a pretty good lead,” he said.

“But it doesn’t matter. It’s not going to change anything about next game. We’ve got to come in and prepare the same way. It’s always the toughest one to get, so we got to make sure we bring our best.”

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