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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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Politics

‘A threat to national security’: Fears drones could be used to lift inmates out of prisons

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Drones are sending 'overwhelming amounts' of drugs into prisons - and could help inmates escape, report warns

Sophisticated drones sending “overwhelming amounts” of drugs and weapons into prisons represent a threat to national security, according to an annual inspection report by the prisons watchdog.

HMP chief inspector of prisons Charlie Taylor has warned criminal gangs are targeting jails and making huge profits selling contraband to a “vulnerable and bored” prison population.

The watchdog boss reiterated his concerns about drones making regular deliveries to two Category A jails, HMP Long Lartin and HMP Manchester, which hold “the most dangerous men in the country”, including terrorists.

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Ex-convict: Prison is ‘birthing bigger criminals’

Mr Taylor said “the police and prison service have in effect ceded the airspace” above these two high-security prisons, which he said was compromising the “safety of staff, prisoners, and ultimately that of the public”.

“The possibility now whereby we’re seeing packages of up to 10kg brought in by serious organised crime means that in some prisons there is now a menu of drugs available,” he said. “Anything from steroids to cannabis, to things like spice and cocaine.”

“Drone technology is moving fast… there is a level of risk that’s posed by drones that I think is different from what we’ve seen in the past,” warned the chief inspector – who also said there’s a “theoretical risk” that a prisoner could escape by being carried out of a jail by a drone.

He urged the prison service to “get a grip” of the issue, stating: “We’d like to see the government, security services, coming together, using technology, using intelligence, so that this risk doesn’t materialise.”

The report highlights disrepair at prisons around the country
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The report highlights disrepair at prisons around the country

The report makes clear that physical security – such as netting, windows and CCTV – is “inadequate” in some jails, including Manchester, with “inexperienced staff” being “manipulated”.

Mr Taylor said there are “basic” measures which could help prevent the use of drones, such as mowing the lawn, “so we don’t get packages disguised as things like astro turf”.

Responding to the report, the Prison Advice and Care Trust (PACT) said: “The ready access to drugs is deeply worrying and is undermining efforts to create places of rehabilitation.”

Mr Taylor’s report found that overcrowding continues to be what he described as a “major issue”, with increasing levels of violence against staff and between prisoners, combined with a lack of purposeful activity.

Some 20% of adult men responding to prisoner surveys said they felt unsafe at the time of the inspection, increasing to 30% in the high security estate.

Andrea Coomber, chief executive of the Howard League for Penal Reform, said: “This report is a checklist for all the reasons the government must prioritise reducing prison numbers, urgently.

“Sentencing reform is essential, and sensible steps to reduce the prison population would save lives.”

Read more UK news:
The human impact of the Post Office scandal
Govt to ban ‘appalling’ NDAs that silence victims

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May: Male prison capacity running at 99%

The report comes after the government pledged to accept most of the recommendations proposed in the independent review of sentencing policy, with the aim of freeing up around 9,500 spaces.

Those measures won’t come into effect until spring 2026.

Prisons Minister Lord Timpson said Mr Taylor’s findings show “the scale of the crisis” the government “inherited”, with “prisons dangerously full, rife with drugs and violence”.

He said: “After just 500 prison places added in 14 years, we’re building 14,000 extra – with 2,400 already delivered – and reforming sentencing to ensure we never run out of space again.

“We’re also investing £40m to bolster security, alongside stepping up cooperation with police to combat drones and stop the contraband which fuels violence behind bars.”

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World

Israeli soldiers ‘psychologically broken’ after ‘confronting the reality’ in Gaza, UN expert says

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Israeli soldiers 'psychologically broken' after 'confronting the reality' in Gaza, UN expert says

A UN expert has said some young soldiers in the Israeli Defence Forces are being left “psychologically broken” after “confront[ing] the reality among the rubble” when serving in Gaza.

Francesca Albanese, the UN Human Rights Council’s special rapporteur on the occupied Palestinian territories, was responding to a Sky News interview with an Israeli solider who described arbitrary killing of civilians in Gaza.

She told The World with Yalda Hakim that “many” of the young people fighting in Gaza are “haunted by what they have seen, what they have done”.

