But Stafford, a maternal-fetal medicine physician at the University of Texas Health Sciences Center in Houston, quickly realized something was wrong: She couldn’t find a heartbeat. The unborn baby boy had already died in the womb. 

Soon after, the mother’s syphilis test — given to all women before delivery — came back positive. The infection had been silently passed from mother to son.

It’s a death, Stafford said, that could’ve been prevented with early detection and a shot of penicillin. 

Syphilis, a sexually transmitted infection, was nearly eliminated in the U.S. at the beginning of the 21st century but has made a dramatic comeback. In 2022, the Centers for Disease Control and Prevention reported more than 200,000 syphilis cases — the highest counts since 1950. Congenital syphilis has similarly increased tenfold over the past decade, the CDC says, even though 90% of cases are fully preventable.

Syphilis in the U.S.

More than 200,000 cases were reported in 2022, the most since 1950.

The return of syphilis is the result, experts say, of poorly funded prevention programs over the past two decades and difficulties in diagnosis; syphilis is referred to as the “great imitator” because its symptoms can vary so widely. Most people don’t show symptoms or know they’re infected, and even if they do visit the doctor’s office, there’s no guarantee they’ll be properly diagnosed.

Stafford said her patient didn’t have the resources to seek prenatal care, and no doctor or public health worker had ever told her that she should get tested for syphilis. So, when the patient noticed a small rash on her belly, she didn’t think too much about it, Stafford added.

“There’s a lot of people who are seen in private practice, hospital ERs, or walk-in centers, and those clinicians are not necessarily thinking of syphilis, they’re not necessarily getting a sexual history,” said Dr. Kenneth Mayer, an infectious disease physician and medical research director of the Fenway Institute in Boston. With a generation of doctors who saw few, if any, syphilis cases during their training, Mayer said that “the issue is tests not being done in the first place.”

The all-encompassing nature of the Covid pandemic added fuel to this fire, as public health departments redirected STI resources toward fighting the coronavirus.

“The solutions for controlling syphilis are relatively straightforward. We’re not talking about high tech approaches or a novel therapeutic,” said Dr. Dave Chokshi, chair of the Common Health Coalition and a former New York City Commissioner of Health. “It simply revolves around closing gaps in testing and treatment.”

As syphilis cases surge, doctors and public health officials are starting to develop innovative and sometimes unconventional strategies to screen people for syphilis and curb the spread of the disease. 

Most often, that comes down to figuring out how to get people tested, a task that’s far easier said than done.

Spreading the word about syphilis

Given these challenges, some public health departments have launched eye-popping awareness campaigns, trying to raise the alarm among both the public and health care providers. 

A few years ago, Donna Fox, the HIV and STI manager at the Toledo-Lucas County Health Department in Ohio, noticed that about one-fifth of syphilis cases in the area were among people who reported paying for sex. 

So, trying to be proactive — and a bit provocative — Fox and her team ran billboards across the county in 2022 saying, “Paying for Sex? Get Tested!”

“We had to go bold, and we had to get to the point,” she said. The pushback was inevitable — “you might have to say something to your 10-year-old who can read,” Fox conceded — but the impact was measurable. From 2021 through 2022, the number of syphilis appointments scheduled via the county health department jumped by almost 50%, and syphilis cases dropped by 12%, she said.

Of course, syphilis doesn’t just spread among sex workers, so last year, Fox’s team broadened the campaign, keeping the same look and feel but instead saying “Syphilis is Serious” with “Spreading Locally!” overlaid over the side.

Other billboard campaigns across the country have featured giant bloodshot, infected eyes with the blurry words “Eye Syphilis is Serious” and a black silhouette of a pregnant woman with a red belly saying “Syphilis Can Be Fatal to Your Baby.” While these billboards are factually true, Mayer describes how this kind of fear-based campaign, or “loss frame,” draws lots of attention but may not be particularly effective at motivating behavioral changes for STIs.

“We’re not telling anybody not to have sex,” Fox said. “We’re telling people to have safe sex,” and to get tested afterward.

The sex positivity message isn’t just for the public. The Toledo-Lucas health department also launched an educational campaign for clinicians, reminding them to take a sexual history of all patients — since the county saw syphilis in people ages 15 to 72 last year — and to order a blood test if they suspect an STI, since the standard “pee in a cup” test can’t detect syphilis.

“Many physicians haven’t seen syphilis, and they’ve got a million things to know,” Fox said. “If we don’t talk to the physicians, we’re not going to get the testing we need done.”

Stafford, the maternal-fetal medicine doctor in Houston, has taken a more hands-on approach. Texas mandates syphilis testing for pregnant women at three points — during their first prenatal visit, around the 28-week mark and before delivery — but in reality, these tests are often missed. So, last year, Stafford launched an alert in UTHealth’s electronic medical records, prompting providers to test their pregnant patients for syphilis at each of the prescribed times. The simple tweak helped increase screening rates from 2% to 47% at all three timepoints, while decreasing congenital syphilis cases by half.

Chokshi sees this as another good example of the public health and health care systems working hand-in-hand, with the former “setting the parameters of what standard of care should look like” and hospitals making it a reality. 

Make syphilis testing convenient

Beyond greater awareness, access to testing and treatment needs to be quick, easy and convenient, Chokshi said. 

Indian Country has led the way on this, partly by necessity: American Indian and Alaska Natives have the highest syphilis rates of any racial or ethnic group, almost seven times higher than white people. 

As such, tribes across the U.S. have turned to incentives, giving people $10 gift cards if they come in for STI testing or treatment, said Jessica Leston, founder of the Raven Collective, an Indigenous public health organization.

“We’re just helping people pay for gas and child care and get food on their table,” Leston said. At Cass Lake Indian Hospital’s pharmacy in rural Minnesota, the strategy increased STI testing tenfold, according to one study, with over 70% of the patients who got a test not having a primary care provider.

In 2023, a coalition of tribal communities partnered with Johns Hopkins School of Medicine to ramp up a program called I Want the Kit, which sends at-home STI test kits in the mail. The tests come in unmarked envelopes with instructions on how to collect a sample and send back the test. Results come back in a week or two, and patients are linked to health care resources if the test comes back positive.

Even with these programs, syphilis testing can be overshadowed by more immediate concerns.

In California, for example, half of pregnant women with syphilis reported methamphetamine use, and a quarter were homeless. In the state’s rural Shasta County, near the Oregon border, almost 100% of pregnant woman with syphilis similarly have a substance use disorder and 90% are unhoused, said Trojan Carvajal,
a supervising public health nurse in the county’s STI unit.

In April 2023, Shasta County launched the CommUNITY Mobile Care Clinic, an RV retrofitted with a reception area and two exam rooms, bringing STI tests and treatments to the county’s most vulnerable — from homeless camps to pop-ups with the local LBGTQ community center. Importantly, there’s no STI branding on the mobile clinic itself, allowing people to feel more comfortable walking in to get tested.

Last year, one-third of all syphilis tests performed by Shasta County were done through the mobile clinic, according to Jai Winchell, a community education specialist with the county’s public health department. These people would likely have never sought syphilis services otherwise, Winchell said, but with this mobile clinic crisscrossing the county and arriving at their doorsteps, they can get tested and treated in just 30 minutes.

Piggybacking syphilis services

Shasta County’s mobile clinic also offers other services, including test strips for deadly drugs like fentanyl and xylazine, naloxone to reverse overdoses and referrals to addiction counselors, as well as water, snacks and dental kits, Winchell said. The idea is to address overlapping concerns together, while also attracting those who wouldn’t have considered STI testing, if not for the package deal.

This approach also helps build trust, said Dr. Arlene Seña, an infectious diseases physician at the University of North Carolina Chapel Hill, showing how mobile clinic staff are invested in you as a person with various needs, rather than a singular problem to be solved. “It might be more costly, but it’s also much, much more effective and helpful to the community,” Seña said.

Syphilis services can also be integrated with general health care services. In March, Stafford launched a rapid testing program at two Houston hospitals aimed at all pregnant women admitted to the emergency department. The program, called Preg-Out, was set up on an opt-out basis, so everyone got tested unless they refused. It took about 15 minutes, and women were offered prenatal care regardless of the result.

“We noticed that pregnant patients, especially those that end up having a child with congenital syphilis, often frequent the ED and don’t get tested,” Stafford said. In the three-month pilot, Stafford said testing rates for pregnant women increased twelvefold, with about 35% of their partners wanting to get tested as well. 

Other hospitals have implemented opt-out screening programs for all patients, including Grady Memorial Hospital in Atlanta in one of their urgent care centers and the University of Chicago in their emergency department. Not every hospital has the resources to test everyone, Seña said, so she believes prioritizing pregnant patients, as done in Houston, can be a high-impact first step.

“You can’t just rely on public health departments to do the brunt of the work for STI recognition and prevention,” she said. “You have to go hand in hand with other providers in the community.”

The future ahead

The U.S. got syphilis rates down before, but that was in the 1990s, when HIV was ravaging through America. 

“What changed behavior then was lethal, hard-to-treat disease,” said Mayer, from Fenway Health. “Now, you have a generation of people who may be less informed,” leading to lower rates of condom use and STI screening rates. 

However, it’s also a time of innovation. In June, the CDC recommended doxycycline post-exposure prophylaxis for high-risk groups — essentially, a morning after pill for STIs. If taken within 72 hours of condomless sex, so-called DoxyPEP reduces syphilis rates by over 70%, and Fenway Health, where half of patients are LGBTQ, has already begun ramping up distribution, Mayer said. Meanwhile, other researchers like Seña have been working on developing a syphilis vaccine, but that’s probably several years down the line.

“Our task right now is to arrest the growth in cases,” said Chokshi, from the Common Health Coalition, and he’s optimistic that these innovative awareness, testing and treatment campaigns can do that. But permanently bending the syphilis curve will require scaling these efforts nationally and promoting greater coordination between health care and public health.

“There’s no reason that the endgame can’t be, once again, trying to eliminate syphilis — this historic scourge that is completely preventable and treatable,” Chokshi said.

This article first appeared on NBCNews.com. Read more from NBC News here:

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Each year, the Centers for Disease Control and Prevention looks to countries in the Southern Hemisphere as a potential indicator for what’s to come in the United States.

Some countries in South America and Africa experienced an earlier start to their flu seasons, which typically run from April to September and sometimes last until October or November, the CDC said in late August.

Influenza A, specifically H3N2 viruses, were predominant in Australia and South America, particularly in Chile, Ecuador and Uruguay, where there were high levels of severe flu-related disease and hospitalizations, the CDC said.

In Africa, influenza A H1N1 viruses dominated, though influenza B has increased in recent weeks, according to the CDC.

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The CDC said getting a flu vaccine is the best form of protection against severe illness and hospitalization.

A local doctor told News4 some people might want to get their shot as soon as possible as flu activity typically begins in America in October. It usually takes two weeks after a flu shot to build strong immunity.

“If you are in a high risk group, you know, 65 and older [or] you’re a pregnant person, then what you would want to do is get it as soon as possible so you can get that extra bit of protection as soon as you can. However, if you’re not in a high risk group, I would recommend waiting probably until the tail end of September or beginning of October. I think those are a great time so that you can get it to last all throughout the flu season,” said Dr. Adrian Dyer, a family medicine physician for MedStar Health.

It’s safe to get a flu shot and the new COVID-19 shot at the same time, according to the CDC. But Dyer said it’s alright to spread them out, if that’s what a patient prefers.

“You don’t have to do all the shots in one visit. You can space them out. Take one today. Take another one in two weeks. Take it slow,” Dyer said.

Children younger than 9 who have never had a flu shot before should get two doses this year, at least four weeks apart, according to the CDC. Kids in that same age group who have only had one shot during previous flu seasons may also need two shots this year.

It was the first time any living human had received a pig organ transplant.

“You never know what the news is, but my dad opened his eyes, and he was awake, and he was doing well. It was incredible,” Bennett Jr. said.

Bennett’s father, David Bennett Sr., had severe congestive heart failure and wasn’t a candidate for a human transplant. He knew he would likely die soon. There was nothing more to do — other than take a chance on a novel, cutting-edge surgery. Bennett Sr. and his son agreed it was worth the risk.  

The achievement made headlines around the world after the transplant surgery in January 2022. The results at first seemed promising, and some family members even began to entertain the idea that Bennett Sr. might eventually leave the hospital.

“There were definitely futuristic conversations, just about home setup and who was going to take care of him and how that would look,” Bennett Jr. said. “Everybody was very optimistic and hopeful.”

But two months later, Bennett Sr.’s body rejected the heart and he died at age 57. In a paper, his doctors at the University of Maryland Medical Center explained that his body had likely produced too many antibodies that fought off the new organ. A drug he’d been given may also have increased the odds of rejection, and a virus in the pig heart further complicated matters. 

Three other patients have followed in Bennett Sr.’s footsteps and received pig organs, most recently a pig kidney transplant in April. Together, they represent the pioneer patients of the burgeoning field of xenotransplantation. For their families, three of which spoke to NBC News about the experience, the journey came with a roller coaster of emotions, from uncertainty to blind hope — and, ultimately, admiration for their loved one’s decision. 

“I would love to still have my dad here, obviously, but I know that his sacrifice wasn’t for nothing,” Bennett Jr. said.

None of the patients survived more than three months. To the public, that might seem like failure. But to the families, the transplants accomplished their goals: to buy their loved ones more time and advance research that could potentially save lives one day.

“Larry approached it in this way: He was going to die. It was inevitable, and it was coming soon,” said Ann Faucette, whose husband of nearly 38 years, Lawrence Faucette, was the second person to receive a pig heart. “So why not offer up his body as a test subject for them to get as much data, do as much research as they could, so in the future there’s that other option for people who need those transplants?”

The promise of xenotransplants lies in the shortage of available human organs. An estimated 17 people die in the U.S. each day waiting for an organ transplant, according to the Health Resources and Services Administration. Because pig organs are more readily available, doctors envision a future in which these operations are as common as a hip replacement. 

But at this early stage, the Food and Drug Administration has only approved xenotransplants for patients on the verge of death with no other options. 

Like Bennett Sr., Lawrence Faucette qualified for a pig heart because he was dying of heart failure. Ann Faucette said that after the surgery, her husband was able to play cards and do physical therapy on an exercise bike. It was a contrast to the day before the surgery, when his heart had stopped and needed to be revived with an internal defibrillator. 

“We’re having full-on conversations. We’re watching football,” Ann said. “It’s like normal life, as normal as it can be in a hospital.”

She focused on the positives: “I was in denial. This was going to work. He was going to get better. He was going to come home,” Ann said.

Her two sons, now 29 and 31, “saw that the end could be at any point, so they made sure that they told Larry how they felt,” she added — that they loved him.

At her husband’s request, Ann bought a new chair for their house in Frederick, Maryland, in preparation for his return. The day it was delivered, she learned his condition had worsened.

“While I’m waiting for the chair, I get the call that they want to put Larry on ECMO,” she said, referring to a life-support device.

He died of transplant rejection roughly two weeks later, less than six weeks after the surgery. 

His doctors said Faucette’s recovery was complicated by the fact that his strength had declined shortly before the operation. 

The two xenotransplants after that followed a similar pattern: After surgery, the patients began to feel much better, then suddenly worsened after several weeks.

Brittany Harvill’s mother, Lisa Pisano, received a genetically modified pig kidney in April. Within a week, she had noticeably improved, Harvill said.

“She’s like, ‘I feel great.’ You could see the color in her face,” she said. “She looked like a whole new person.”

Before the surgery, Pisano could hardly walk due to shortness of breath and extreme fatigue. She had heart and kidney failure, so her surgery was more complicated than the others: Doctors implanted a mechanical heart pump eight days before the pig kidney. After the surgery, Pisano seemed more alert than ever, according to Harvill. She FaceTimed her grandchildren from the hospital, watched cooking shows and hung out with her daughter.

“I would bring pictures and then we would talk about what the kids were up to,” Harvill said.

But the demands of the transplant proved too much for Pisano’s other organs. Doctors prescribed blood-pressure medication, but it ultimately led to the rejection of the kidney. Pisano died in hospice care on July 7, around 12 weeks after the transplant.

Harvill said her mom was confident in her decision, but she still wishes Pisano had lived long enough to see her granddaughter, Olivia, go off to kindergarten.

“One thing that upsets me is that my mom would have loved to be there for that,” she said through tears.

Harvill believes the kidney transplant “100% would have worked” had it not been for her mom’s heart issues.

“Now I think the doctors definitely know, people that are as sick as my mom maybe aren’t the best people to do it,” she said.

Indeed, the surgeons who’ve done the xenotransplants and other experts in the field say these first four patients were not ideal candidates, since those on death’s door are likely to be too weak to support a new organ.

“If we could choose patients who are much more likely to do well, then we’d get a better idea about how successful it’s going to be,” said Dr. David Cooper, a physician investigator of transplant surgery at the Massachusetts General Research Institute, who did not perform any of the operations.

But for the FDA to approve such a transplant in a healthier patient, Cooper said, the agency wants to see more consistent one-year survival in studies done in animals. Privately, doctors had hoped that would be the case for the human patients. 

“We hoped for six months, and maybe a year. Out of ignorance, we felt our animal data supported that. We actually thought we’d do better in the humans,” said Dr. Bartley Griffith, clinical director of the cardiac xenotransplantation program at the University of Maryland School of Medicine, who operated on Faucette and Bennett Sr.

The only xenotransplant patient who recovered enough to return home was Rick Slayman, who received a pig kidney at Massachusetts General Hospital in March. He had terminal kidney disease, diabetes, high blood pressure and heart disease. 

Slayman’s family declined to be interviewed. According to his surgeon, Dr. Tatsuo Kawai, the dialysis Slayman had required before the transplant was no longer needed afterward, and his only struggle was climbing the three flights of stairs to his apartment.

Still, Slayman died less than eight weeks after his surgery, from what doctors suspect was a fatal arrhythmia. An autopsy showed that his heart disease was more advanced than his doctors had thought.

“The autopsy didn’t show any rejection or any abnormality in the kidneys, so in terms of transplant, we think this was successful,” said Kawai, who directs the Legorreta Center for Clinical Transplant Tolerance at Mass General.

The Bennett, Faucette and Harvill families do not regret their loved ones’ participation in the experimental transplants. Each saw any extra time as a gift, and they remain optimistic about xenotransplantation’s potential. Harvill compared the situation to the first human heart transplant in 1967. That patient died after 18 days, but thousands of such transplants are now performed in the U.S. each year.

