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.

Across the country, 3,755 cases of congenital syphilis were reported to the CDC in 2022 — that’s 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 County’s 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 they’re 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 can’t 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 Miller’s 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.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).

Plenty of fish and vegetables and minimal consumption of sugar-sweetened drinks at this age may be key to protection, the findings indicate. A linked editorial suggests that it may now be time for doctors to recommend a ‘preventive’ diet for infants, given the mounting evidence indicative of biological plausibility.

Cases of inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, are increasing globally. Although there is no obvious explanation for this trend, changes in dietary patterns are thought to have a contributory role, because of their impact on the gut microbiome.

While various studies have looked at the influence of diet on IBD risk in adults, there is little in the way of research on the potential influence of early childhood diet on risk.

In a bid to plug this knowledge gap, the researchers drew on survey data from the All Babies in Southeast Sweden study (ABIS) and The Norwegian Mother, Father and Child Cohort Study (MoBa).

ABIS includes 21,700 children born between October 1997 and October 1999; MoBa includes 114, 500 children, 95,200 mothers, and 75,200 fathers recruited from across Norway between 1999 and 2008.

Parents were asked specific questions about their children’s diet when they were aged 12-18 months and 30-36 months. The final analysis included dietary information for 81,280 1 year olds: 11,013 (48% girls) from ABIS and 70, 267 (49% girls) from MoBa.

Diet quality, gleaned from measuring intake of meat, fish, fruit, vegetables, dairy, sweets, snacks, and drinks, was assessed using a modified version of the Healthy Eating Index (HEI) scoring system, adapted for children. The weekly frequency of specific food groups was also assessed.

Higher diet quality—a higher intake of vegetables, fruit, and fish, and a lower intake of meat, sweets, snacks, and drinks—was reflected in a higher HEI score. The total score was divided into thirds to indicate a low, medium, or high quality diet.

Reference: High quality diet in early life may curb subsequent inflammatory bowel disease risk; BMJ JOURNAL, Gut; DOI: 10.1136/gutjnl-2023-330971

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The vaccine is available for everyone from 6 months of age to those at age 65.

Get vaccinated today.

Protect yourself and your family.

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The Environmental Protection Agency (EPA) is recommending that people in Guyana wear dust masks due to a high concentration of Sahara dust in parts of Guyana. Air quality monitoring stations list air quality in parts of Georgetown, East Bank Demerara and East Berbice as “unhealthy”. “The public is advised to limit their time spent outdoors ...

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THE PANCREAS is a tiny gland that helps with digestion and controls sugar in your blood. It makes juices and hormones to keep you healthy. Now, the pancreas might struggle to produce enough insulin in conditions like type 1 diabetes, when the...

For a growing number of people, "medical tourism" can be dangerous — even fatal.

Twenty-nine U.S. citizens have died after they had cosmetic surgery in the Dominican Republic between 2009 and 2018, according to a Jan. 25 report from the Centers for Disease Control and Prevention (CDC).

More alarming is that the deaths have spiked in recent years. Between 2009 and 2018, there were an average of 4.1 deaths per year. Between 2019 and 2022, that average rose to 13 per year — peaking at 17 deaths in 2020.

ASK A DOC: ‘WHAT SHOULD I DO, OR NOT DO, PRIOR TO SURGERY?’

The deaths were linked to "fat or venous thromboembolism," which is when a blood clot forms in a vein, the CDC reported.

Most of the patients had risk factors for the condition, such as obesity, diabetes, tobacco use and multiple surgical procedures being performed at once.

The Consular Section of the U.S. Embassy in the Dominican Republic has recorded cosmetic surgery-associated deaths among U.S. citizens since 2009. 

The embassy contacted the CDC upon noticing the uptick in deaths — which sparked an investigation.

All but one of the deaths involved women, the report stated. The average age of the patients at the time of death was 40.

TOP PLASTIC SURGERIES: THESE WERE THE MOST IN-DEMAND PROCEDURES IN 2022

For the 24 deaths that occurred between 2019 and 2020, liposuction was performed on all of the patients, usually along with other procedures, including gluteal fat transfer, abdominoplasty and breast augmentation.

Fat embolism was the cause of death in 55% of the cases and pulmonary venous thromboembolism was the determining cause in 35% of the cases, the report said.

Josef Hadeed, M.D., chair of the Patient Safety Committee for the American Society of Plastic Surgeons (ASPS), who was not involved in the CDC investigation, noted that the CDC’s report highlights the dangers associated with destination procedures.