“It doesn’t make sense,” Ms Albanese said. “This is not a war, this is an assault against civilians and this is producing a fracture in many of them.

“As that soldier’s testimony reveals, especially the youngest among the soldiers have been convinced this is a form of patriotism, of defending Israel and Israeli society against this opaque but very hard felt enemy, which is Hamas.

“But the thing is that they’ve come to confront the reality among the rubble of Gaza.”

An Israeli soldier directs a tank at a staging area near the border with the Gaza Strip, in southern Israel, Tuesday, July 1, 2025. (AP Photo/Ariel Schalit)
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An Israeli soldier directs a tank near the border with the Gaza Strip, in southern Israel. Pic: AP

Being in Gaza is “probably this is the first time the Israeli soldiers are awakening to this,” she added. “And they don’t make sense of this because their attachment to being part of the IDF, which is embedded in their national ideology, is too strong.

More on War In Gaza

“This is why they are psychologically broken.”

Jonathan Conricus, a former IDF spokesman who is now a senior fellow at the Foundation for Defence of Democracies, said he believes the Sky News interview with the former IDF solider “reflects one part of how ugly, difficult and horrible fighting in a densely populated, urban terrain is”.

“I think [the ex-soldier] is reflecting on how difficult it is to fight in such an area and what the challenges are on the battlefield,” he said.

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Ex-IDF spokesperson: ‘No distinction between military and civilians’

‘An economy of genocide’

Ms Albanese, one of dozens of independent UN-mandated experts, also said her most recent report for the human rights council has identified “an economy of genocide” in Israel.

The system, she told Hakim, is made up of more than 60 private sector companies “that have become enmeshed in the economy of occupation […] that have Israel displace the Palestinians and replace them with settlers, settlements and infrastructure Israel runs.”

Israel has rejected allegations of genocide in Gaza, citing its right to defend itself after Hamas’s attack on 7 October 2023.

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‘Israel has shifted towards economy of genocide’

The companies named in Ms Albanese’s report are in, but not limited to, the financial sector, big tech and the military industry.

“These companies can be held responsible for being directed linked to, or contributing, or causing human rights impacts,” she said. “We’re not talking of human rights violations, we are talking of crimes.”

“Some of the companies have engaged in good faith, others have not,” Ms Albanese said.

Read more:
Israeli soldier describes arbitrary killing of civilians in Gaza
British surgeons on life in Gaza

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The companies she has named include American technology giant Palantir, which has issued a statement to Sky News.

It said it is “not true” that Palantir “is the (or a) developer of the ‘Gospel’ – the AI-assisted targeting software allegedly used by the IDF in Gaza, and that we are involved with the ‘Lavender’ database used by the IDF for targeting cross-referencing”.

“Both capabilities are independent of and pre-ate Palantir’s announced partnership with the Israeli Defence Ministry,” the statement added.

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US

Texas floods: At least 104 killed – as new images show scale of the destruction

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Texas floods: At least 104 killed - as new images show scale of the destruction

At least 104 people have died in the flash floods that have left a trail of destruction across Texas.

Kerr County Sheriff’s Office said the number of bodies found in the area had risen from 75 to 84 – including 56 adults and 28 children.

The have been seven fatalities in Travis County, six in Kendall County, four in Burnet County, two in Williamson County and one in Tom Green County.

Earlier, White House press secretary Karoline Leavitt warned that “the situation on the ground remains dangerous” and that there “could be additional public safety threats with additional incoming heavy rain”.

Latest updates – Texas floods

A view inside a cabin at Camp Mystic after the flooding. Pic: Ronaldo Schemidt/AFP via Getty Images
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A view inside a cabin at Camp Mystic after the flooding. Pic: Ronaldo Schemidt/AFP via Getty Images

The floods that first struck on Friday have wreaked havoc and left people in a state of grief – with 27 of the confirmed deaths having taken place at a girls’ summer camp in Kerr County.

Among those killed at Camp Mystic were Renee Smajstrla and Sarah Marsh, both eight, Eloise Peck and Lila Bonner, both nine, and the camp’s director Richard Eastland.