The families are also aware of how much doctors learned from each surgery.

“The excitement in their voices and on their faces when they talk about the data that Larry was able to give them … it makes me grateful,” Faucette said.

On her wedding anniversary, she baked around 500 cookies for the hospital’s nursing staff.

Dr. Robert Montgomery, who did Pisano’s surgery and directs the NYU Langone Transplant Institute, said many people on the transplant waiting list are interested in a xenotransplant.

“I can’t tell you how many people call my office every week who want this. That’s what I think is underappreciated, is how desperate people are,” he said.

All of the researchers are eager to try another transplant as soon as they can find the right candidate and get FDA approval.

“We are at a place now where we feel 100% better informed,” Griffith said. “Whether that’ll translate to our next patient living a year, we’re not sure, but we moved from total ignorance to a really good idea of what our enemy is.”

This article first appeared on NBCNews.com. Read more from NBC News here:

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But Stafford, a maternal-fetal medicine physician at the University of Texas Health Sciences Center in Houston, quickly realized something was wrong: She couldn’t find a heartbeat. The unborn baby boy had already died in the womb. 

Soon after, the mother’s syphilis test — given to all women before delivery — came back positive. The infection had been silently passed from mother to son.

It’s a death, Stafford said, that could’ve been prevented with early detection and a shot of penicillin. 

Syphilis, a sexually transmitted infection, was nearly eliminated in the U.S. at the beginning of the 21st century but has made a dramatic comeback. In 2022, the Centers for Disease Control and Prevention reported more than 200,000 syphilis cases — the highest counts since 1950. Congenital syphilis has similarly increased tenfold over the past decade, the CDC says, even though 90% of cases are fully preventable.

Syphilis in the U.S.

More than 200,000 cases were reported in 2022, the most since 1950.

The return of syphilis is the result, experts say, of poorly funded prevention programs over the past two decades and difficulties in diagnosis; syphilis is referred to as the “great imitator” because its symptoms can vary so widely. Most people don’t show symptoms or know they’re infected, and even if they do visit the doctor’s office, there’s no guarantee they’ll be properly diagnosed.

Stafford said her patient didn’t have the resources to seek prenatal care, and no doctor or public health worker had ever told her that she should get tested for syphilis. So, when the patient noticed a small rash on her belly, she didn’t think too much about it, Stafford added.

“There’s a lot of people who are seen in private practice, hospital ERs, or walk-in centers, and those clinicians are not necessarily thinking of syphilis, they’re not necessarily getting a sexual history,” said Dr. Kenneth Mayer, an infectious disease physician and medical research director of the Fenway Institute in Boston. With a generation of doctors who saw few, if any, syphilis cases during their training, Mayer said that “the issue is tests not being done in the first place.”

The all-encompassing nature of the Covid pandemic added fuel to this fire, as public health departments redirected STI resources toward fighting the coronavirus.

“The solutions for controlling syphilis are relatively straightforward. We’re not talking about high tech approaches or a novel therapeutic,” said Dr. Dave Chokshi, chair of the Common Health Coalition and a former New York City Commissioner of Health. “It simply revolves around closing gaps in testing and treatment.”

As syphilis cases surge, doctors and public health officials are starting to develop innovative and sometimes unconventional strategies to screen people for syphilis and curb the spread of the disease. 

Most often, that comes down to figuring out how to get people tested, a task that’s far easier said than done.

Spreading the word about syphilis

Given these challenges, some public health departments have launched eye-popping awareness campaigns, trying to raise the alarm among both the public and health care providers. 

A few years ago, Donna Fox, the HIV and STI manager at the Toledo-Lucas County Health Department in Ohio, noticed that about one-fifth of syphilis cases in the area were among people who reported paying for sex. 

So, trying to be proactive — and a bit provocative — Fox and her team ran billboards across the county in 2022 saying, “Paying for Sex? Get Tested!”

“We had to go bold, and we had to get to the point,” she said. The pushback was inevitable — “you might have to say something to your 10-year-old who can read,” Fox conceded — but the impact was measurable. From 2021 through 2022, the number of syphilis appointments scheduled via the county health department jumped by almost 50%, and syphilis cases dropped by 12%, she said.

Of course, syphilis doesn’t just spread among sex workers, so last year, Fox’s team broadened the campaign, keeping the same look and feel but instead saying “Syphilis is Serious” with “Spreading Locally!” overlaid over the side.

Other billboard campaigns across the country have featured giant bloodshot, infected eyes with the blurry words “Eye Syphilis is Serious” and a black silhouette of a pregnant woman with a red belly saying “Syphilis Can Be Fatal to Your Baby.” While these billboards are factually true, Mayer describes how this kind of fear-based campaign, or “loss frame,” draws lots of attention but may not be particularly effective at motivating behavioral changes for STIs.

“We’re not telling anybody not to have sex,” Fox said. “We’re telling people to have safe sex,” and to get tested afterward.

The sex positivity message isn’t just for the public. The Toledo-Lucas health department also launched an educational campaign for clinicians, reminding them to take a sexual history of all patients — since the county saw syphilis in people ages 15 to 72 last year — and to order a blood test if they suspect an STI, since the standard “pee in a cup” test can’t detect syphilis.

“Many physicians haven’t seen syphilis, and they’ve got a million things to know,” Fox said. “If we don’t talk to the physicians, we’re not going to get the testing we need done.”

Stafford, the maternal-fetal medicine doctor in Houston, has taken a more hands-on approach. Texas mandates syphilis testing for pregnant women at three points — during their first prenatal visit, around the 28-week mark and before delivery — but in reality, these tests are often missed. So, last year, Stafford launched an alert in UTHealth’s electronic medical records, prompting providers to test their pregnant patients for syphilis at each of the prescribed times. The simple tweak helped increase screening rates from 2% to 47% at all three timepoints, while decreasing congenital syphilis cases by half.

Chokshi sees this as another good example of the public health and health care systems working hand-in-hand, with the former “setting the parameters of what standard of care should look like” and hospitals making it a reality. 

Make syphilis testing convenient

Beyond greater awareness, access to testing and treatment needs to be quick, easy and convenient, Chokshi said. 

Indian Country has led the way on this, partly by necessity: American Indian and Alaska Natives have the highest syphilis rates of any racial or ethnic group, almost seven times higher than white people. 

As such, tribes across the U.S. have turned to incentives, giving people $10 gift cards if they come in for STI testing or treatment, said Jessica Leston, founder of the Raven Collective, an Indigenous public health organization.

“We’re just helping people pay for gas and child care and get food on their table,” Leston said. At Cass Lake Indian Hospital’s pharmacy in rural Minnesota, the strategy increased STI testing tenfold, according to one study, with over 70% of the patients who got a test not having a primary care provider.

In 2023, a coalition of tribal communities partnered with Johns Hopkins School of Medicine to ramp up a program called I Want the Kit, which sends at-home STI test kits in the mail. The tests come in unmarked envelopes with instructions on how to collect a sample and send back the test. Results come back in a week or two, and patients are linked to health care resources if the test comes back positive.

Even with these programs, syphilis testing can be overshadowed by more immediate concerns.

In California, for example, half of pregnant women with syphilis reported methamphetamine use, and a quarter were homeless. In the state’s rural Shasta County, near the Oregon border, almost 100% of pregnant woman with syphilis similarly have a substance use disorder and 90% are unhoused, said Trojan Carvajal,
a supervising public health nurse in the county’s STI unit.

In April 2023, Shasta County launched the CommUNITY Mobile Care Clinic, an RV retrofitted with a reception area and two exam rooms, bringing STI tests and treatments to the county’s most vulnerable — from homeless camps to pop-ups with the local LBGTQ community center. Importantly, there’s no STI branding on the mobile clinic itself, allowing people to feel more comfortable walking in to get tested.

Last year, one-third of all syphilis tests performed by Shasta County were done through the mobile clinic, according to Jai Winchell, a community education specialist with the county’s public health department. These people would likely have never sought syphilis services otherwise, Winchell said, but with this mobile clinic crisscrossing the county and arriving at their doorsteps, they can get tested and treated in just 30 minutes.

Piggybacking syphilis services

Shasta County’s mobile clinic also offers other services, including test strips for deadly drugs like fentanyl and xylazine, naloxone to reverse overdoses and referrals to addiction counselors, as well as water, snacks and dental kits, Winchell said. The idea is to address overlapping concerns together, while also attracting those who wouldn’t have considered STI testing, if not for the package deal.

This approach also helps build trust, said Dr. Arlene Seña, an infectious diseases physician at the University of North Carolina Chapel Hill, showing how mobile clinic staff are invested in you as a person with various needs, rather than a singular problem to be solved. “It might be more costly, but it’s also much, much more effective and helpful to the community,” Seña said.

Syphilis services can also be integrated with general health care services. In March, Stafford launched a rapid testing program at two Houston hospitals aimed at all pregnant women admitted to the emergency department. The program, called Preg-Out, was set up on an opt-out basis, so everyone got tested unless they refused. It took about 15 minutes, and women were offered prenatal care regardless of the result.

“We noticed that pregnant patients, especially those that end up having a child with congenital syphilis, often frequent the ED and don’t get tested,” Stafford said. In the three-month pilot, Stafford said testing rates for pregnant women increased twelvefold, with about 35% of their partners wanting to get tested as well. 

Other hospitals have implemented opt-out screening programs for all patients, including Grady Memorial Hospital in Atlanta in one of their urgent care centers and the University of Chicago in their emergency department. Not every hospital has the resources to test everyone, Seña said, so she believes prioritizing pregnant patients, as done in Houston, can be a high-impact first step.

“You can’t just rely on public health departments to do the brunt of the work for STI recognition and prevention,” she said. “You have to go hand in hand with other providers in the community.”

The future ahead

The U.S. got syphilis rates down before, but that was in the 1990s, when HIV was ravaging through America. 

“What changed behavior then was lethal, hard-to-treat disease,” said Mayer, from Fenway Health. “Now, you have a generation of people who may be less informed,” leading to lower rates of condom use and STI screening rates. 

However, it’s also a time of innovation. In June, the CDC recommended doxycycline post-exposure prophylaxis for high-risk groups — essentially, a morning after pill for STIs. If taken within 72 hours of condomless sex, so-called DoxyPEP reduces syphilis rates by over 70%, and Fenway Health, where half of patients are LGBTQ, has already begun ramping up distribution, Mayer said. Meanwhile, other researchers like Seña have been working on developing a syphilis vaccine, but that’s probably several years down the line.

“Our task right now is to arrest the growth in cases,” said Chokshi, from the Common Health Coalition, and he’s optimistic that these innovative awareness, testing and treatment campaigns can do that. But permanently bending the syphilis curve will require scaling these efforts nationally and promoting greater coordination between health care and public health.

“There’s no reason that the endgame can’t be, once again, trying to eliminate syphilis — this historic scourge that is completely preventable and treatable,” Chokshi said.

This article first appeared on NBCNews.com. Read more from NBC News here:

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A Bethesda-based neuro-optometrist says it might be something else: vision problems.

Margaret Barry and her daughter Sasha started looking for solutions after Sasha wasn’t progressing in school like she should.

‘We actually hired a math tutor and they worked on the exact same problem for a year,” Barry said.

The mom said that her daughter wouldn’t want to read even though she loved being read to. When considering if Sasha had ADHD, she didn’t want to medicate her unless it was necessary.

“All these things that to me, were just personality quirks,” Barry said. “They weren’t necessarily related to her eyes. All of a sudden, that lined up, I thought: ‘We should investigate this.’”

Barry and Sasha then traveled from Boston to visit Dr. Bryce Appelbaum, a neuro-optometrist, to try out vision therapy instead.

He explained that ADHD symptoms aren’t exclusive to ADHD.

“ADHD is an incomplete diagnosis, in my opinion, until hidden functional vision problems that cause the exact same symptoms and behaviors are ruled out first,” Appelbaum said.

Sasha was diagnosed with what’s known as “convergence insufficiency” where her eyes weren’t working together.

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“If you can’t converge your eyes to see a single clear image as it’s approaching you or even within arm’s length, how are you supposed to track across the page when you’re reading? Or doing desk work without having a really hard time and rubbing your eyes,” Appelbaum said.

Appelbaum said that signs like losing their place in reading, skipping words and being distracted easily are warning signs that their vision could be preventing them from their potential.

“We’re all told from a young age to keep our eyes on the ball, but we’re never taught how. We’re teaching Sasha how to do that,” Appelbaum said.

Since visiting Appelaum, Sasha has started treatment. Unlike an ADHD medication meant to manage symptoms, vision therapy is meant to permanently fix them.

Barry said that by the end of the first week, it was like night and day with the difference in Sasha’s vision. She was even able to read a text message for the first time.

“She looked at it and she read it out loud and I looked at her and said ‘Did you just read that?!’ and she goes “I did!” Barry said. “She was not able to do that the day before!”

Barry encourages other parents to try out vision therapy as an option before going straight to ADHD medication.

“I want every single parent to know better so that they can do better,” Appelbaum said. “And to really question what a doctor is telling them in terms of a treatment option.”

Most research about HPV’s potential impact on fertility has focused on women. But in recent years, researchers have increasingly expanded their focus to include the infection’s association with male fertility.

A new study from Argentinian researchers has found that the strains of HPV considered high risk because of their links to cancer were not only more common than low-risk strains in a small study population of men, they also appeared to pose a greater threat to sperm quality.

The study, published Friday in Frontiers in Cellular and Infection Microbiology, found that high-risk HPV appears to suppress key components of the immune system in the male genital tract. This could hamper the body’s ability to clear HPV, a process that typically takes about six months to a year after infection, while raising the risk of other infections that may also compromise male fertility.

“Individuals often have no symptoms or signs, yet still carry HPV in the male genital tract,” said the study’s senior author, Virginia Rivero, a professor of immunology at the National University of Córdoba in Argentina.

A 2020 systematic review of 50 studies found that 21% of infertile men had HPV-positive semen, compared with 8% in the general male population. Even after accounting for female infertility, men with HPV in their semen had three-fold greater odds of being infertile than those without the virus.

There are over 200 known strains of HPV. The riskiest handful can cause multiple cancers, including, in the U.S., about 26,000 diagnoses in women and 21,000 in men each year, according to the Centers for Disease Control and Prevention. The most common HPV-driven malignancy is cervical cancer, with about 13,800 invasive cases annually. Research suggests that most people are unaware that the virus can also cause vulval, anal, throat, vaginal and penile cancer.

A vaccine for HPV has been available since 2006, when it was initially recommended just for girls; the recommendation was expanded to boys in 2011. The current version, which is given in a two- or three-dose series, prevents nine of the riskiest HPV strains, including those that cause genital warts.

The CDC recommends routine HPV vaccination for all boys and girls at 11 or 12 years old — children can receive it at as young as age 9 — and for those through age 26 who were not previously fully vaccinated. Experts consider the vaccine exceptionally safe.

A CDC study published Thursday found that for adolescents born in 2007, about 65% were fully vaccinated for HPV by age 15, compared with 60% of those born in 2008. The CDC attributes this statistically significant difference to disruptions from the Covid pandemic, beginning when the younger group turned 12.

Vaccination at older ages typically provides less benefit, since so many people contract at least one strain of HPV after becoming sexually active. But the CDC suggests that people up to age 45 may still discuss potential vaccination with their doctors. 

High-risk HPV lowers immune cells

In her new study, Rivero and her colleagues studied the ejaculate samples of 205 men, none of whom were vaccinated for HPV. The men, who had a median age of 35, sought a fertility assessment or treatment for urinary-tract problems from 2018 to 2021 at a urology clinic in Argentina.

Thirty-nine, or 19%, of the men tested positive for HPV. Researchers were able to identify 20 men among them who had high-risk strains and seven men with low-risk HPV.  

On the surface, the investigators didn’t find any notable differences in the semen quality between the men with either type of HPV and a group of 43 men who tested negative for the virus. When they examined the semen more closely with highly sensitive tools, they found clues suggesting how high-risk HPV strains might be influencing male infertility.

The men with high-risk HPV had a lower level of certain immune cells in their semen, suggesting the virus had hampered the body’s ability to fight it off. This suppression of immune cells might also have raised the men’s risk of other infections that could further compromise their ability to conceive.

There was also evidence that the sperm of the men with high-risk HPV were sustaining damage from what’s known as oxidative stress. This could explain why these men had a higher level of dead sperm compared with those who didn’t have the virus.

Dr. Eugenio Ventimiglia, an oncologist in the unit of urology at the Università Vita-Salute San Raffaele in Milan, Italy, said the new study, which he was not involved in, “provides insight into the biological mechanisms potentially linking HPV to male reproductive health issues.” 

Nevertheless, he said its findings should be “interpreted cautiously.”

“Instead of conclusively proving a cause-effect relationship between HPV and male factor infertility, the study’s findings are more appropriately seen as generating hypotheses for further research,” Ventimiglia said.

Can vaccination protect men’s fertility?

Men’s HPV might also affect fertility in part by transmitting the virus into the woman’s reproductive tract; the virus might then harm the pregnancy at various stages, including before the fertilized egg implants in the womb. Couples receiving assisted reproductive technology have a greater chance of miscarriage if the man has HPV in his semen, researchers have found.

Research indicates that providing the HPV vaccine to men who are having trouble conceiving and who have an active HPV infection might help them clear the virus faster and potentially improve their chances of conceiving.

“Whatever other changes are thought to be associated with HPV, it should be noted that HPV infection is usually brief, as is the sperm lifespan,” said Dr. Marie-Hélène Mayrand, an epidemiologist and the chair of the obstetrics and gynecology department of University of Montreal. “This is reassuring that any effect, if found, would be brief and self-limited.” Mayrand was not involved in the new research.

Rivero advises that men struggling with fertility receive testing for HPV and other sexually transmitted infections that could affect their fertility. If positive for HPV, additional testing may be needed to identify specific strains. 

The test results, Rivero said, could help men identify a potential driver of their infertility. 

HPV vaccination rates among adolescent boys and men have been rising over the last decade. Recent research suggested that the HPV vaccine was linked to a drastically lower rate of head and neck cancers in men and adolescent boys. 

It’s not yet known if the vaccine could protect men’s fertility. 

“When a critical mass of boys and girls are vaccinated, it is likely that the transmission of the HPV genotypes covered by the vaccines will decrease.” Rivero said. “But the broader impact on fertility remains uncertain.”

Rivero said she hoped to see a larger study in the future that could lend more statistical heft to her findings. Her own lab plans to further study how simultaneous infections with HPV and other STIs might influence male fertility.