"Too often, patients will travel to other countries as the procedures are cheaper there," Hadeed, who is also a plastic surgeon with practices in Beverly Hills, California, and Miami, Florida, told Fox News Digital in an interview. 

"However, there are a lot of risks associated with traveling to other countries for cosmetic procedures."

He added, "All surgery carries risk, but there are excessive deaths outlined in the report, most of which were presumably avoidable."

When it comes to the price of surgery, Hadeed advised patients that "you get what you pay for. Just because something is cheaper doesn't mean it is better for you."

He also said, "The most important issue in plastic surgery is patient safety."

Jonathan Kaplan, M.D., a board-certified plastic surgeon who practices at Pacific Heights Plastic Surgery in San Francisco, who was also not involved in the report, said the CDC’s latest findings are "sad but true."

"There are risks with any surgery, but in the U.S., you have a better sense of whether doctors are board-certified in the specialty they’re practicing in," he told Fox News Digital in an email.

"There is also the added risk of going to a facility in a foreign country that has no quality assurance or safety protocols as required by law in the U.S.," Kaplan added.

International travel automatically puts patients at a higher risk for thromboembolic events, where they can develop potentially fatal blood clots, Hadeed said.

Another consideration is that those having surgery outside the U.S. won’t be able to get any assistance from the doctor if any complications arise, Kaplan warned.

BBL NOT ALWAYS A-OK: WHY THE BRAZILIAN BUTT LIFT IS ONE OF THE DEADLIEST PLASTIC SURGERIES EVER

"Then you’ll have to find a doctor locally who will charge you an exorbitant amount to fix the problem and you’ll end up spending more than what you saved initially," he said.

While all surgeries carry some element of risk, the "Brazilian Butt Lift" (BBL) has been associated with the highest risk of death in plastic surgery, which is corroborated by the report, noted Hadeed. 

"While I cannot specifically comment on what led to the deaths in the Dominican Republic, I can say that using an ultrasound is essential while performing a Brazilian Butt Lift," he told Fox News Digital. 

When the fat is injected into one of the blood vessels within the gluteal muscle, it can enter the bloodstream and make its way to the blood vessels of the lungs, blocking off circulation and leading to immediate death — which constitutes a fat embolism, the doctor said.

ASK A DOC: 'WHAT SHOULD I KNOW BEFORE GETTING A BREAST LIFT?'

This can be prevented by using an ultrasound, he noted, which allows the plastic surgeon to visualize the gluteal muscle and ensure that the fat is placed above, and not within, the muscle. 

"This has already become state law in Florida as of 2023," said Hadeed.

While Hadeed said it’s "better" to look for plastic surgeons within the U.S., if patients do decide to travel outside the country, they should carefully research a provider.

It is critical to find a plastic surgeon who is board-certified by the American Board of Plastic Surgery and is a member of the American Society of Plastic Surgeons, Hadeed emphasized. 

The surgeon — as well as the entire surgical team, including the anesthesiologists, nurses and surgical techs — should be adequately trained in the specific procedures, the doctor added.

"It is equally important to ensure that the facility in which the procedure is being performed is fully accredited to the same standards that are found in the United States and has the proper safety measures in place," said Hadeed.

"Also remember that longer flights increase the risk of venous thromboembolism, and it is advised to wait several days after travel before undergoing a surgical procedure, which can add to the cost of the travel when you factor in additional days of staying in a hotel," he pointed out.

When asked for his advice on international surgery, Kaplan said simply, "Don’t do it."

"The money you save is not worth it if you have a complication, which is a very real possibility," he said. 

"And remember, complications don’t have to be major — they can be minor, but still a nuisance if you don’t have a doctor locally to take care of it," he went on. "And even the smallest complication will be much more expensive to take care of in the U.S. if your original surgery was outside the country."

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For those who are considering having an elective surgical procedure outside the U.S., the CDC recommends discussing the risks with a doctor here first.

The agency also emphasized the importance of surgeons conducting proper preoperative exams and only performing one procedure for each operation.

The study did have some limitations, the CDC acknowledged.

"No reliable statistics on the number of U.S. citizens who receive cosmetic surgery in the Dominican Republic each year are available, precluding calculation of the risk for perioperative death," the report stated.

Also, the data only included deaths that were reported to the U.S. Embassy — which means the actual number could be higher.

The mortality count also does not include deaths resulting from post-surgical infections, the CDC noted.

Fox News Digital reached out to the CDC requesting comment on the report.

For more Health articles, visit www.foxnews.com/health.