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A photo has now emerged showing the inside of the camp on Saturday after the waters hit.

At least 41 people are still missing in the state – including 10 girls from Camp Mystic.

Renee Smajstrla, 8, died in the flash floods at Camp Mystic, Texas. Pic: Family handout
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Renee Smajstrla, eight, died in the flash floods at Camp Mystic, Texas. Pic: Family handout

Sarah Marsh, 8, died in the flash floods at Camp Mystic, Texas. Pic: Family handout
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Sarah Marsh, eight, died in the flash floods at Camp Mystic, Texas. Pic: Family handout

In her news conference, Ms Leavitt criticised people who have claimed the Trump administration’s cuts to the National Weather Service (NWS) have played a role in the worsening the disaster.

It comes after Texas officials criticised the NWS by claiming it failed to warn the public about the impending danger.

Meanwhile, Senate Democratic Leader Chuck Schumer asked the Department of Commerce’s acting inspector general on Monday to probe whether staffing vacancies at the NWS’s San Antonio office contributed to “delays, gaps, or diminished accuracy” in forecasting the flooding.

The NWS did not immediately respond to a request for comment on Mr Schumer’s letter, but earlier defended its forecasting and emergency management.

Flooding near Kerville, Texas. Pic: US Coast Guard/AP
Image:
Flooding near Kerville, Texas. Pic: US Coast Guard/AP

Ms Leavitt has told reporters that claims Mr Trump was responsible for any issues related to the flash floods response were “depraved and despicable”.

“It is not [a political game], it is a national tragedy,” she said.

The press secretary also claimed, in relation to some NWS offices being reportedly understaffed, that one place actually had “too many people”.

“Any person who has deliberately lied about the facts around the catastrophic event, you should be deeply ashamed,” she said.

Rescuers at Camp Mystic along the Guadalupe River in Texas after a flash flood swept through the area. Pic: AP
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Rescuers at Camp Mystic along the Guadalupe River in Texas after a flash flood swept through the area. Pic: AP

Members from Texas Game Wardens of the Law Enforcement Division works following flash flooding, in Kerrville, Texas.
Pic: Reuters
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Members from Texas Game Wardens of the Law Enforcement Division works following flash flooding, in Kerrville, Texas. Pic: Reuters

She also said that Mr Trump was going to visit Texas “later in the week”.

Previously, Mr Trump said it was likely he would visit on Friday.

Car is wedged in the ground following deadly floods in Texas
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Car is wedged in the ground following deadly floods in Texas

White House press secretary Karoline Leavitt speaks with reporters in the James Brady Press Briefing Room at the White House, Monday, July 7, 2025, in Washington.
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Karoline Leavitt in the press briefing room

Texas Senator Ted Cruz spoke at a news conference and said: “Texas is grieving right now, the pain, the shock of what has transpired these last few days has broken the heart of our state.

“Those numbers [the number of dead] are continuing to go up… that’s every parent’s nightmare, every mum and dad.”

A view inside a cabin at Camp Mystic after the flooding. Pic: Ronaldo Schemidt/AFP via Getty Images
Image:
A view inside a cabin at Camp Mystic after the flooding. Pic: Ronaldo Schemidt/AFP via Getty Images

Damaged vehicles and debris are seen roped off near the banks of the Guadalupe River after flooding in Ingram, Texas. Pic: AP
Image:
Damaged vehicles and debris are seen roped off near the banks of the Guadalupe River after flooding in Ingram, Texas. Pic: AP

He said he had picked up his own daughter from a camp in the area last week.

Mr Cruz added: “You know what I’d do? What I did when this happened? Just go hug your kids.

“Because I’ve got to tell you, I hugged my girls with tears in my eyes.”

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Texas flooding: Aerial footage of rescues

Dalton Rice, the city manager of Kerrville in Kerr County, was asked whether evacuation warnings could have been issued earlier.

He said: “It’s very tough to make those calls because we also don’t want to cry wolf.

“You know, we want to make sure that we activated [it] at the right time.”

He added: “We had first responders getting swept away, responding to the first areas of rainfall. That’s how quick it happened.

“They were driving to these areas and one of them got swept off the road.”

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