This story first appeared on NBCNews.com. More from NBC News:

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Bekele, from Fairfax, Virginia, is being recognized for developing an affordable bar of soap that could make delivering medications for skin cancers, including melanoma, more accessible.

Melanoma is the most invasive type of skin cancer with the highest risk of death, according to Cleveland Clinic. However, it is highly curable, if caught early.

“It’s absolutely incredible to think that one day, my bar of soap will be able to make a direct impact on somebody else’s life,” the 15-year-old told Time. “That’s the reason I started this all in the first place.”

Bekele’s passion for science started at an early age. He conducted his first science experiment when he was just 4 years old, mixing together any household products he could get his hands on and seeing what would happen. He advanced to a chemistry set when he was 6. A few years ago, he decided to tackle skin cancer.

Some of Bekele’s earliest memories were of seeing laborers work under the searing heat with no heat protection in Ethiopia, where Bekele was born, according to Time. After emigrating to the U.S., the young scientist said he realized what a “big problem the sun and ultraviolet radiation is when you’re exposed to it for a long time.”

Then, Bekele learned about imiquimod, a cream-based drug that can help destroy tumors. While effective, the drug can be expensive, often being prescribed as part of a treatment plan that can cost $40,000. Imiquimod’s retail price can go up to $180 without insurance, and is even more expensive in Ethiopia.

Bekele realized a bar of soap could be an effective, accessible and cost-saving delivery system for the drug.

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To turn this idea into reality, Bekele applied to — and won — 3M’s Young Scientist Challenge in 2023, securing $25,000 and the title of “America’s Top Young Scientist.” With the help of Johns Hopkins professor and molecular biologist Vito Rebecca, Bekele has been testing the soap on lab mice at the university’s lab for almost half a year.

“[His idea] immediately piqued my interest, because I thought, how cool, him wanting to make it accessible to the whole world,” Rebecca said to Time.

The soap still has a long way to go: Testing, patenting it and getting FDA certification could take a decade. But even then, Bekele will only be 25 years old. Most medical school students don’t graduate until they are 28.

Bekele is only going into his sophomore year at Woodson High School in Fairfax this year. Still, he is incredibly humble.

“Anybody could do what I did,” Bekele said. “I just came up with an idea. I worked towards that idea, and I was able to bring it to life.”

Shield has previously been available to doctors as a screening tool, at an out-of-pocket cost of $895. With the FDA approval, Medicare and private insurance companies are much more likely to cover the cost of the blood test, making it more widely accessible for patients.

Dr. Arvind Dasari, an associate professor in the department of gastrointestinal and medical oncology at the University of Texas MD Anderson Cancer Center, called the approval a “welcome development.”

But, he cautioned, “we’ll have to wait and see what the impact will be in terms of improving screening and reducing the incidence of mortality.”

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The American Cancer Society estimates that more than 53,000 people will die of colorectal cancer this year.

Research published in March showed Shield was 83% effective in finding colorectal cancers. It works by detecting the DNA that cancerous tumors release into the bloodstream.

It’s most effective in finding later-stage cancers, when tumors release more of that DNA. The study found that Shield only detected 13% of earlier-stage polyps.

The test would need to be given at least every three years, starting at age 45 — the same age it’s recommended to begin colorectal screening.

A positive test isn’t necessarily a diagnosis. If the results indicate cancer is present, patients would still need a colonoscopy so doctors can see where tumors are located and how far they’ve progressed.

“People have to understand that a positive Shield test requires a colonoscopy to confirm that you have an advanced lesion or colorectal cancer, or that the results were false,” said Robert Smith, senior vice president of Early Cancer Detection Science at the American Cancer Society. “A test like this is not complete if it’s positive and you have not had a colonoscopy.”

This is the second blood test to screen for colon cancer; Epigenomics’ Epi proColon was approved in 2016. But it’s rarely used, Smith said, because of concerns about its accuracy. It’s also not covered by Medicare or private insurance.

Since the mid-1990s there’s been a troubling rise in colon cancer in people younger than 55, with rates increase increasing by 1% to 2% per year among that age group. At the same time, cases and deaths among adults 60 and older have been declining, according to the American Cancer Society.

“What breaks my heart is that it’s preventable,” said Dr. William Grady, a gastroenterologist at Fred Hutchinson Cancer Center in Seattle. “One of my biggest joys is when I’m doing colonoscopy and I can take out polyps” that, if left alone, would have progressed to cancer.

Indeed, colorectal cancer is one of the only cancers that can be prevented with screening, and colonoscopy is, by far, the most accurate way to detect it. But screening rates are extraordinarily low. Fewer than 60% of people who are eligible have had their recommended screening.

“The biggest problem with colon cancer right now is that there’s a significant part of the population that’s not getting screened,” said Dr. Sapna Syngal, director of strategic planning for prevention and early cancer detection at the Dana-Farber Cancer Center in Boston. “If this test increases the number of people getting screened, it’s going to have a huge impact.” 

Grady, who led the March study of the Shield test, said it’s often adults in their 40s and 50s who are least likely to be compliant with screening.

“These are people who are employed, many have families, and so you have all of these other life responsibilities that get in the way of taking care of themselves, he said.

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Colonoscopy is time-consuming, forcing people to take at least one day off work. There’s also a certain “ick” factor that many people find unpalatable. During the procedure, doctors insert a tiny camera into the rectum to look for tumors or spots that may become cancerous in the future.

That camera needs a clear view of the colon. The day before the colonoscopy, patients have to take a strong dose of laxatives. That is, they spend a lot of time in the bathroom.

“Many people don’t like the messiness of dealing with stool and many people really don’t like the colonoscopy — mostly the prep,” said Electra Paskett, deputy director for population sciences and community outreach at the Ohio State University Comprehensive Cancer Center. “I think a blood test would be ideal for many people.”

Another colon cancer screening method includes fecal occult blood tests that detect blood in the stool, which can be a warning sign of colon polyps or cancer. The FIT-DNA tests, such as Cologuard, are very effective at detecting cancer, but are less effective at detecting precancerous polyps. 

John Gormly, 77, of Newport Beach, California, had avoided colonoscopy screening for years. When his doctor gave him the option of the Shield blood test, he took it.

“He called me a day or so later and said, ‘I don’t like the results whatsoever. I’m going to send you off to get a colonoscopy,’” Gormly recalled. “Turns out I had stage 2 colon cancer.” Surgeons were able to remove the tumor completely.

“Thank God I had taken that blood test,” Gormly said. “I never felt anything, never knew anything was wrong. Short of that blood test, I don’t know how it would have turned out.”

This story first appeared on NBCNews.com.  More from NBC News:

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But Stafford, a maternal-fetal medicine physician at the University of Texas Health Sciences Center in Houston, quickly realized something was wrong: She couldn’t find a heartbeat. The unborn baby boy had already died in the womb. 

Soon after, the mother’s syphilis test — given to all women before delivery — came back positive. The infection had been silently passed from mother to son.

It’s a death, Stafford said, that could’ve been prevented with early detection and a shot of penicillin. 

Syphilis, a sexually transmitted infection, was nearly eliminated in the U.S. at the beginning of the 21st century but has made a dramatic comeback. In 2022, the Centers for Disease Control and Prevention reported more than 200,000 syphilis cases — the highest counts since 1950. Congenital syphilis has similarly increased tenfold over the past decade, the CDC says, even though 90% of cases are fully preventable.

Syphilis in the U.S.

More than 200,000 cases were reported in 2022, the most since 1950.

The return of syphilis is the result, experts say, of poorly funded prevention programs over the past two decades and difficulties in diagnosis; syphilis is referred to as the “great imitator” because its symptoms can vary so widely. Most people don’t show symptoms or know they’re infected, and even if they do visit the doctor’s office, there’s no guarantee they’ll be properly diagnosed.

Stafford said her patient didn’t have the resources to seek prenatal care, and no doctor or public health worker had ever told her that she should get tested for syphilis. So, when the patient noticed a small rash on her belly, she didn’t think too much about it, Stafford added.

“There’s a lot of people who are seen in private practice, hospital ERs, or walk-in centers, and those clinicians are not necessarily thinking of syphilis, they’re not necessarily getting a sexual history,” said Dr. Kenneth Mayer, an infectious disease physician and medical research director of the Fenway Institute in Boston. With a generation of doctors who saw few, if any, syphilis cases during their training, Mayer said that “the issue is tests not being done in the first place.”

The all-encompassing nature of the Covid pandemic added fuel to this fire, as public health departments redirected STI resources toward fighting the coronavirus.

“The solutions for controlling syphilis are relatively straightforward. We’re not talking about high tech approaches or a novel therapeutic,” said Dr. Dave Chokshi, chair of the Common Health Coalition and a former New York City Commissioner of Health. “It simply revolves around closing gaps in testing and treatment.”

As syphilis cases surge, doctors and public health officials are starting to develop innovative and sometimes unconventional strategies to screen people for syphilis and curb the spread of the disease. 

Most often, that comes down to figuring out how to get people tested, a task that’s far easier said than done.

Spreading the word about syphilis

Given these challenges, some public health departments have launched eye-popping awareness campaigns, trying to raise the alarm among both the public and health care providers. 

A few years ago, Donna Fox, the HIV and STI manager at the Toledo-Lucas County Health Department in Ohio, noticed that about one-fifth of syphilis cases in the area were among people who reported paying for sex. 

So, trying to be proactive — and a bit provocative — Fox and her team ran billboards across the county in 2022 saying, “Paying for Sex? Get Tested!”

“We had to go bold, and we had to get to the point,” she said. The pushback was inevitable — “you might have to say something to your 10-year-old who can read,” Fox conceded — but the impact was measurable. From 2021 through 2022, the number of syphilis appointments scheduled via the county health department jumped by almost 50%, and syphilis cases dropped by 12%, she said.

Of course, syphilis doesn’t just spread among sex workers, so last year, Fox’s team broadened the campaign, keeping the same look and feel but instead saying “Syphilis is Serious” with “Spreading Locally!” overlaid over the side.

Other billboard campaigns across the country have featured giant bloodshot, infected eyes with the blurry words “Eye Syphilis is Serious” and a black silhouette of a pregnant woman with a red belly saying “Syphilis Can Be Fatal to Your Baby.” While these billboards are factually true, Mayer describes how this kind of fear-based campaign, or “loss frame,” draws lots of attention but may not be particularly effective at motivating behavioral changes for STIs.

“We’re not telling anybody not to have sex,” Fox said. “We’re telling people to have safe sex,” and to get tested afterward.

The sex positivity message isn’t just for the public. The Toledo-Lucas health department also launched an educational campaign for clinicians, reminding them to take a sexual history of all patients — since the county saw syphilis in people ages 15 to 72 last year — and to order a blood test if they suspect an STI, since the standard “pee in a cup” test can’t detect syphilis.

“Many physicians haven’t seen syphilis, and they’ve got a million things to know,” Fox said. “If we don’t talk to the physicians, we’re not going to get the testing we need done.”

Stafford, the maternal-fetal medicine doctor in Houston, has taken a more hands-on approach. Texas mandates syphilis testing for pregnant women at three points — during their first prenatal visit, around the 28-week mark and before delivery — but in reality, these tests are often missed. So, last year, Stafford launched an alert in UTHealth’s electronic medical records, prompting providers to test their pregnant patients for syphilis at each of the prescribed times. The simple tweak helped increase screening rates from 2% to 47% at all three timepoints, while decreasing congenital syphilis cases by half.

Chokshi sees this as another good example of the public health and health care systems working hand-in-hand, with the former “setting the parameters of what standard of care should look like” and hospitals making it a reality. 

Make syphilis testing convenient

Beyond greater awareness, access to testing and treatment needs to be quick, easy and convenient, Chokshi said. 

Indian Country has led the way on this, partly by necessity: American Indian and Alaska Natives have the highest syphilis rates of any racial or ethnic group, almost seven times higher than white people. 

As such, tribes across the U.S. have turned to incentives, giving people $10 gift cards if they come in for STI testing or treatment, said Jessica Leston, founder of the Raven Collective, an Indigenous public health organization.

“We’re just helping people pay for gas and child care and get food on their table,” Leston said. At Cass Lake Indian Hospital’s pharmacy in rural Minnesota, the strategy increased STI testing tenfold, according to one study, with over 70% of the patients who got a test not having a primary care provider.

In 2023, a coalition of tribal communities partnered with Johns Hopkins School of Medicine to ramp up a program called I Want the Kit, which sends at-home STI test kits in the mail. The tests come in unmarked envelopes with instructions on how to collect a sample and send back the test. Results come back in a week or two, and patients are linked to health care resources if the test comes back positive.

Even with these programs, syphilis testing can be overshadowed by more immediate concerns.

In California, for example, half of pregnant women with syphilis reported methamphetamine use, and a quarter were homeless. In the state’s rural Shasta County, near the Oregon border, almost 100% of pregnant woman with syphilis similarly have a substance use disorder and 90% are unhoused, said Trojan Carvajal,
a supervising public health nurse in the county’s STI unit.

In April 2023, Shasta County launched the CommUNITY Mobile Care Clinic, an RV retrofitted with a reception area and two exam rooms, bringing STI tests and treatments to the county’s most vulnerable — from homeless camps to pop-ups with the local LBGTQ community center. Importantly, there’s no STI branding on the mobile clinic itself, allowing people to feel more comfortable walking in to get tested.

Last year, one-third of all syphilis tests performed by Shasta County were done through the mobile clinic, according to Jai Winchell, a community education specialist with the county’s public health department. These people would likely have never sought syphilis services otherwise, Winchell said, but with this mobile clinic crisscrossing the county and arriving at their doorsteps, they can get tested and treated in just 30 minutes.

Piggybacking syphilis services

Shasta County’s mobile clinic also offers other services, including test strips for deadly drugs like fentanyl and xylazine, naloxone to reverse overdoses and referrals to addiction counselors, as well as water, snacks and dental kits, Winchell said. The idea is to address overlapping concerns together, while also attracting those who wouldn’t have considered STI testing, if not for the package deal.

This approach also helps build trust, said Dr. Arlene Seña, an infectious diseases physician at the University of North Carolina Chapel Hill, showing how mobile clinic staff are invested in you as a person with various needs, rather than a singular problem to be solved. “It might be more costly, but it’s also much, much more effective and helpful to the community,” Seña said.

Syphilis services can also be integrated with general health care services. In March, Stafford launched a rapid testing program at two Houston hospitals aimed at all pregnant women admitted to the emergency department. The program, called Preg-Out, was set up on an opt-out basis, so everyone got tested unless they refused. It took about 15 minutes, and women were offered prenatal care regardless of the result.

“We noticed that pregnant patients, especially those that end up having a child with congenital syphilis, often frequent the ED and don’t get tested,” Stafford said. In the three-month pilot, Stafford said testing rates for pregnant women increased twelvefold, with about 35% of their partners wanting to get tested as well. 

Other hospitals have implemented opt-out screening programs for all patients, including Grady Memorial Hospital in Atlanta in one of their urgent care centers and the University of Chicago in their emergency department. Not every hospital has the resources to test everyone, Seña said, so she believes prioritizing pregnant patients, as done in Houston, can be a high-impact first step.

“You can’t just rely on public health departments to do the brunt of the work for STI recognition and prevention,” she said. “You have to go hand in hand with other providers in the community.”

The future ahead

The U.S. got syphilis rates down before, but that was in the 1990s, when HIV was ravaging through America. 

“What changed behavior then was lethal, hard-to-treat disease,” said Mayer, from Fenway Health. “Now, you have a generation of people who may be less informed,” leading to lower rates of condom use and STI screening rates. 

However, it’s also a time of innovation. In June, the CDC recommended doxycycline post-exposure prophylaxis for high-risk groups — essentially, a morning after pill for STIs. If taken within 72 hours of condomless sex, so-called DoxyPEP reduces syphilis rates by over 70%, and Fenway Health, where half of patients are LGBTQ, has already begun ramping up distribution, Mayer said. Meanwhile, other researchers like Seña have been working on developing a syphilis vaccine, but that’s probably several years down the line.

“Our task right now is to arrest the growth in cases,” said Chokshi, from the Common Health Coalition, and he’s optimistic that these innovative awareness, testing and treatment campaigns can do that. But permanently bending the syphilis curve will require scaling these efforts nationally and promoting greater coordination between health care and public health.

“There’s no reason that the endgame can’t be, once again, trying to eliminate syphilis — this historic scourge that is completely preventable and treatable,” Chokshi said.

This article first appeared on NBCNews.com. Read more from NBC News here:

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It’s tricky to tell if memory problems are caused by Alzheimer’s. That requires confirming one of the disease’s hallmark signs — buildup of a sticky protein called beta-amyloid — with a hard-to-get brain scan or uncomfortable spinal tap. Many patients instead are diagnosed based on symptoms and cognitive exams.

Labs have begun offering a variety of tests that can detect certain signs of Alzheimer’s in blood. Scientists are excited by their potential but the tests aren’t widely used yet because there’s little data to guide doctors about which kind to order and when. The U.S. Food and Drug Administration hasn’t formally approved any of them and there’s little insurance coverage.

“What tests can we trust?” asked Dr. Suzanne Schindler, a neurologist at Washington University in St. Louis who’s part of a research project examining that. While some are very accurate, “other tests are not much better than a flip of a coin.”

More than 6 million people in the United States and millions more around the world have Alzheimer’s, the most common form of dementia. Its telltale “biomarkers” are brain-clogging amyloid plaques and abnormal tau protein that leads to neuron-killing tangles.

New drugs, Leqembi and Kisunla, can modestly slow worsening symptoms by removing gunky amyloid from the brain. But they only work in the earliest stages of Alzheimer’s and proving patients qualify in time can be difficult. Measuring amyloid in spinal fluid is invasive. A special PET scan to spot plaques is costly and getting an appointment can take months.

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Even specialists can struggle to tell if Alzheimer’s or something else is to blame for a patient’s symptoms.

“I have patients not infrequently who I am convinced have Alzheimer’s disease and I do testing and it’s negative,” Schindler said.

Blood tests so far have been used mostly in carefully controlled research settings. But a new study of about 1,200 patients in Sweden shows they also can work in the real-world bustle of doctors’ offices — especially primary care doctors who see far more people with memory problems than specialists but have fewer tools to evaluate them.

In the study, patients who visited either a primary care doctor or a specialist for memory complaints got an initial diagnosis using traditional exams, gave blood for testing and were sent for a confirmatory spinal tap or brain scan.