Here are the top medical news of the day:

Ebastine provides subjective relief among patients with non-constipated IBS

Ebastine may provide subjective relief among patients with non-constipated IBS suggests a new study published in the Gut.

They evaluated the histamine 1 receptor antagonist ebastine as a potential treatment for patients with non-constipated irritable bowel syndrome (IBS) in a randomised, placebo-controlled phase 2 study. Non-constipated patients with IBS fulfilling the Rome III criteria were randomly assigned to 20 mg ebastine or placebo for 12 weeks. Subjects scored global relief of symptoms (GRS) and abdominal pain intensity (API). A subject was considered a weekly responder for global relief of symptoms if total or obvious relief was reported and a responder for abdominal pain intensity if the weekly average pain score was reduced by at least 30% vs baseline.

The primary endpoints were the proportion of subjects who were weekly responders for at least 6 out of the 12 treatment weeks for both global relief of symptoms and abdominal pain intensity 'GRS+API', composite endpoint) and for global relief of symptoms and abdominal pain intensity separately. Results: 202 participants (32±11 years, 68% female) were randomly allocated to receive ebastine (n=101) or placebo (n=101).

Treatment with ebastine resulted in significantly more responders (12%, 12/92) for global relief of symptoms+abdominal pain intensity compared with placebo (4%, 4/87, p=0.047) while the proportion of responders for global relief of symptoms and abdominal pain intensity separately was higher for ebastine compared with placebo, although not statistically significant (placebo vs ebastine, global relief of symptoms: 7% (6/87) vs 15%.

The study shows that ebastine is superior to placebo and should be further evaluated as a novel treatment for patients with non-constipated IBS.

Reference: Decraecker L, De Looze D, Hirsch DP, De Schepper H, Arts J, Caenepeel P, Bredenoord AJ, Kolkman J, Bellens K, Van Beek K, Pia F, Peetermans W, Vanuytsel T, Denadai-Souza A, Belmans A, Boeckxstaens G. Treatment of non-constipated irritable bowel syndrome with the histamine 1 receptor antagonist ebastine: a randomised, double-blind, placebo-controlled trial. Gut. 2024 Jan 8:gutjnl-2023-331634. doi: 10.1136/gutjnl-2023-331634. Epub ahead of print. PMID: 38191268.

Excessive gestational weight gain to cause higher risk of mortality in women

A recent study published in The Lancet revealed that excessive weight gain during pregnancy was associated with a 9% to 12% increase in all-cause mortality risk in women with BMI in the normal and overweight range respectively.

Weight gain is a common phenomenon during pregnancy, but excessive gain may be a sign of adverse health issues for mothers.

According to a study of pregnant women with low-risk pregnancy complications in Singapore, approximately 60% of them either gained too little or too much weight during pregnancy. Exceeding the recommended weight gain was associated with a higher risk of caesarean section (C-section) deliveries and the birth of larger babies – rendering this an increasingly alarming issue to be studied.

The impact of such weight gain is usually associated with greater postpartum weight retention, and pregnancy complications such as gestational diabetes, and pregnancy-induced hypertension, as well as a higher chance of requiring a C-section. However, its long-term implications have hitherto remained unknown.

Professor Cuilin Zhang from the Department of Gynaecology and Obstetrics at the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), and Director of the Global Center for Asian Women’s Health (GloW) at NUS Medicine and colleagues from the University of Pennsylvania and the US National Institutes of Health have investigated the association between weight gain during pregnancy, and mortality rate, with a follow-up period of over 50 years.

Excessive weight gain for women with a pre-pregnancy BMI in the underweight and normal range led to an 84% and 20% increased risk of mortality from cardiovascular disease respectively. At the same time, women with a BMI in the overweight range held a 77% increased risk of mortality from diabetes.

Considering current knowledge and the phenomenon of weight gain during pregnancy, the lack of studies and information on this renders the novel findings critical. The findings from this large well-characterised study, with more than 50 years of follow-up data, provide important evidence on the significance of women’s health for reproduction and their overall long-term health, wellbeing, and longevity.

“Promoting women’s health and achieving healthy longevity should start early in women’s lives. In particular, women’s health at their reproductive age and during pregnancy, are critical time windows that have long-term health impacts over their lifespan, as well as intergenerational impact on the offspring and the family,” said Prof Zhang, the principal investigator and last author of the study.

Reference: Stefanie N Hinkle, Prof Sunni L Mumford, Prof Katherine L Grantz, Prof Pauline Mendola, Gestational weight change in a diverse pregnancy cohort and mortality over 50 years: a prospective observational cohort study