Blood testing was far more accurate, Lund University researchers reported Sunday at the Alzheimer’s Association International Conference in Philadelphia. The primary care doctors’ initial diagnosis was 61% accurate and the specialists’ 73% — but the blood test was 91% accurate, according to the findings, which also were published in the Journal of the American Medical Association.

There’s almost “a wild West” in the variety being offered, said Dr. John Hsiao of the National Institute on Aging. They measure different biomarkers, in different ways.

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Doctors and researchers should only use blood tests proven to have a greater than 90% accuracy rate, said Alzheimer’s Association chief science officer Maria Carrillo.

Today’s tests most likely to meet that benchmark measure what’s called p-tau217, Carrillo and Hsiao agreed. Schindler helped lead an unusual direct comparison of several kinds of blood tests, funded by the Foundation for the National Institutes of Health, that came to the same conclusion.

That type of test measures a form of tau that correlates with how much plaque buildup someone has, Schindler explained. A high level signals a strong likelihood the person has Alzheimer’s while a low level indicates that’s probably not the cause of memory loss.

Several companies are developing p-tau217 tests including ALZpath Inc., Roche, Eli Lilly and C2N Diagnostics, which supplied the version used in the Swedish study.

Only doctors can order them from labs. The Alzheimer’s Association is working on guidelines and several companies plan to seek FDA approval, which would clarify proper use.

For now, Carrillo said doctors should use blood testing only in people with memory problems, after checking the accuracy of the type they order.

Especially for primary care physicians, “it really has great potential to help them in sorting out who to give a reassuring message and who to send on to memory specialists,” said Dr. Sebastian Palmqvist of Lund University, who led the Swedish study with Lund’s Dr. Oskar Hansson.

The tests aren’t yet for people who don’t have symptoms but worry about Alzheimer’s in the family — unless it’s part of enrollment in research studies, Schindler stressed.

That’s partly because amyloid buildup can begin two decades before the first sign of memory problems, and so far there are no preventive steps other than basic advice to eat healthy, exercise and get enough sleep. But there are studies underway testing possible therapies for people at high risk of Alzheimer’s, and some include blood testing.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Researchers at Northwestern Medicine and Brigham and Women’s Hospital say they’ve discovered a root cause of lupus, a disease that affects hundreds of thousands of people in the U.S. 

Scientists have long suspected that a person’s genetics or hormones may predispose them to lupus, and that the disease may be triggered by environmental factors like a previous viral infection or exposure to certain chemicals.

Now, a study published Wednesday in the journal Nature outlines a clear pathway for how the disease likely develops, pointing to abnormalities in the immune systems of people with lupus.

“What we found was this fundamental imbalance in the types of T cells that patients with lupus make,” said Dr. Deepak Rao, one of the study authors and a rheumatologist at Brigham and Women’s Hospital in Massachusetts. T-cells are white blood cells that play a key role in the body’s immune response. 

The study arrived at its findings by comparing blood samples from 19 people with lupus to blood samples from healthy individuals. The comparison showed that people with lupus have too much of a particular T cell associated with damage in healthy cells and too little of another T cell associated with repair.

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At the heart of this imbalance is a protein called interferon, which helps defend the body against pathogens. Scientists have known for many years that people with lupus have excess amounts of type I interferon — but the new study links this issue to several negative effects.

First, too much type I interferon can block a protein called the aryl hydrocarbon receptor, which helps regulate the body’s response to bacteria or environmental pollutants. 

Blocking this receptor hinders the production of T cells that can help heal wounds on the barrier of the skin, lungs and gut. It also stimulates the production of T cells involved in creating autoantibodies, which attack healthy cells and are a hallmark of lupus.

Rao said the theory could explain the vast majority of lupus cases.  

“I think this is going to apply to essentially all patients with lupus,” he said.

But other experts questioned the idea that there’s a singular explanation for all instances of lupus.

“It’s very exciting research and very hopeful, but I think that it might be too early to say that it’s the root cause of the disease,” said Mara Lennard Richard, scientific program officer for the Lupus Research Alliance. The alliance is a private funder of lupus research and contributed grant funding to Rao’s study.

Because lupus symptoms are so varied and the contributing factors are manifold, “it’s been very hard to find one singular root cause for the disease,” Lennard Richard said. “Obviously, if this turns out to be the cause of lupus, that would be amazing and really fantastic for people living with lupus.”

Dr. Jill Buyon, director of the division of rheumatology and the Lupus Center at NYU Langone Health, said the theory would need to be tested in a larger sample of people.

“Until they study 100 patients prospectively, how are we going to know?” said Buyon, who was not involved in the study.

The Centers for Disease Control and Prevention estimates that more than 200,000 people in the U.S. have lupus, though the Lupus Foundation of America puts the total much higher: roughly 1.5 million people. Around 90% of people with lupus are women.

Common symptoms include extreme fatigue, joint pain or skin rashes. In rare cases, the disease may lead to kidney or heart damage, or weaken the immune system so the body can’t fight off infections. These issues can be fatal or life-threatening.

Lupus has historically been difficult to treat. Many of the current options broadly suppress the immune system, including beneficial T cells that fight infection. And for some people with the disease, standard treatments aren’t effective. 

The new study hints at the possibility of better treatments in the future, which could take the forms of infusions or pills, said Dr. Jaehyuk Choi, one of the study authors and a dermatologist at Northwestern Medicine.

The study found that giving people with lupus anifrolumab, a drug that blocks interferon, prevented the T-cell imbalance that likely leads to the disease. 

“We followed patients who received this as part of their clinical care and showed that in patients who got the drug, this cell imbalance was fixed or was on the way to getting fixed,” Choi said.

In blood samples of people with lupus, the researchers also tested the effects of adding a small molecule that activates the aryl hydrocarbon receptor. They found that it limited the accumulation of disease-promoting T cells. 

The major challenge to developing a new treatment, according to Choi, is finding ways to administer it without activating aryl hydrocarbon receptors throughout the whole body, which may result in more side effects.

Even if such a treatment becomes available, Buyon said, it’s unlikely to work for everyone with lupus.

“We have come to the profound understanding that one drug will not do it all,” she said.

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But Stafford, a maternal-fetal medicine physician at the University of Texas Health Sciences Center in Houston, quickly realized something was wrong: She couldn’t find a heartbeat. The unborn baby boy had already died in the womb. 

Soon after, the mother’s syphilis test — given to all women before delivery — came back positive. The infection had been silently passed from mother to son.

It’s a death, Stafford said, that could’ve been prevented with early detection and a shot of penicillin. 

Syphilis, a sexually transmitted infection, was nearly eliminated in the U.S. at the beginning of the 21st century but has made a dramatic comeback. In 2022, the Centers for Disease Control and Prevention reported more than 200,000 syphilis cases — the highest counts since 1950. Congenital syphilis has similarly increased tenfold over the past decade, the CDC says, even though 90% of cases are fully preventable.

Syphilis in the U.S.

More than 200,000 cases were reported in 2022, the most since 1950.

The return of syphilis is the result, experts say, of poorly funded prevention programs over the past two decades and difficulties in diagnosis; syphilis is referred to as the “great imitator” because its symptoms can vary so widely. Most people don’t show symptoms or know they’re infected, and even if they do visit the doctor’s office, there’s no guarantee they’ll be properly diagnosed.

Stafford said her patient didn’t have the resources to seek prenatal care, and no doctor or public health worker had ever told her that she should get tested for syphilis. So, when the patient noticed a small rash on her belly, she didn’t think too much about it, Stafford added.

“There’s a lot of people who are seen in private practice, hospital ERs, or walk-in centers, and those clinicians are not necessarily thinking of syphilis, they’re not necessarily getting a sexual history,” said Dr. Kenneth Mayer, an infectious disease physician and medical research director of the Fenway Institute in Boston. With a generation of doctors who saw few, if any, syphilis cases during their training, Mayer said that “the issue is tests not being done in the first place.”

The all-encompassing nature of the Covid pandemic added fuel to this fire, as public health departments redirected STI resources toward fighting the coronavirus.

“The solutions for controlling syphilis are relatively straightforward. We’re not talking about high tech approaches or a novel therapeutic,” said Dr. Dave Chokshi, chair of the Common Health Coalition and a former New York City Commissioner of Health. “It simply revolves around closing gaps in testing and treatment.”

As syphilis cases surge, doctors and public health officials are starting to develop innovative and sometimes unconventional strategies to screen people for syphilis and curb the spread of the disease. 

Most often, that comes down to figuring out how to get people tested, a task that’s far easier said than done.

Spreading the word about syphilis

Given these challenges, some public health departments have launched eye-popping awareness campaigns, trying to raise the alarm among both the public and health care providers. 

A few years ago, Donna Fox, the HIV and STI manager at the Toledo-Lucas County Health Department in Ohio, noticed that about one-fifth of syphilis cases in the area were among people who reported paying for sex. 

So, trying to be proactive — and a bit provocative — Fox and her team ran billboards across the county in 2022 saying, “Paying for Sex? Get Tested!”

“We had to go bold, and we had to get to the point,” she said. The pushback was inevitable — “you might have to say something to your 10-year-old who can read,” Fox conceded — but the impact was measurable. From 2021 through 2022, the number of syphilis appointments scheduled via the county health department jumped by almost 50%, and syphilis cases dropped by 12%, she said.

Of course, syphilis doesn’t just spread among sex workers, so last year, Fox’s team broadened the campaign, keeping the same look and feel but instead saying “Syphilis is Serious” with “Spreading Locally!” overlaid over the side.

Other billboard campaigns across the country have featured giant bloodshot, infected eyes with the blurry words “Eye Syphilis is Serious” and a black silhouette of a pregnant woman with a red belly saying “Syphilis Can Be Fatal to Your Baby.” While these billboards are factually true, Mayer describes how this kind of fear-based campaign, or “loss frame,” draws lots of attention but may not be particularly effective at motivating behavioral changes for STIs.

“We’re not telling anybody not to have sex,” Fox said. “We’re telling people to have safe sex,” and to get tested afterward.

The sex positivity message isn’t just for the public. The Toledo-Lucas health department also launched an educational campaign for clinicians, reminding them to take a sexual history of all patients — since the county saw syphilis in people ages 15 to 72 last year — and to order a blood test if they suspect an STI, since the standard “pee in a cup” test can’t detect syphilis.

“Many physicians haven’t seen syphilis, and they’ve got a million things to know,” Fox said. “If we don’t talk to the physicians, we’re not going to get the testing we need done.”

Stafford, the maternal-fetal medicine doctor in Houston, has taken a more hands-on approach. Texas mandates syphilis testing for pregnant women at three points — during their first prenatal visit, around the 28-week mark and before delivery — but in reality, these tests are often missed. So, last year, Stafford launched an alert in UTHealth’s electronic medical records, prompting providers to test their pregnant patients for syphilis at each of the prescribed times. The simple tweak helped increase screening rates from 2% to 47% at all three timepoints, while decreasing congenital syphilis cases by half.

Chokshi sees this as another good example of the public health and health care systems working hand-in-hand, with the former “setting the parameters of what standard of care should look like” and hospitals making it a reality. 

Make syphilis testing convenient

Beyond greater awareness, access to testing and treatment needs to be quick, easy and convenient, Chokshi said. 

Indian Country has led the way on this, partly by necessity: American Indian and Alaska Natives have the highest syphilis rates of any racial or ethnic group, almost seven times higher than white people. 

As such, tribes across the U.S. have turned to incentives, giving people $10 gift cards if they come in for STI testing or treatment, said Jessica Leston, founder of the Raven Collective, an Indigenous public health organization.

“We’re just helping people pay for gas and child care and get food on their table,” Leston said. At Cass Lake Indian Hospital’s pharmacy in rural Minnesota, the strategy increased STI testing tenfold, according to one study, with over 70% of the patients who got a test not having a primary care provider.

In 2023, a coalition of tribal communities partnered with Johns Hopkins School of Medicine to ramp up a program called I Want the Kit, which sends at-home STI test kits in the mail. The tests come in unmarked envelopes with instructions on how to collect a sample and send back the test. Results come back in a week or two, and patients are linked to health care resources if the test comes back positive.

Even with these programs, syphilis testing can be overshadowed by more immediate concerns.

In California, for example, half of pregnant women with syphilis reported methamphetamine use, and a quarter were homeless. In the state’s rural Shasta County, near the Oregon border, almost 100% of pregnant woman with syphilis similarly have a substance use disorder and 90% are unhoused, said Trojan Carvajal,
a supervising public health nurse in the county’s STI unit.

In April 2023, Shasta County launched the CommUNITY Mobile Care Clinic, an RV retrofitted with a reception area and two exam rooms, bringing STI tests and treatments to the county’s most vulnerable — from homeless camps to pop-ups with the local LBGTQ community center. Importantly, there’s no STI branding on the mobile clinic itself, allowing people to feel more comfortable walking in to get tested.

Last year, one-third of all syphilis tests performed by Shasta County were done through the mobile clinic, according to Jai Winchell, a community education specialist with the county’s public health department. These people would likely have never sought syphilis services otherwise, Winchell said, but with this mobile clinic crisscrossing the county and arriving at their doorsteps, they can get tested and treated in just 30 minutes.

Piggybacking syphilis services

Shasta County’s mobile clinic also offers other services, including test strips for deadly drugs like fentanyl and xylazine, naloxone to reverse overdoses and referrals to addiction counselors, as well as water, snacks and dental kits, Winchell said. The idea is to address overlapping concerns together, while also attracting those who wouldn’t have considered STI testing, if not for the package deal.

This approach also helps build trust, said Dr. Arlene Seña, an infectious diseases physician at the University of North Carolina Chapel Hill, showing how mobile clinic staff are invested in you as a person with various needs, rather than a singular problem to be solved. “It might be more costly, but it’s also much, much more effective and helpful to the community,” Seña said.

Syphilis services can also be integrated with general health care services. In March, Stafford launched a rapid testing program at two Houston hospitals aimed at all pregnant women admitted to the emergency department. The program, called Preg-Out, was set up on an opt-out basis, so everyone got tested unless they refused. It took about 15 minutes, and women were offered prenatal care regardless of the result.

“We noticed that pregnant patients, especially those that end up having a child with congenital syphilis, often frequent the ED and don’t get tested,” Stafford said. In the three-month pilot, Stafford said testing rates for pregnant women increased twelvefold, with about 35% of their partners wanting to get tested as well. 

Other hospitals have implemented opt-out screening programs for all patients, including Grady Memorial Hospital in Atlanta in one of their urgent care centers and the University of Chicago in their emergency department. Not every hospital has the resources to test everyone, Seña said, so she believes prioritizing pregnant patients, as done in Houston, can be a high-impact first step.

“You can’t just rely on public health departments to do the brunt of the work for STI recognition and prevention,” she said. “You have to go hand in hand with other providers in the community.”

The future ahead

The U.S. got syphilis rates down before, but that was in the 1990s, when HIV was ravaging through America. 

“What changed behavior then was lethal, hard-to-treat disease,” said Mayer, from Fenway Health. “Now, you have a generation of people who may be less informed,” leading to lower rates of condom use and STI screening rates. 

However, it’s also a time of innovation. In June, the CDC recommended doxycycline post-exposure prophylaxis for high-risk groups — essentially, a morning after pill for STIs. If taken within 72 hours of condomless sex, so-called DoxyPEP reduces syphilis rates by over 70%, and Fenway Health, where half of patients are LGBTQ, has already begun ramping up distribution, Mayer said. Meanwhile, other researchers like Seña have been working on developing a syphilis vaccine, but that’s probably several years down the line.

“Our task right now is to arrest the growth in cases,” said Chokshi, from the Common Health Coalition, and he’s optimistic that these innovative awareness, testing and treatment campaigns can do that. But permanently bending the syphilis curve will require scaling these efforts nationally and promoting greater coordination between health care and public health.

“There’s no reason that the endgame can’t be, once again, trying to eliminate syphilis — this historic scourge that is completely preventable and treatable,” Chokshi said.

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While Joro spiders are harmless to people and pets, their size and presence could trigger insectophobia, an excessive and intense fear of insects.

News4 spoke with Dr. Asha Patton-Smith, a child and adolescent psychiatrist with Kaiser Permanente, about how to calm yourself — and your children — if you spot the spiders.

How is insectophobia different than the average fear of bugs and spiders?

“Insectophobia is not just not liking insects. It is an intense fear that is in many ways something that can’t be explained and not something really that is understandable or based in reality. So people are deathly afraid of these things and it typically manifests in panic symptoms, sometimes almost paralysis, refusing to go into an area where they see the insect. Fear of seeing the insect prevents them from moving forward in daily activities. So it really is a big deal,” Patton-Smith said.

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“Please, everyone, educate yourself about what this spider looks like because it’s striking. It’s a bright color. It’s sometimes as big as the female hand. So it is huge, and what you can do is be prepared if you see it,” Patton-Smith said.

Female Joro spiders have gray-blue and yellow stripes on its abdomen and black legs with yellow bands. It’s underside has distinct red markings. Male Joro spiders are brown and smaller.

Athough startling, Patton-Smith says to focus on the fact that they are harmelss. A study from the University of Georgia found the spiders are actually quite shy.

“You know that, apparently, they’re very docile. They don’t attack … so they’re not going to hurt you,” Patton-Smith said.

“At the same time, how to overcome fear is to get information. So, learn about the spider, read about the spider, research about the spider and if that’s not enough, especially for people that are dealing with intense fear, we usually treat it like we would any type of anxiety or panic symptoms. So relaxation techniques, deep breathing,” she said.

“If that’s not enough, it’s time to talk to a mental health professional. There’s a specific type of therapy that can be done, cognitive behavioral therapy, that reframes some of the intensive, fears and there’s also exposure therapy, where you work with the therapist on slowly being exposed to whatever the insect is or the spider is, so that can slowly decrease the fear in a graduated way.”

What other steps can you take to help children or others who fear spiders?

“Yeah, so the first thing is try to be as calm as possible in these situations. Now … it’s sometimes very difficult. So if you’re afraid in a situation or you’re seeing some sort of insect that you don’t like to say, ‘Okay, this is really bothering me I’m going to take some deep breaths right now because this is really challenging.’ That helps kids know that emotions are okay, showing emotions are fine and we can slowly recircuit our brain waves and recircuit our brain chemistry to make sure that we are handling the anxiety in a meaningful way. But education is key. Learning about whatever the threat is really does help.”

The Joro Spider is native to East Asia and first arrived on U.S. soil years ago after hitching a ride on cargo ships. Experts say they can live from the Southeast all the way into northern Canada.

Starting in the fall, the donation will cover full tuition for medical students from families earning less than $300,000. Living expenses and fees will be covered for students from families who earn up to $175,000.

Bloomberg Philanthropies said that currently almost two-thirds of all students seeking a doctor of medicine degree from Johns Hopkins qualify for financial aid, and 45% of the current class will also receive living expenses. The school estimates that graduates’ average total loans will decrease from $104,000 currently to $60,279 by 2029.

The gift will also increase financial aid for students at the university’s schools of nursing, public health, and other graduate schools.

“By reducing the financial barriers to these essential fields, we can free more students to pursue careers they’re passionate about – and enable them to serve more of the families and communities who need them the most,” Michael Bloomberg, founder of Bloomberg Philanthropies and Bloomberg LP, said in a statement on Monday. Bloomberg received a bachelor’s degree in electrical engineering from Johns Hopkins University in 1964.

The entire gift has been delivered to John Hopkins’ endowment and every penny will go directly to students, said Ron Daniels, president of Johns Hopkins University.

“Mike has really been moved by the challenges that the professions confronted during the course of the pandemic and the heroic efforts they’ve made to protecting and providing care to American citizens during the pandemic,” Daniels said in an interview. “I think he simply wanted to recognize the importance of these fields and provide this support to ensure that the best and brightest could attend medical school and the school of nursing and public health.”

Bloomberg Philanthropies previously gifted $1.8 billion to Johns Hopkins in 2018 to ensure that undergraduate students are accepted regardless of their family’s income.

Johns Hopkins will be the latest medical school to offer free tuition to most or all of their medical students.

In February Ruth Gottesman, a former professor at the Albert Einstein College of Medicine and the widow of a Wall Street investor, announced that she was donating $1 billion to the school. The gift meant that four-year students immediately received free tuition and all other students will be offered free tuition in the fall.

In 2018, Kenneth and Elaine Langone gave $100 million to the NYU Grossman School of Medicine to make tuition free for all current and future medical students through an endowment fund. The couple gave a second gift of $200 million in 2023 to the NYU Grossman Long Island School of Medicine to guarantee free tuition for all medical students. Kenneth Langone is a co-founder of Home Depot.

Other medical schools, like UCLA’s David Geffen School of Medicine, offer merit-based scholarships thanks to some $146 million in donations from the recording industry mogul, David Geffen. The Cleveland Clinic Lerner College of Medicine has also offered tuition-free education for medical students since 2008.

Candice Chen, associate professor, Milken Institute School of Public Health at The George Washington University, has researched the social missions of medical schools and had a strong reaction to the recent major gifts to John Hopkins, NYU and Albert Einstein.

“Collectively the medical schools right now, I hate to say this, but they’re failing in terms of producing primary care, mental health specialists as well as the doctors who will work in and serve in rural and underserved communities,” Chen said. She would have loved to see this gift go to Meharry Medical College in Tennessee, for example, which is a historically Black school that has produced many primary care doctors who work in communities that have shortages.

There have been only a handful of previous $1 billion donations to universities in the U.S., most coming in the past several years.

In 2022, the venture capitalist John Doerr and his wife, Ann, gave $1.1 billion to Stanford University for a new school focusing on climate change.

The small liberal arts school, McPherson College, in Kansas, has received two matching pledges since 2022 from an anonymous donor totaling $1 billion. The school, which has around 800 enrolled students, has a program for automotive restoration and is located about 57 miles north of Wichita, Kansas.

Bloomberg, the former New York mayor, gave $3 billion to charities in 2023, making him one of the largest donors, according to research by the Chronicle of Philanthropy.

But Stafford, a maternal-fetal medicine physician at the University of Texas Health Sciences Center in Houston, quickly realized something was wrong: She couldn’t find a heartbeat. The unborn baby boy had already died in the womb. 

Soon after, the mother’s syphilis test — given to all women before delivery — came back positive. The infection had been silently passed from mother to son.

It’s a death, Stafford said, that could’ve been prevented with early detection and a shot of penicillin. 

Syphilis, a sexually transmitted infection, was nearly eliminated in the U.S. at the beginning of the 21st century but has made a dramatic comeback. In 2022, the Centers for Disease Control and Prevention reported more than 200,000 syphilis cases — the highest counts since 1950. Congenital syphilis has similarly increased tenfold over the past decade, the CDC says, even though 90% of cases are fully preventable.

Syphilis in the U.S.

More than 200,000 cases were reported in 2022, the most since 1950.

The return of syphilis is the result, experts say, of poorly funded prevention programs over the past two decades and difficulties in diagnosis; syphilis is referred to as the “great imitator” because its symptoms can vary so widely. Most people don’t show symptoms or know they’re infected, and even if they do visit the doctor’s office, there’s no guarantee they’ll be properly diagnosed.

Stafford said her patient didn’t have the resources to seek prenatal care, and no doctor or public health worker had ever told her that she should get tested for syphilis. So, when the patient noticed a small rash on her belly, she didn’t think too much about it, Stafford added.

“There’s a lot of people who are seen in private practice, hospital ERs, or walk-in centers, and those clinicians are not necessarily thinking of syphilis, they’re not necessarily getting a sexual history,” said Dr. Kenneth Mayer, an infectious disease physician and medical research director of the Fenway Institute in Boston. With a generation of doctors who saw few, if any, syphilis cases during their training, Mayer said that “the issue is tests not being done in the first place.”

The all-encompassing nature of the Covid pandemic added fuel to this fire, as public health departments redirected STI resources toward fighting the coronavirus.

“The solutions for controlling syphilis are relatively straightforward. We’re not talking about high tech approaches or a novel therapeutic,” said Dr. Dave Chokshi, chair of the Common Health Coalition and a former New York City Commissioner of Health. “It simply revolves around closing gaps in testing and treatment.”

As syphilis cases surge, doctors and public health officials are starting to develop innovative and sometimes unconventional strategies to screen people for syphilis and curb the spread of the disease. 

Most often, that comes down to figuring out how to get people tested, a task that’s far easier said than done.

Spreading the word about syphilis

Given these challenges, some public health departments have launched eye-popping awareness campaigns, trying to raise the alarm among both the public and health care providers. 

A few years ago, Donna Fox, the HIV and STI manager at the Toledo-Lucas County Health Department in Ohio, noticed that about one-fifth of syphilis cases in the area were among people who reported paying for sex. 

So, trying to be proactive — and a bit provocative — Fox and her team ran billboards across the county in 2022 saying, “Paying for Sex? Get Tested!”

“We had to go bold, and we had to get to the point,” she said. The pushback was inevitable — “you might have to say something to your 10-year-old who can read,” Fox conceded — but the impact was measurable. From 2021 through 2022, the number of syphilis appointments scheduled via the county health department jumped by almost 50%, and syphilis cases dropped by 12%, she said.

Of course, syphilis doesn’t just spread among sex workers, so last year, Fox’s team broadened the campaign, keeping the same look and feel but instead saying “Syphilis is Serious” with “Spreading Locally!” overlaid over the side.

Other billboard campaigns across the country have featured giant bloodshot, infected eyes with the blurry words “Eye Syphilis is Serious” and a black silhouette of a pregnant woman with a red belly saying “Syphilis Can Be Fatal to Your Baby.” While these billboards are factually true, Mayer describes how this kind of fear-based campaign, or “loss frame,” draws lots of attention but may not be particularly effective at motivating behavioral changes for STIs.

“We’re not telling anybody not to have sex,” Fox said. “We’re telling people to have safe sex,” and to get tested afterward.

The sex positivity message isn’t just for the public. The Toledo-Lucas health department also launched an educational campaign for clinicians, reminding them to take a sexual history of all patients — since the county saw syphilis in people ages 15 to 72 last year — and to order a blood test if they suspect an STI, since the standard “pee in a cup” test can’t detect syphilis.

“Many physicians haven’t seen syphilis, and they’ve got a million things to know,” Fox said. “If we don’t talk to the physicians, we’re not going to get the testing we need done.”

Stafford, the maternal-fetal medicine doctor in Houston, has taken a more hands-on approach. Texas mandates syphilis testing for pregnant women at three points — during their first prenatal visit, around the 28-week mark and before delivery — but in reality, these tests are often missed. So, last year, Stafford launched an alert in UTHealth’s electronic medical records, prompting providers to test their pregnant patients for syphilis at each of the prescribed times. The simple tweak helped increase screening rates from 2% to 47% at all three timepoints, while decreasing congenital syphilis cases by half.

Chokshi sees this as another good example of the public health and health care systems working hand-in-hand, with the former “setting the parameters of what standard of care should look like” and hospitals making it a reality. 

Make syphilis testing convenient

Beyond greater awareness, access to testing and treatment needs to be quick, easy and convenient, Chokshi said. 

Indian Country has led the way on this, partly by necessity: American Indian and Alaska Natives have the highest syphilis rates of any racial or ethnic group, almost seven times higher than white people. 

As such, tribes across the U.S. have turned to incentives, giving people $10 gift cards if they come in for STI testing or treatment, said Jessica Leston, founder of the Raven Collective, an Indigenous public health organization.

“We’re just helping people pay for gas and child care and get food on their table,” Leston said. At Cass Lake Indian Hospital’s pharmacy in rural Minnesota, the strategy increased STI testing tenfold, according to one study, with over 70% of the patients who got a test not having a primary care provider.

In 2023, a coalition of tribal communities partnered with Johns Hopkins School of Medicine to ramp up a program called I Want the Kit, which sends at-home STI test kits in the mail. The tests come in unmarked envelopes with instructions on how to collect a sample and send back the test. Results come back in a week or two, and patients are linked to health care resources if the test comes back positive.

Even with these programs, syphilis testing can be overshadowed by more immediate concerns.

In California, for example, half of pregnant women with syphilis reported methamphetamine use, and a quarter were homeless. In the state’s rural Shasta County, near the Oregon border, almost 100% of pregnant woman with syphilis similarly have a substance use disorder and 90% are unhoused, said Trojan Carvajal,
a supervising public health nurse in the county’s STI unit.

In April 2023, Shasta County launched the CommUNITY Mobile Care Clinic, an RV retrofitted with a reception area and two exam rooms, bringing STI tests and treatments to the county’s most vulnerable — from homeless camps to pop-ups with the local LBGTQ community center. Importantly, there’s no STI branding on the mobile clinic itself, allowing people to feel more comfortable walking in to get tested.

Last year, one-third of all syphilis tests performed by Shasta County were done through the mobile clinic, according to Jai Winchell, a community education specialist with the county’s public health department. These people would likely have never sought syphilis services otherwise, Winchell said, but with this mobile clinic crisscrossing the county and arriving at their doorsteps, they can get tested and treated in just 30 minutes.

Piggybacking syphilis services

Shasta County’s mobile clinic also offers other services, including test strips for deadly drugs like fentanyl and xylazine, naloxone to reverse overdoses and referrals to addiction counselors, as well as water, snacks and dental kits, Winchell said. The idea is to address overlapping concerns together, while also attracting those who wouldn’t have considered STI testing, if not for the package deal.

This approach also helps build trust, said Dr. Arlene Seña, an infectious diseases physician at the University of North Carolina Chapel Hill, showing how mobile clinic staff are invested in you as a person with various needs, rather than a singular problem to be solved. “It might be more costly, but it’s also much, much more effective and helpful to the community,” Seña said.

Syphilis services can also be integrated with general health care services. In March, Stafford launched a rapid testing program at two Houston hospitals aimed at all pregnant women admitted to the emergency department. The program, called Preg-Out, was set up on an opt-out basis, so everyone got tested unless they refused. It took about 15 minutes, and women were offered prenatal care regardless of the result.

“We noticed that pregnant patients, especially those that end up having a child with congenital syphilis, often frequent the ED and don’t get tested,” Stafford said. In the three-month pilot, Stafford said testing rates for pregnant women increased twelvefold, with about 35% of their partners wanting to get tested as well. 

Other hospitals have implemented opt-out screening programs for all patients, including Grady Memorial Hospital in Atlanta in one of their urgent care centers and the University of Chicago in their emergency department. Not every hospital has the resources to test everyone, Seña said, so she believes prioritizing pregnant patients, as done in Houston, can be a high-impact first step.

“You can’t just rely on public health departments to do the brunt of the work for STI recognition and prevention,” she said. “You have to go hand in hand with other providers in the community.”

The future ahead

The U.S. got syphilis rates down before, but that was in the 1990s, when HIV was ravaging through America. 

“What changed behavior then was lethal, hard-to-treat disease,” said Mayer, from Fenway Health. “Now, you have a generation of people who may be less informed,” leading to lower rates of condom use and STI screening rates. 

However, it’s also a time of innovation. In June, the CDC recommended doxycycline post-exposure prophylaxis for high-risk groups — essentially, a morning after pill for STIs. If taken within 72 hours of condomless sex, so-called DoxyPEP reduces syphilis rates by over 70%, and Fenway Health, where half of patients are LGBTQ, has already begun ramping up distribution, Mayer said. Meanwhile, other researchers like Seña have been working on developing a syphilis vaccine, but that’s probably several years down the line.

“Our task right now is to arrest the growth in cases,” said Chokshi, from the Common Health Coalition, and he’s optimistic that these innovative awareness, testing and treatment campaigns can do that. But permanently bending the syphilis curve will require scaling these efforts nationally and promoting greater coordination between health care and public health.

“There’s no reason that the endgame can’t be, once again, trying to eliminate syphilis — this historic scourge that is completely preventable and treatable,” Chokshi said.

This article first appeared on NBCNews.com. Read more from NBC News here:

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After thorough testing, officials were unable to detect E. coli in the water. The source of the outbreak remains unknown. 

The VDH conducted extensive water testing approximately four weeks after the incidents, but results showed no presence of E. coli. Additionally, fecal bacteria levels were not high enough to pose a public health concern. 

According to the VDH, E. coli infection causes stomach cramps and diarrhea, and can cause include vomiting, fever and chills. In severe cases, it can damage organs, including the kidneys, and lead to hemolytic uremic syndrome, which affects the kidneys and the body’s blood clotting system.

Ava Inglett,15, of Northern Virginia, was one of the people affected by the outbreak. 

She suffered severe complications, including renal failure, and underwent multiple blood transfusions and dialysis sessions.

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The VDH reminds the public that natural bodies of water, such as Lake Anna, always pose some health risks because they are untreated. Swimmers are advised to take precautions such as avoiding swallowing water, showering after swimming, and avoiding the water if they have open wounds or are ill. 

“I just want people to know and think twice before they let their child take a swim in that water, because I would hate for anybody else to go through what my daughter’s been through,” Judy Inglett, Ava’s mother, previously told News4.

News4 sends breaking news stories by email. Go here to sign up to get breaking news alerts in your inbox.

While the investigation into the Memorial Day outbreak is closed, the VDH will continue enhanced public health surveillance through July 17 in light of Fourth of July celebrations. Regular bacterial monitoring of Lake Anna will continue as part of routine public health measures. 

Botanically known as Toxicodendron radicans, poison ivy contains oily chemical compounds called urushiols in its leaves, stems and roots. According to the American Skin Association, about 85% of the U.S. population is allergic to urushiols, with roughly 10% to 15% of those considered “highly allergic.”

That makes the plant concerning — and possibly dangerous — for most Americans, with 50 million people affected each year, the group says. So, in most cases, it should be removed.

But the itchy, blistering and sometimes painful dermatitis that affects most people who brush up against poison ivy can discourage efforts to tackle it.

It’s a Catch-22: You need to remove it because you’re allergic but you’re allergic so you can’t remove it.

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First, know how to identify it

Making a positive ID can be tricky.

Poison ivy takes on different appearances at different times of year. Most often, its leaves are composed of three leaflets apiece (as referenced in the childhood rhyme, “leaves of three, let it be”). The middle stem is longer than the stems of the side leaflets. Young foliage is shiny; older leaves are dull. Larger, older vines, especially those climbing up trees, are hairy. Leaf color can be green, red, pink-tinged, yellow or orange. Leaf shape can also vary, with smooth, lobed or toothed margins.

I’ll confess, it confuses me, too. I once pulled up a raspberry plant (RIP) that I misidentified as poison ivy.

Consult with a poison ivy expert, bring a (bagged) sample to your local cooperative extension office, download a plant identification app or compare photos of your vine to those in books or on an educational website.

Then, either call in a professional or, if removing it yourself, carefully implement protective measures.

How to remove it safely

Wear long sleeves, pants, gloves and goggles, and don’t touch anything, especially your face, during the process. Avoid contact with tools or clothing used during the job, and remove all clothing afterward so as not to allow it to come into contact with skin or other surfaces.

The best way to eradicate poison ivy is to pull it up by its roots. If you garden in a four-season area, the job will be easiest in early spring, after winter’s freeze-thaw cycles have softened the ground. Otherwise, waiting until after rainfall is best for the same reason.

Pulling, you’ll notice, will likely leave some of the roots behind, as they can grow up to a foot deep. The entire root system must be completely dug up to avoid a reoccurrence, but if you’re tired, that can wait until tomorrow.

As you dig, you’ll notice the plant also has runner roots that have grown horizontally under the soil surface. Depending on the size of the plant, they can extend up to 20 feet from it. Remove them, too.

How to clean up properly afterward

Proper disposal of all plant parts is critical. Place them in a tightly sealed, heavy black plastic bag and set it out with the trash. Never burn poison ivy, because the smoke would contain toxins that could be fatal if inhaled.

When you’re finished, don’t touch your door. Don’t get yourself a drink. Don’t open the washing machine. Don’t. Touch. Anything.

This is easiest if you have someone to open the door, put your clothes into the washer, etc. If not, take care to do things in the proper order to avoid cross-contamination: Strip naked, remove your gloves then wash your hands with a liquid cleanser specially formulated to remove traces of the resins. One is Tecnu, which also can be used to launder contaminated clothing.

Then, bring the bottle into the shower with you. Avoid bathing with ordinary soap because it can spread the oils to other parts of your body.

Urushiols can also be transmitted to people via gardening tools, footwear, clothing and pets for as long as a year or two after contact, so anything that touched the plant should be thoroughly cleaned, too. Then wash your hands again. You can’t be too careful.

As time goes on, some sprouts will likely reappear, so repeated pulling and digging may be required over the next several seasons.

Other options

If pulling is not possible, herbicides containing triclopyr or glyphosate can be used to kill the plant. I do not advocate the use of these chemicals except in extreme circumstances, such as to control Japanese knotweed. But if you are severely allergic, I consider poison ivy removal in that category.

Just know that these herbicides will kill every plant they come in contact with, including grass. They also have toxic properties that will remain in the soil for some time. Use them only on a windless day to avoid overspray and take care to directly target only the poison ivy. Apply to leaves as directed, following precautions on the package label.

Plants should wilt within 24 hours, turn brown within three days and die in a couple of weeks, at which point they can be removed. Take the same precautions as above because dead (and dormant) plants still contain toxins. Repeat applications may be necessary.

And don’t get cocky. Just because you’re not allergic today doesn’t mean you won’t be tomorrow. Always protect yourself.

Drug companies are racing to develop GLP-1 drugs following the blockbuster success of Novo Nordisk’s Ozempic and Wegovy and Eli Lilly’s Mounjaro and Zepbound.

Some of the experimental drugs may go beyond diabetes and weight loss, improving liver and heart function while reducing side effects such as muscle loss common to the existing medications. At the 2024 American Diabetes Association conference in Orlando, Florida, researchers are expected to present data on 27 GLP-1 drugs in development.

“We’ve heard about Ozempic and Mounjaro and so on, but now we’re seeing lots and lots of different drug candidates in the pipeline, from very early-stage preclinical all the way through late-stage clinical,” said Dr. Marlon Pragnell, ADA’s vice president of research and science. “It’s very exciting to see so much right now.”

A large portion of the data presented comes from animal studies or early-stage human trials. However, some presentations include mid-to late-stage trials, according to a list shared by the organization.

Approval by the Food and Drug Administration is likely years away for most. Some of the drugs showcased could be available for prescription in the U.S. within the next few years.

“We’ve witnessed an unprecedented acceleration in the development of GLP drugs,” said Dr. Christopher McGowan, a gastroenterologist who runs a weight loss clinic in Cary, North Carolina. “We are now firmly entrenched in the era of the GLP.”

While the existing drugs are highly effective, new drugs that are more affordable and have fewer side effects are needed, McGowan added.

There aren’t just GLP-1 drugs in the pipeline. On Thursday, ahead of the diabetes conference, Denmark-based biotech firm Zealand Pharma released data that showed a high dose of its experimental weight loss drug petrelintide helped reduce body weight by an average of 8.6% at 16 weeks.

The weekly injectable medication is unique because it mimics the hormone amylin, which helps control blood sugar. The hope is patients will experience fewer side effects like nausea commonly associated with GLP-1 drugs such as Wegovy and Zepbound.

Can glucagon hormone help with weight loss?

GLP-1 medications work, in part, by slowing down how quickly food passes through the stomach, leading people to feel fuller longer. In several of the upcoming weight loss drugs, a different hormone called glucagon is in the spotlight. Glucagon is a key blood-sugar-regulating hormone that can mimic the effects of exercise.

One of the drugs featured at the conference on Sunday is called pemvidutide, from Maryland-based biotech firm Altimmune.

The drug contains the GLP-1 hormone, a key ingredient in Ozempic and Wegovy, in addition to glucagon.

Altimmune released data from a phase 2 trial of 391 adults with obesity or who are overweight with at least one weight-related comorbidity such as high blood pressure. Patients were randomized to either get one of three doses of pemvidutide or a placebo for 48 weeks.

Researchers found that patients who got the highest dose of the drug lost on average 15.6% of their body weight after 48 weeks, compared to the 2.2% body weight loss seen in patients who got a placebo. In similar trials, semaglutide was shown to reduce body weight by around 15% after 68 weeks.

These are not direct comparisons because the drugs weren’t compared in a head-to-head clinical trial.

Dr. Scott Harris, Altimmune’s chief medical officer, said the drug has been shown to help people lose weight, as well as provide health benefits to the liver and heart. What’s more, the drug has shown benefits in preserving lean body mass. Some studies have suggested that semaglutide, the active ingredient in Ozempic and Wegovy, can cause muscle loss.

“If people take the drugs long term, what’s going to be their long-term health? What’s going to be the long-term effects on their body composition, their muscle, their ability to function?” he said.

Harris said that people who got pemvidutide lost on average 21% of their lean body mass, which is lower than the around 25% of lean body mass people typically lose with diet and exercise.

“We’re the next wave of obesity drugs,” Altimmune President and CEO Vipin Garg said. “The first wave of mechanisms was all driven by appetite suppression. We are adding another component.”

Altimmune expects to begin a phase 3 trial soon. The company hopes the drug will be available in the U.S. sometime in 2028.

Competition could drive down costs

Expanding the number of weight loss drugs available is important for several reasons, experts say.

More options could also help alleviate the shortages seen in the U.S. with Novo Nordisk’s and Lilly’s weight loss drugs.

Increased competition could drive down the high cost of the drugs over time. A month’s supply of Wegovy or Zepbound can cost more than $1,000, often financially untenable for many patients, experts say.

Patients can also respond differently to treatments, said Dr. Fatima Cody Stanford, an associate professor of medicine and pediatrics at Harvard Medical School. In fact, some have found the existing GLP-1 options ineffective.

“Different GLP-1 drugs may have varying levels of efficacy and potency,” she said. “Some patients may respond better to one drug over another, depending on how their body metabolizes and responds to the medication.”

Since starting Ozempic in June 2022, Danielle Griffin has not seen the results her doctor predicted. “She really expected to see a huge difference in my weight, and I just never saw it,” said the 38-year-old from Elida, New Mexico. Griffin weighed about 300 pounds and has lost only about 10 pound in two years. She said her “expectations were pretty much shattered from that.”

Amid insurance battles and shortages, she has also tried Wegovy and Mounjaro, but didn’t see a difference in her weight.

“I don’t feel like there are options, especially for myself, for someone who the medications not working for.”

The prospect of new medications on the horizon excites Griffin. “I would be willing to try it,” she said, adding that “it could be life changing, honestly, and you know that alone gives me something to look forward to.”

More drugs in the pipeline

Eli Lilly, which makes Zepbound and the diabetes version Mounjaro, has two more GLP-1 drugs in development.

On Sunday, Lilly released new data about retatrutide, an injectable drug that combines GLP-1 and glucagon, plus another hormone called GIP. GIP is thought to improve how the body breaks down sugar.

In an earlier trial, retatrutide helped people lose, on average, about 24% of their body weight, the equivalent of about 58 pounds — greater weight loss than any other drug on the market.

New findings showed the weekly medication also significantly reduced blood sugar levels in people with Type 2 diabetes.

On Saturday, there were also new findings on the experimental mazdutide, which Lilly is developing in partnership with the Chinese biotech firm Innovent Biologics. The drug combines GLP-1 and glucagon.

In a phase 3 study of adults in China who were overweight or had obesity, researchers found that after 48 weeks, a 6-milligram dose of the drug led to an average body weight reduction of 14.4%.

The drug also led to a reduction in serum uric acid — a chemical that can build up in the bloodstream, causing health problems, and has been associated with obesity, according to Dr. Linong Ji, director of the Peking University Diabetes Center, who presented the findings.

That was “quite unique and never reported for other GLP-1-based therapies,” he said in an interview.

The drug could be approved in China in 2025, Ji said.

Improving metabolic conditions

An estimated 75% of people with obesity have nonalcoholic fatty liver disease and 34% have MASH, or metabolic dysfunction-associated steatohepatitis, according to researchers with the German drugmaker Boehringer Ingelheim. Fatty liver disease occurs when the body begins to store fat in the liver. It can progress to MASH, when fat buildup causes inflammation and scarring.

In a phase 2 trial of people who were overweight or had obesity, Boehringer Ingelheim’s survodutide, which uses both GLP-1 and glucagon, led to weight loss of 19% at 46 weeks. Another phase 2 study in people with MASH and fibrosis found that 83% of participants also showed improvement in MASH.

Survodutide “has significant potential to make a meaningful difference to people living with cardiovascular, renal and metabolic conditions,” said Dr. Waheed Jamal, Boehringer Ingelheim’s corporate vice president and head of cardiometabolic medicine.

On Friday, the company released two studies on the drug. One, in hamsters, found that weight loss was associated with improvements in insulin and cholesterol. The second, in people with Type 2 diabetes or people with obesity, found the drug helped improve blood sugar levels. 

The company is looking to begin a phase 3 trial.

This article first appeared on NBCNews.com. Read more from NBC News here:

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High up in the hills of Barcelona, brain science start-up Neuroelectrics is developing therapies that it says will improve the lives of people living with brain disease. 

The group manufactures around 400 devices, which it ships to 75 different countries worldwide each year.

Its main product is a headcap, which monitors the brain’s electrical activity and stimulates regions of the brain with mild electrical currents.

Co-founder and CEO Ana Maiques believes it will significantly improve the lives of people suffering with epilepsy.

“In the world, there are 60 million patients suffering from epilepsy and one third of those don’t respond to medication,” Maiques told CNBC Tech: The Edge in an interview.

“These patients usually go into surgery, either a craniotomy — we remove the part of the brain that is creating the seizures — or an implanted device. So Neuroelectrics is bringing this noninvasive solution to try to reduce seizures.”

In a 17-patient study approved by U.S. Food and Drug Administration, the technology demonstrated a median seizure reduction of 41%. Neuroelectrics is pursuing FDA approval by September 2025.

In addition to epilepsy, Maiques and her team are optimistic that the headgear can also be used to treat depression and Alzheimer’s.

“Our devices read the electrical activity of the brain, but also inject electricity. So, the areas that we’re focused on are those that are clearly electric. So, when you have epilepsy, you have an electrical discharge in one area of your brain, so they can really target and help them,” said Roser Sanchez-Todo, R&D director for Neuroelectrics’ brain modelling department.

NeuroTwin

Before a patient can use the technology, Neuroelectrics builds a replica of their brain, known as a NeuroTwin.

“We’ve been using what is now called AI, or machine learning, for years. If you think of flight pilots, they don’t go into planes, they are in simulators. So, why can you not have a simulator of the brain, where you can really have a digital copy of your brain?” Maiques said.

“Then we can say, if we provide you this treatment, or this stimulation, how is your brain going to react? We are very excited about our NeuroTwin technology. I think it’s going to change the way we look at brain diseases,” she added.

The end goal is for patients to be able to use the cap at home, which is essential as it takes ten daily 20-minute sessions for around eight weeks for the average epilepsy patient to feel results.

“Then you just go. You put your headcap on, maybe you need some help in order to put the gel for the electrodes, and you just press the start stimulation,” Sanchez-Todo said.

“Usually, it’s from 20 minutes to an hour that you’re sitting and relaxing. Then you just need to take it out, clean it, and then for the next day you repeat.”

Moderna on Monday said its combination vaccine that targets both Covid-19 and the flu was more effective than existing standalone shots for those viruses in a late-stage trial. 

The biotech company is the first to release positive phase three data on a Covid and flu combination shot, giving it a potential lead over rival vaccine makers Pfizer and Novavax. 

Moderna plans to file for regulatory approval for its combination jab this summer in the U.S. and hopes it can enter the market in 2025, the company’s CEO Stephane Bancel said in an interview. 

Moderna, Pfizer and Novavax have said that combination shots will simplify how people can protect themselves against respiratory viruses that typically surge around the same time of the year. The added convenience is critical as fewer Americans roll up their sleeves to get vaccinated against Covid. 

Bancel added that combination shots could reduce the burden of respiratory viruses on pharmacists and the broader U.S. health-care system, which has been grappling with a labor shortage that has many workers stretched thin.

Moderna’s messenger RNA combination shot, called mRNA-1083, is made up of both the company’s vaccine candidate for seasonal influenza and a newer, “next-generation” version of its Covid shot. Both of those experimental vaccines – mRNA-1010 and mRNA-1283 – have shown positive results in separate phase three trials. 

The ongoing late-stage trial on mRNA-1083 examined the combination shot in 8,000 patients. 

The study compared the combination shot with an enhanced flu vaccine called Fluzone HD and Moderna’s currently licensed Covid shot, Spikevax, in one group of patients ages 65 and above. The trial also compared Moderna’s combination jab with a standard flu shot called Fluarix and Spikevax in another group of participants between the ages of 50 and 64. 

In both age groups, a single dose of Moderna’s combination vaccine produced “statistically significantly higher” immune responses against three strains of influenza and the Covid omicron variant XBB.1.5.

Moderna said the safety of the combination shot, along with how well patients could tolerate it, was acceptable. The most common side effects were injection site pain, fatigue, muscle pain and headache. The majority of those effects were mild to moderate in severity. 

Moderna is also developing a combination shot targeting the flu and RSV, and another vaccine targeting all three respiratory viruses: Covid, flu and RSV. 

Meanwhile, Pfizer and BioNTech also are studying a vaccine that targets both Covid and the flu in a late-stage trial. Novavax is developing a combination for those viruses as well, but its Covid shot uses protein-based technology.

Researchers say there’s been an alarming increase among adults in their 40s and 50s who have been diagnosed with the disorder. That has ripple effects on the family members of those younger patients, who often fill caregiving roles.

Two Northern Virginia sisters, whose mother died of the mind-robbing disease, want others to know what to look out for, and what can help.

Friends and family of Holly Davis called her Hurricane Holly — a true force of nature.

“She was a fierce friend, a fierce mom, a fierce worker,” said Madeline Davis, one of Holly’s daughters. She did everything with such passion, but God forbid, if you got her riled up too much, the hurricane came out.”

Madeline and her sister, Tenley Davis, say Holly loved her job as a commercial real estate broker. She was always on the go.

That’s why it seemed odd when she started missing meetings.

“I was like, oh, this is beyond what I’m noticing at home. This is much bigger,” Madeline said.

Over the years, the Alexandria mom became more forgetful and the changes in her demeanor became harder to ignore. Once an avid reader, she was no longer able to read, and had trouble communicating.

Holly underwent a series of cognitive tests, and was later diagnosed with early onset Alzheimer’s disease, as well as frontotemporal dementia — the same condition Bruce Willis has.

Holly was only 51 years old when she was diagnosed.

“It’s very overwhelming, and it takes an emotional toll,” said Tenley.

Early-onset Alzheimer’s is still rare. Only 5% to 10% of cases are diagnosed in people under the age of 65.

But those numbers are on the rise in recent years, with a 200% increase in Alzheimer’s diagnoses among people between age 30 and age 64.

According to the Alzheimer’s Association, the lifetime risk for Alzheimer’s at age 45 is 1 in 5 for women and 1 in 10 for men. (The lifetime risk of a disease is the risk of developing that disease between a given age and death.)

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The Davis sisters were stunned, especially since Holly didn’t have any genetic markers for Alzheimer’s.

But they soon found ways to cope, using music to connect with their mom, and developing their own special language to communicate.

“The most important thing with the loss of speech was never being like, ‘What? What do you mean?’ Or trying to dissect it. It’s just going with the flow, making them feel normal,” said Tenley.

Nationwide, more than 16 million family members or friends will care for someone with Alzheimer’s or dementia. For many, it consumes their lives.

“She was a 24-hour job,” said Tenley. “She could not feed herself. She cannot walk alone. It was… it was hard.”

Eventually, as the brain disorder worsened, Holly moved into a memory care facility. She passed away in January 2022.

Her family says they struggled in the days and months that followed.

“I was looking for support groups and I went to one, and I was the only one who didn’t have gray hair,” said Madeline. “It’s really important for folks to know, you know, you’re not alone, which is a blessing and a curse.”

That’s why the Davis sisters are sharing their story, so others know they’re not alone. They’re now moving forward with purpose — keeping their mom’s memory close as they go.

“I’ve always tried to live by the rule of, you know, if she were here, make her proud, you know. Do exactly what she would have wanted you to do. Some days it’s easier than others, but you have to keep going forward.”

It’s normal to forget things as we age, but if your memory problems start to impact your life, like your job, driving, or communicating, it’s important to seek medical attention.

Since healthcare providers generally don’t look for Alzheimer’s in younger people, getting an accurate diagnosis can be a long and frustrating process. But an early diagnosis is crucial to increase the types of treatments available and help to slow the progression of the disease.

But Stafford, a maternal-fetal medicine physician at the University of Texas Health Sciences Center in Houston, quickly realized something was wrong: She couldn’t find a heartbeat. The unborn baby boy had already died in the womb. 

Soon after, the mother’s syphilis test — given to all women before delivery — came back positive. The infection had been silently passed from mother to son.

It’s a death, Stafford said, that could’ve been prevented with early detection and a shot of penicillin. 

Syphilis, a sexually transmitted infection, was nearly eliminated in the U.S. at the beginning of the 21st century but has made a dramatic comeback. In 2022, the Centers for Disease Control and Prevention reported more than 200,000 syphilis cases — the highest counts since 1950. Congenital syphilis has similarly increased tenfold over the past decade, the CDC says, even though 90% of cases are fully preventable.

Syphilis in the U.S.

More than 200,000 cases were reported in 2022, the most since 1950.

The return of syphilis is the result, experts say, of poorly funded prevention programs over the past two decades and difficulties in diagnosis; syphilis is referred to as the “great imitator” because its symptoms can vary so widely. Most people don’t show symptoms or know they’re infected, and even if they do visit the doctor’s office, there’s no guarantee they’ll be properly diagnosed.

Stafford said her patient didn’t have the resources to seek prenatal care, and no doctor or public health worker had ever told her that she should get tested for syphilis. So, when the patient noticed a small rash on her belly, she didn’t think too much about it, Stafford added.

“There’s a lot of people who are seen in private practice, hospital ERs, or walk-in centers, and those clinicians are not necessarily thinking of syphilis, they’re not necessarily getting a sexual history,” said Dr. Kenneth Mayer, an infectious disease physician and medical research director of the Fenway Institute in Boston. With a generation of doctors who saw few, if any, syphilis cases during their training, Mayer said that “the issue is tests not being done in the first place.”

The all-encompassing nature of the Covid pandemic added fuel to this fire, as public health departments redirected STI resources toward fighting the coronavirus.

“The solutions for controlling syphilis are relatively straightforward. We’re not talking about high tech approaches or a novel therapeutic,” said Dr. Dave Chokshi, chair of the Common Health Coalition and a former New York City Commissioner of Health. “It simply revolves around closing gaps in testing and treatment.”

As syphilis cases surge, doctors and public health officials are starting to develop innovative and sometimes unconventional strategies to screen people for syphilis and curb the spread of the disease. 

Most often, that comes down to figuring out how to get people tested, a task that’s far easier said than done.

Spreading the word about syphilis

Given these challenges, some public health departments have launched eye-popping awareness campaigns, trying to raise the alarm among both the public and health care providers. 

A few years ago, Donna Fox, the HIV and STI manager at the Toledo-Lucas County Health Department in Ohio, noticed that about one-fifth of syphilis cases in the area were among people who reported paying for sex. 

So, trying to be proactive — and a bit provocative — Fox and her team ran billboards across the county in 2022 saying, “Paying for Sex? Get Tested!”

“We had to go bold, and we had to get to the point,” she said. The pushback was inevitable — “you might have to say something to your 10-year-old who can read,” Fox conceded — but the impact was measurable. From 2021 through 2022, the number of syphilis appointments scheduled via the county health department jumped by almost 50%, and syphilis cases dropped by 12%, she said.

Of course, syphilis doesn’t just spread among sex workers, so last year, Fox’s team broadened the campaign, keeping the same look and feel but instead saying “Syphilis is Serious” with “Spreading Locally!” overlaid over the side.

Other billboard campaigns across the country have featured giant bloodshot, infected eyes with the blurry words “Eye Syphilis is Serious” and a black silhouette of a pregnant woman with a red belly saying “Syphilis Can Be Fatal to Your Baby.” While these billboards are factually true, Mayer describes how this kind of fear-based campaign, or “loss frame,” draws lots of attention but may not be particularly effective at motivating behavioral changes for STIs.

“We’re not telling anybody not to have sex,” Fox said. “We’re telling people to have safe sex,” and to get tested afterward.

The sex positivity message isn’t just for the public. The Toledo-Lucas health department also launched an educational campaign for clinicians, reminding them to take a sexual history of all patients — since the county saw syphilis in people ages 15 to 72 last year — and to order a blood test if they suspect an STI, since the standard “pee in a cup” test can’t detect syphilis.

“Many physicians haven’t seen syphilis, and they’ve got a million things to know,” Fox said. “If we don’t talk to the physicians, we’re not going to get the testing we need done.”

Stafford, the maternal-fetal medicine doctor in Houston, has taken a more hands-on approach. Texas mandates syphilis testing for pregnant women at three points — during their first prenatal visit, around the 28-week mark and before delivery — but in reality, these tests are often missed. So, last year, Stafford launched an alert in UTHealth’s electronic medical records, prompting providers to test their pregnant patients for syphilis at each of the prescribed times. The simple tweak helped increase screening rates from 2% to 47% at all three timepoints, while decreasing congenital syphilis cases by half.

Chokshi sees this as another good example of the public health and health care systems working hand-in-hand, with the former “setting the parameters of what standard of care should look like” and hospitals making it a reality. 

Make syphilis testing convenient

Beyond greater awareness, access to testing and treatment needs to be quick, easy and convenient, Chokshi said. 

Indian Country has led the way on this, partly by necessity: American Indian and Alaska Natives have the highest syphilis rates of any racial or ethnic group, almost seven times higher than white people. 

As such, tribes across the U.S. have turned to incentives, giving people $10 gift cards if they come in for STI testing or treatment, said Jessica Leston, founder of the Raven Collective, an Indigenous public health organization.

“We’re just helping people pay for gas and child care and get food on their table,” Leston said. At Cass Lake Indian Hospital’s pharmacy in rural Minnesota, the strategy increased STI testing tenfold, according to one study, with over 70% of the patients who got a test not having a primary care provider.

In 2023, a coalition of tribal communities partnered with Johns Hopkins School of Medicine to ramp up a program called I Want the Kit, which sends at-home STI test kits in the mail. The tests come in unmarked envelopes with instructions on how to collect a sample and send back the test. Results come back in a week or two, and patients are linked to health care resources if the test comes back positive.

Even with these programs, syphilis testing can be overshadowed by more immediate concerns.

In California, for example, half of pregnant women with syphilis reported methamphetamine use, and a quarter were homeless. In the state’s rural Shasta County, near the Oregon border, almost 100% of pregnant woman with syphilis similarly have a substance use disorder and 90% are unhoused, said Trojan Carvajal,
a supervising public health nurse in the county’s STI unit.

In April 2023, Shasta County launched the CommUNITY Mobile Care Clinic, an RV retrofitted with a reception area and two exam rooms, bringing STI tests and treatments to the county’s most vulnerable — from homeless camps to pop-ups with the local LBGTQ community center. Importantly, there’s no STI branding on the mobile clinic itself, allowing people to feel more comfortable walking in to get tested.

Last year, one-third of all syphilis tests performed by Shasta County were done through the mobile clinic, according to Jai Winchell, a community education specialist with the county’s public health department. These people would likely have never sought syphilis services otherwise, Winchell said, but with this mobile clinic crisscrossing the county and arriving at their doorsteps, they can get tested and treated in just 30 minutes.

Piggybacking syphilis services

Shasta County’s mobile clinic also offers other services, including test strips for deadly drugs like fentanyl and xylazine, naloxone to reverse overdoses and referrals to addiction counselors, as well as water, snacks and dental kits, Winchell said. The idea is to address overlapping concerns together, while also attracting those who wouldn’t have considered STI testing, if not for the package deal.

This approach also helps build trust, said Dr. Arlene Seña, an infectious diseases physician at the University of North Carolina Chapel Hill, showing how mobile clinic staff are invested in you as a person with various needs, rather than a singular problem to be solved. “It might be more costly, but it’s also much, much more effective and helpful to the community,” Seña said.

Syphilis services can also be integrated with general health care services. In March, Stafford launched a rapid testing program at two Houston hospitals aimed at all pregnant women admitted to the emergency department. The program, called Preg-Out, was set up on an opt-out basis, so everyone got tested unless they refused. It took about 15 minutes, and women were offered prenatal care regardless of the result.

“We noticed that pregnant patients, especially those that end up having a child with congenital syphilis, often frequent the ED and don’t get tested,” Stafford said. In the three-month pilot, Stafford said testing rates for pregnant women increased twelvefold, with about 35% of their partners wanting to get tested as well. 

Other hospitals have implemented opt-out screening programs for all patients, including Grady Memorial Hospital in Atlanta in one of their urgent care centers and the University of Chicago in their emergency department. Not every hospital has the resources to test everyone, Seña said, so she believes prioritizing pregnant patients, as done in Houston, can be a high-impact first step.

“You can’t just rely on public health departments to do the brunt of the work for STI recognition and prevention,” she said. “You have to go hand in hand with other providers in the community.”

The future ahead

The U.S. got syphilis rates down before, but that was in the 1990s, when HIV was ravaging through America. 

“What changed behavior then was lethal, hard-to-treat disease,” said Mayer, from Fenway Health. “Now, you have a generation of people who may be less informed,” leading to lower rates of condom use and STI screening rates. 

However, it’s also a time of innovation. In June, the CDC recommended doxycycline post-exposure prophylaxis for high-risk groups — essentially, a morning after pill for STIs. If taken within 72 hours of condomless sex, so-called DoxyPEP reduces syphilis rates by over 70%, and Fenway Health, where half of patients are LGBTQ, has already begun ramping up distribution, Mayer said. Meanwhile, other researchers like Seña have been working on developing a syphilis vaccine, but that’s probably several years down the line.

“Our task right now is to arrest the growth in cases,” said Chokshi, from the Common Health Coalition, and he’s optimistic that these innovative awareness, testing and treatment campaigns can do that. But permanently bending the syphilis curve will require scaling these efforts nationally and promoting greater coordination between health care and public health.

“There’s no reason that the endgame can’t be, once again, trying to eliminate syphilis — this historic scourge that is completely preventable and treatable,” Chokshi said.

This article first appeared on NBCNews.com. Read more from NBC News here:

• A Gazan girl’s pink rollerblades become an image of tragedy and desperation
• Biden officials ‘watered down’ warnings about crumbling security before Afghan withdrawal, new House GOP report says
• Liz Cheney says it’s ‘not enough’ for anti-Trump Republicans to vote for someone other than Harris

But Stafford, a maternal-fetal medicine physician at the University of Texas Health Sciences Center in Houston, quickly realized something was wrong: She couldn’t find a heartbeat. The unborn baby boy had already died in the womb. 

Soon after, the mother’s syphilis test — given to all women before delivery — came back positive. The infection had been silently passed from mother to son.

It’s a death, Stafford said, that could’ve been prevented with early detection and a shot of penicillin. 

Syphilis, a sexually transmitted infection, was nearly eliminated in the U.S. at the beginning of the 21st century but has made a dramatic comeback. In 2022, the Centers for Disease Control and Prevention reported more than 200,000 syphilis cases — the highest counts since 1950. Congenital syphilis has similarly increased tenfold over the past decade, the CDC says, even though 90% of cases are fully preventable.

Syphilis in the U.S.

More than 200,000 cases were reported in 2022, the most since 1950.

The return of syphilis is the result, experts say, of poorly funded prevention programs over the past two decades and difficulties in diagnosis; syphilis is referred to as the “great imitator” because its symptoms can vary so widely. Most people don’t show symptoms or know they’re infected, and even if they do visit the doctor’s office, there’s no guarantee they’ll be properly diagnosed.

Stafford said her patient didn’t have the resources to seek prenatal care, and no doctor or public health worker had ever told her that she should get tested for syphilis. So, when the patient noticed a small rash on her belly, she didn’t think too much about it, Stafford added.

“There’s a lot of people who are seen in private practice, hospital ERs, or walk-in centers, and those clinicians are not necessarily thinking of syphilis, they’re not necessarily getting a sexual history,” said Dr. Kenneth Mayer, an infectious disease physician and medical research director of the Fenway Institute in Boston. With a generation of doctors who saw few, if any, syphilis cases during their training, Mayer said that “the issue is tests not being done in the first place.”

The all-encompassing nature of the Covid pandemic added fuel to this fire, as public health departments redirected STI resources toward fighting the coronavirus.

“The solutions for controlling syphilis are relatively straightforward. We’re not talking about high tech approaches or a novel therapeutic,” said Dr. Dave Chokshi, chair of the Common Health Coalition and a former New York City Commissioner of Health. “It simply revolves around closing gaps in testing and treatment.”

As syphilis cases surge, doctors and public health officials are starting to develop innovative and sometimes unconventional strategies to screen people for syphilis and curb the spread of the disease. 

Most often, that comes down to figuring out how to get people tested, a task that’s far easier said than done.

Spreading the word about syphilis

Given these challenges, some public health departments have launched eye-popping awareness campaigns, trying to raise the alarm among both the public and health care providers. 

A few years ago, Donna Fox, the HIV and STI manager at the Toledo-Lucas County Health Department in Ohio, noticed that about one-fifth of syphilis cases in the area were among people who reported paying for sex. 

So, trying to be proactive — and a bit provocative — Fox and her team ran billboards across the county in 2022 saying, “Paying for Sex? Get Tested!”

“We had to go bold, and we had to get to the point,” she said. The pushback was inevitable — “you might have to say something to your 10-year-old who can read,” Fox conceded — but the impact was measurable. From 2021 through 2022, the number of syphilis appointments scheduled via the county health department jumped by almost 50%, and syphilis cases dropped by 12%, she said.

Of course, syphilis doesn’t just spread among sex workers, so last year, Fox’s team broadened the campaign, keeping the same look and feel but instead saying “Syphilis is Serious” with “Spreading Locally!” overlaid over the side.

Other billboard campaigns across the country have featured giant bloodshot, infected eyes with the blurry words “Eye Syphilis is Serious” and a black silhouette of a pregnant woman with a red belly saying “Syphilis Can Be Fatal to Your Baby.” While these billboards are factually true, Mayer describes how this kind of fear-based campaign, or “loss frame,” draws lots of attention but may not be particularly effective at motivating behavioral changes for STIs.

“We’re not telling anybody not to have sex,” Fox said. “We’re telling people to have safe sex,” and to get tested afterward.

The sex positivity message isn’t just for the public. The Toledo-Lucas health department also launched an educational campaign for clinicians, reminding them to take a sexual history of all patients — since the county saw syphilis in people ages 15 to 72 last year — and to order a blood test if they suspect an STI, since the standard “pee in a cup” test can’t detect syphilis.

“Many physicians haven’t seen syphilis, and they’ve got a million things to know,” Fox said. “If we don’t talk to the physicians, we’re not going to get the testing we need done.”

Stafford, the maternal-fetal medicine doctor in Houston, has taken a more hands-on approach. Texas mandates syphilis testing for pregnant women at three points — during their first prenatal visit, around the 28-week mark and before delivery — but in reality, these tests are often missed. So, last year, Stafford launched an alert in UTHealth’s electronic medical records, prompting providers to test their pregnant patients for syphilis at each of the prescribed times. The simple tweak helped increase screening rates from 2% to 47% at all three timepoints, while decreasing congenital syphilis cases by half.

Chokshi sees this as another good example of the public health and health care systems working hand-in-hand, with the former “setting the parameters of what standard of care should look like” and hospitals making it a reality. 

Make syphilis testing convenient

Beyond greater awareness, access to testing and treatment needs to be quick, easy and convenient, Chokshi said. 

Indian Country has led the way on this, partly by necessity: American Indian and Alaska Natives have the highest syphilis rates of any racial or ethnic group, almost seven times higher than white people. 

As such, tribes across the U.S. have turned to incentives, giving people $10 gift cards if they come in for STI testing or treatment, said Jessica Leston, founder of the Raven Collective, an Indigenous public health organization.

“We’re just helping people pay for gas and child care and get food on their table,” Leston said. At Cass Lake Indian Hospital’s pharmacy in rural Minnesota, the strategy increased STI testing tenfold, according to one study, with over 70% of the patients who got a test not having a primary care provider.

In 2023, a coalition of tribal communities partnered with Johns Hopkins School of Medicine to ramp up a program called I Want the Kit, which sends at-home STI test kits in the mail. The tests come in unmarked envelopes with instructions on how to collect a sample and send back the test. Results come back in a week or two, and patients are linked to health care resources if the test comes back positive.

Even with these programs, syphilis testing can be overshadowed by more immediate concerns.

In California, for example, half of pregnant women with syphilis reported methamphetamine use, and a quarter were homeless. In the state’s rural Shasta County, near the Oregon border, almost 100% of pregnant woman with syphilis similarly have a substance use disorder and 90% are unhoused, said Trojan Carvajal,
a supervising public health nurse in the county’s STI unit.

In April 2023, Shasta County launched the CommUNITY Mobile Care Clinic, an RV retrofitted with a reception area and two exam rooms, bringing STI tests and treatments to the county’s most vulnerable — from homeless camps to pop-ups with the local LBGTQ community center. Importantly, there’s no STI branding on the mobile clinic itself, allowing people to feel more comfortable walking in to get tested.

Last year, one-third of all syphilis tests performed by Shasta County were done through the mobile clinic, according to Jai Winchell, a community education specialist with the county’s public health department. These people would likely have never sought syphilis services otherwise, Winchell said, but with this mobile clinic crisscrossing the county and arriving at their doorsteps, they can get tested and treated in just 30 minutes.

Piggybacking syphilis services

Shasta County’s mobile clinic also offers other services, including test strips for deadly drugs like fentanyl and xylazine, naloxone to reverse overdoses and referrals to addiction counselors, as well as water, snacks and dental kits, Winchell said. The idea is to address overlapping concerns together, while also attracting those who wouldn’t have considered STI testing, if not for the package deal.

This approach also helps build trust, said Dr. Arlene Seña, an infectious diseases physician at the University of North Carolina Chapel Hill, showing how mobile clinic staff are invested in you as a person with various needs, rather than a singular problem to be solved. “It might be more costly, but it’s also much, much more effective and helpful to the community,” Seña said.

Syphilis services can also be integrated with general health care services. In March, Stafford launched a rapid testing program at two Houston hospitals aimed at all pregnant women admitted to the emergency department. The program, called Preg-Out, was set up on an opt-out basis, so everyone got tested unless they refused. It took about 15 minutes, and women were offered prenatal care regardless of the result.

“We noticed that pregnant patients, especially those that end up having a child with congenital syphilis, often frequent the ED and don’t get tested,” Stafford said. In the three-month pilot, Stafford said testing rates for pregnant women increased twelvefold, with about 35% of their partners wanting to get tested as well. 

Other hospitals have implemented opt-out screening programs for all patients, including Grady Memorial Hospital in Atlanta in one of their urgent care centers and the University of Chicago in their emergency department. Not every hospital has the resources to test everyone, Seña said, so she believes prioritizing pregnant patients, as done in Houston, can be a high-impact first step.

“You can’t just rely on public health departments to do the brunt of the work for STI recognition and prevention,” she said. “You have to go hand in hand with other providers in the community.”

The future ahead

The U.S. got syphilis rates down before, but that was in the 1990s, when HIV was ravaging through America. 

“What changed behavior then was lethal, hard-to-treat disease,” said Mayer, from Fenway Health. “Now, you have a generation of people who may be less informed,” leading to lower rates of condom use and STI screening rates. 

However, it’s also a time of innovation. In June, the CDC recommended doxycycline post-exposure prophylaxis for high-risk groups — essentially, a morning after pill for STIs. If taken within 72 hours of condomless sex, so-called DoxyPEP reduces syphilis rates by over 70%, and Fenway Health, where half of patients are LGBTQ, has already begun ramping up distribution, Mayer said. Meanwhile, other researchers like Seña have been working on developing a syphilis vaccine, but that’s probably several years down the line.

“Our task right now is to arrest the growth in cases,” said Chokshi, from the Common Health Coalition, and he’s optimistic that these innovative awareness, testing and treatment campaigns can do that. But permanently bending the syphilis curve will require scaling these efforts nationally and promoting greater coordination between health care and public health.

“There’s no reason that the endgame can’t be, once again, trying to eliminate syphilis — this historic scourge that is completely preventable and treatable,” Chokshi said.

This article first appeared on NBCNews.com. Read more from NBC News here:

• A Gazan girl’s pink rollerblades become an image of tragedy and desperation
• Biden officials ‘watered down’ warnings about crumbling security before Afghan withdrawal, new House GOP report says
• Liz Cheney says it’s ‘not enough’ for anti-Trump Republicans to vote for someone other than Harris

“Even if you’re not clearing like a snow-covered driveway or digging out your car, cold weather can cause high blood pressure, and that’s a key risk factor for strokes and for heart attacks,” said Catherine Roberts with Consumer Reports.

Doctors say the best thing to do in the winter is to stay warm.

“Staying bundled up so your core temperature is higher is good. Most of it because if you’re cold and you’re shivering, that puts a lot of stress on the body, said Dr. Joshua Willey, a neurologist.

Willey said it’s especially important to keep in mind when exerting yourself outdoors. Dress in layers and keep your core, or torso, warm to help keep blood flowing to your extremities.

“If you have problems with the circulation to the legs, making sure that your legs are well bundled up so that there’s enough circulation getting to your feet,” he said.

While you can’t do anything about the weather, you can cut other risk factors. One study found that 80% of strokes are preventable.

Steps doctors recommend taking to prevent stroke:

• Keep health issues such as high blood pressure, atrial fibrillation, type 2 diabetes and high cholesterol under control.
• Get enough physical activity and eat a healthy diet.
• Limit alcohol to one drink per day for women and two drinks per day for men.

It’s also important to stay alert to the signs of a stroke. If someone is having balance or vision problems, their face is drooping, or they are experiencing arm weakness or slurred speech, get help immediately.

Ozempic, Wegovy and similar drugs have been in short supply over the past year as demand has grown.

For those who do manage to find them, the drugs aren’t cheap. They typically cost more than $1,000 a month without insurance.

Between high costs and and nationwide shortages, many have turned to knockoff versions.

Searches for “Ozempic dupe” have skyrocketed by 373% in the past year, according to Kaly.com, and #Ozempic has gained 1.3 billion views on social media platforms like TikTok.

Some compounding pharmacies, which mix and alter drug ingredients to create custom medications for patients, are offering copycat injections at a fraction of the cost. They’re about $100 to $200 for a month’s supply, but the Food and Drug Administration hasn’t approved the medications.

The FDA told News4 it’s monitoring the internet for fraudulent or unapproved products and has issued warning letters to pharmacies to stop the distribution of illegally marketed semaglutide – the active ingredient in both Wegovy and Ozempic.

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“No one knows exactly what it is and no one knows where it’s coming from So it’s actually pretty dangerous,” said Dr. Domenica Rubino with the Washington Center for Weight Management and Research in Arlington, Virginia.

Rubino said the copycat versions of semaglutide are often mixed with vitamins or other ingredients that haven’t been tested and might not be safe.

Regulators are also sounding the alarm. Four states, including West Virginia, Louisiana, Mississippi and North Carolina, are threatening legal action over safety concerns, saying it’s almost impossible for compounding pharmacies to replicate weight loss drugs on the market.

That’s because there are no FDA-approved generic versions of Wegovy or Ozempic, and drug maker Novo Nordisk said it doesn’t supply its ingredients to others.

“You have to understand that there’s a desperateness,” Rubino said.

Despite the risk, News4 found dozens of companies selling semaglutide on social media platforms, some promising overnight delivery of vials with liquid that patients are told to inject weekly.

Several websites even offer telehealth visits in which people can get the medications without ever seeing a provider on video or in person.

“This is about health. It’s not about weight loss. It’s not about fitting into your designer dress — and I can’t stress that enough,” Rubinio said.

Patients who are considering taking weight loss medication should always consult with a doctor or health care provider.

Doctors said it’s also important for people to do their research before taking the medications and understand the potential side effects, which can include nausea and vomiting to changes in vision and kidney problems. In serious cases, Ozempic and Wegovy could cause intestinal blockages, according to the drug’s warning label.

Dr. Dean Ornish, who founded the Preventive Medicine Research Institute in California, is leading the clinical trial.

“For the last 45 years, I’ve directed research showing that simple lifestyle changes: what we eat, how we respond to stress, how much exercise we get and how much love and social support we have cannot only help prevent, but often reverse the progression of the most common and costly chronic diseases,” said Ornish, who is also a professor of medicine at the University of California San Francisco.

Through previous studies, Ornish found that lifestyle changes can reverse heart disease in some patients. Now, he’s seeing if it works in the fight against Alzheimer’s.

“What’s good for your heart is good for your brain. We know that Alzheimer’s and heart disease share many of these same underlying biological mechanisms,” Ornish said.

Healthy eating and exercise have been shown to reduce the risk of cognitive decline and dementia but this research takes it a step further to see if it can actually prevent or reverse the disease.

Participants of the study will follow a lifestyle medicine program that includes:

1. Eating a whole foods, plant-based diet: “Fruits, vegetables, whole grains, legumes, soy products, ideally as close as they come in nature as possible, minimally processed, low in fat, low in sugar,” Ornish said.
2. Getting moderate exercise: Ornish said walking half-an-hour to an hour three times a week and incorporating some strength training qualifies as moderate exercise.
3. Reducing stress: Using meditation and other yoga-based stress management techniques.
4. Increasing social support: Joining support groups or spending quality time with friends and family.

“To reduce it to its essence: to eat well, move more, stress less and love more. That’s it,” Ornish said.

Ornish is teaming up with leading neurologists across the country, including at Harvard Medical School, to put the theory to the test.

“Our unique contribution has been to be using these very high tech, expensive state of the art scientific measures to prove how powerful these very simple and low tech and low cost interventions can be,” he said.

While the results of the trial aren’t expected until next year, others in the field are watching closely.

Dr. Jessica Caldwell, with the Women’s Alzheimer’s Movement Prevention Center at Cleveland Clinic in Las Vegas, said she encourages her patients to get moving to keep their mind sharp.

“Physical exercise directly impacts the brain right away, as well as for months afterward,” Caldwell said. “It changes the levels of your neurochemistry that supports memory. When we exercise, it improves our mood, it can reduce our stress levels.”

More than 6 million Americans are living with Alzheimer’s. Doctors said the disease starts decades before a person develops memory loss and other symptoms.

For years, Keith Thomas has been unable to move his arms and hands after a diving accident left him paralyzed from the chest down.

“I went to dive into the pool aggressively, as usual, and then I just blacked out. And the next thing you know, there was a helicopter on the front lawn,” Thomas said.

Now, a simple gesture like shaking someone’s hand gives him tremendous hope.

“When I feel the sense of touch, it’s like, it’s unreal because I haven’t felt that in three years now,” Keith Thomas said.

Through a new procedure called a double neural bypass, doctors at Northwell Health’s Feinstein Institutes for Medical Research in New York implanted five tiny computer chips in Thomas’ brain that can literally read his mind.

“This is the first time the brain has been linked directly to spinal cord stimulation and to the body to restore movement and the sense of touch where the user’s thoughts are actually driving that therapy,” said Professor Chad Bouton, the vice president of Advanced Engineering and director of the Neural Bypass and Brain-Computer Interface Laboratory at the Feinstein Institutes for Medical Research.

The 15-hour surgery was a delicate dance with Thomas awake for part of the procedure, giving surgeons feedback in real-time.

“I placed it right over one area and he said, ‘I feel my thumb.’ I said, ‘What part of your thumb?’ He said, ‘My thumb tip, the inside of my thumb tip.’ And I said, ‘Oh, we found it. We got it,'” said Dr. Ashesh Mehta, a neurosurgeon and professor.

Now, if Thomas thinks of grabbing a bottle, electrical signals are sent to a patch on his neck or arm, bypassing the injured sections of his spine to reconnect with his brain.

“Now I’m thinking and I’m seeing my thoughts like happen in real time onscreen,” Thomas said. “It just changed my life.”

AI isn’t just helping patients regain movement.

In a separate study published in the journal Nature, researchers from UC San Francisco and UC Berkeley are using artificial intelligence to help a paralyzed mother reclaim her voice.

Ann Johnson suffered a stroke almost 20 years ago and cannot move her body or her mouth.

Now, she’s able to have a conversation with her husband through a digital avatar.

The technology decodes Johnson’s brain signals, turning them into sentences and facial expressions through 250 electrodes that are implanted onto the surface of her brain that’s responsible for speech.

For weeks, Johnson helped train the AI algorithms to recognize her brain activity by repeating different words and phrases.

“A lot of my inspiration actually comes from seeing patients and feeling frustration that we yet don’t have treatments for helping them,” said Dr. Edward Chang, the chair of neurological surgery at UCSF.

UCSF researchers say the AI system is faster and more accurate than other devices that allow paralysis patients to communicate. Their next step is to create a wireless version of the device.

Both studies, though, have tremendous promise using AI technology that could one day help countless people with neurological and movement disorders.

But Stafford, a maternal-fetal medicine physician at the University of Texas Health Sciences Center in Houston, quickly realized something was wrong: She couldn’t find a heartbeat. The unborn baby boy had already died in the womb. 

Soon after, the mother’s syphilis test — given to all women before delivery — came back positive. The infection had been silently passed from mother to son.

It’s a death, Stafford said, that could’ve been prevented with early detection and a shot of penicillin. 

Syphilis, a sexually transmitted infection, was nearly eliminated in the U.S. at the beginning of the 21st century but has made a dramatic comeback. In 2022, the Centers for Disease Control and Prevention reported more than 200,000 syphilis cases — the highest counts since 1950. Congenital syphilis has similarly increased tenfold over the past decade, the CDC says, even though 90% of cases are fully preventable.

Syphilis in the U.S.

More than 200,000 cases were reported in 2022, the most since 1950.

The return of syphilis is the result, experts say, of poorly funded prevention programs over the past two decades and difficulties in diagnosis; syphilis is referred to as the “great imitator” because its symptoms can vary so widely. Most people don’t show symptoms or know they’re infected, and even if they do visit the doctor’s office, there’s no guarantee they’ll be properly diagnosed.

Stafford said her patient didn’t have the resources to seek prenatal care, and no doctor or public health worker had ever told her that she should get tested for syphilis. So, when the patient noticed a small rash on her belly, she didn’t think too much about it, Stafford added.

“There’s a lot of people who are seen in private practice, hospital ERs, or walk-in centers, and those clinicians are not necessarily thinking of syphilis, they’re not necessarily getting a sexual history,” said Dr. Kenneth Mayer, an infectious disease physician and medical research director of the Fenway Institute in Boston. With a generation of doctors who saw few, if any, syphilis cases during their training, Mayer said that “the issue is tests not being done in the first place.”

The all-encompassing nature of the Covid pandemic added fuel to this fire, as public health departments redirected STI resources toward fighting the coronavirus.

“The solutions for controlling syphilis are relatively straightforward. We’re not talking about high tech approaches or a novel therapeutic,” said Dr. Dave Chokshi, chair of the Common Health Coalition and a former New York City Commissioner of Health. “It simply revolves around closing gaps in testing and treatment.”

As syphilis cases surge, doctors and public health officials are starting to develop innovative and sometimes unconventional strategies to screen people for syphilis and curb the spread of the disease. 

Most often, that comes down to figuring out how to get people tested, a task that’s far easier said than done.

Spreading the word about syphilis

Given these challenges, some public health departments have launched eye-popping awareness campaigns, trying to raise the alarm among both the public and health care providers. 

A few years ago, Donna Fox, the HIV and STI manager at the Toledo-Lucas County Health Department in Ohio, noticed that about one-fifth of syphilis cases in the area were among people who reported paying for sex. 

So, trying to be proactive — and a bit provocative — Fox and her team ran billboards across the county in 2022 saying, “Paying for Sex? Get Tested!”

“We had to go bold, and we had to get to the point,” she said. The pushback was inevitable — “you might have to say something to your 10-year-old who can read,” Fox conceded — but the impact was measurable. From 2021 through 2022, the number of syphilis appointments scheduled via the county health department jumped by almost 50%, and syphilis cases dropped by 12%, she said.

Of course, syphilis doesn’t just spread among sex workers, so last year, Fox’s team broadened the campaign, keeping the same look and feel but instead saying “Syphilis is Serious” with “Spreading Locally!” overlaid over the side.

Other billboard campaigns across the country have featured giant bloodshot, infected eyes with the blurry words “Eye Syphilis is Serious” and a black silhouette of a pregnant woman with a red belly saying “Syphilis Can Be Fatal to Your Baby.” While these billboards are factually true, Mayer describes how this kind of fear-based campaign, or “loss frame,” draws lots of attention but may not be particularly effective at motivating behavioral changes for STIs.

“We’re not telling anybody not to have sex,” Fox said. “We’re telling people to have safe sex,” and to get tested afterward.

The sex positivity message isn’t just for the public. The Toledo-Lucas health department also launched an educational campaign for clinicians, reminding them to take a sexual history of all patients — since the county saw syphilis in people ages 15 to 72 last year — and to order a blood test if they suspect an STI, since the standard “pee in a cup” test can’t detect syphilis.

“Many physicians haven’t seen syphilis, and they’ve got a million things to know,” Fox said. “If we don’t talk to the physicians, we’re not going to get the testing we need done.”

Stafford, the maternal-fetal medicine doctor in Houston, has taken a more hands-on approach. Texas mandates syphilis testing for pregnant women at three points — during their first prenatal visit, around the 28-week mark and before delivery — but in reality, these tests are often missed. So, last year, Stafford launched an alert in UTHealth’s electronic medical records, prompting providers to test their pregnant patients for syphilis at each of the prescribed times. The simple tweak helped increase screening rates from 2% to 47% at all three timepoints, while decreasing congenital syphilis cases by half.

Chokshi sees this as another good example of the public health and health care systems working hand-in-hand, with the former “setting the parameters of what standard of care should look like” and hospitals making it a reality. 

Make syphilis testing convenient

Beyond greater awareness, access to testing and treatment needs to be quick, easy and convenient, Chokshi said. 

Indian Country has led the way on this, partly by necessity: American Indian and Alaska Natives have the highest syphilis rates of any racial or ethnic group, almost seven times higher than white people. 

As such, tribes across the U.S. have turned to incentives, giving people $10 gift cards if they come in for STI testing or treatment, said Jessica Leston, founder of the Raven Collective, an Indigenous public health organization.

“We’re just helping people pay for gas and child care and get food on their table,” Leston said. At Cass Lake Indian Hospital’s pharmacy in rural Minnesota, the strategy increased STI testing tenfold, according to one study, with over 70% of the patients who got a test not having a primary care provider.

In 2023, a coalition of tribal communities partnered with Johns Hopkins School of Medicine to ramp up a program called I Want the Kit, which sends at-home STI test kits in the mail. The tests come in unmarked envelopes with instructions on how to collect a sample and send back the test. Results come back in a week or two, and patients are linked to health care resources if the test comes back positive.

Even with these programs, syphilis testing can be overshadowed by more immediate concerns.

In California, for example, half of pregnant women with syphilis reported methamphetamine use, and a quarter were homeless. In the state’s rural Shasta County, near the Oregon border, almost 100% of pregnant woman with syphilis similarly have a substance use disorder and 90% are unhoused, said Trojan Carvajal,
a supervising public health nurse in the county’s STI unit.

In April 2023, Shasta County launched the CommUNITY Mobile Care Clinic, an RV retrofitted with a reception area and two exam rooms, bringing STI tests and treatments to the county’s most vulnerable — from homeless camps to pop-ups with the local LBGTQ community center. Importantly, there’s no STI branding on the mobile clinic itself, allowing people to feel more comfortable walking in to get tested.

Last year, one-third of all syphilis tests performed by Shasta County were done through the mobile clinic, according to Jai Winchell, a community education specialist with the county’s public health department. These people would likely have never sought syphilis services otherwise, Winchell said, but with this mobile clinic crisscrossing the county and arriving at their doorsteps, they can get tested and treated in just 30 minutes.

Piggybacking syphilis services

Shasta County’s mobile clinic also offers other services, including test strips for deadly drugs like fentanyl and xylazine, naloxone to reverse overdoses and referrals to addiction counselors, as well as water, snacks and dental kits, Winchell said. The idea is to address overlapping concerns together, while also attracting those who wouldn’t have considered STI testing, if not for the package deal.

This approach also helps build trust, said Dr. Arlene Seña, an infectious diseases physician at the University of North Carolina Chapel Hill, showing how mobile clinic staff are invested in you as a person with various needs, rather than a singular problem to be solved. “It might be more costly, but it’s also much, much more effective and helpful to the community,” Seña said.

Syphilis services can also be integrated with general health care services. In March, Stafford launched a rapid testing program at two Houston hospitals aimed at all pregnant women admitted to the emergency department. The program, called Preg-Out, was set up on an opt-out basis, so everyone got tested unless they refused. It took about 15 minutes, and women were offered prenatal care regardless of the result.

“We noticed that pregnant patients, especially those that end up having a child with congenital syphilis, often frequent the ED and don’t get tested,” Stafford said. In the three-month pilot, Stafford said testing rates for pregnant women increased twelvefold, with about 35% of their partners wanting to get tested as well. 

Other hospitals have implemented opt-out screening programs for all patients, including Grady Memorial Hospital in Atlanta in one of their urgent care centers and the University of Chicago in their emergency department. Not every hospital has the resources to test everyone, Seña said, so she believes prioritizing pregnant patients, as done in Houston, can be a high-impact first step.

“You can’t just rely on public health departments to do the brunt of the work for STI recognition and prevention,” she said. “You have to go hand in hand with other providers in the community.”

The future ahead

The U.S. got syphilis rates down before, but that was in the 1990s, when HIV was ravaging through America. 

“What changed behavior then was lethal, hard-to-treat disease,” said Mayer, from Fenway Health. “Now, you have a generation of people who may be less informed,” leading to lower rates of condom use and STI screening rates. 

However, it’s also a time of innovation. In June, the CDC recommended doxycycline post-exposure prophylaxis for high-risk groups — essentially, a morning after pill for STIs. If taken within 72 hours of condomless sex, so-called DoxyPEP reduces syphilis rates by over 70%, and Fenway Health, where half of patients are LGBTQ, has already begun ramping up distribution, Mayer said. Meanwhile, other researchers like Seña have been working on developing a syphilis vaccine, but that’s probably several years down the line.

“Our task right now is to arrest the growth in cases,” said Chokshi, from the Common Health Coalition, and he’s optimistic that these innovative awareness, testing and treatment campaigns can do that. But permanently bending the syphilis curve will require scaling these efforts nationally and promoting greater coordination between health care and public health.

“There’s no reason that the endgame can’t be, once again, trying to eliminate syphilis — this historic scourge that is completely preventable and treatable,” Chokshi said.

This article first appeared on NBCNews.com. Read more from NBC News here:

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The preventative procedure can be uncomfortable, even painful — and you usually have to hold your breath while one of the most sensitive parts of your body is smushed in a machine that takes images.

“The anxiety was getting to me, and the fear,” said patient Stephanie Batistas.

VHC Health, a Northern Virginia Hospital, wants to change all that. Think warm robes, mood lighting and new technology that allows you to control the pressure during a mammogram.

They hope the changes will make women less hesitant to get their regular check-ups.

“I would go every few years because I would dread it so much,” Batistas said. “But with COVID, I hadn’t been here in four years.” 

The new technology aims to make the experience a lot more comfortable.

“We wanted this spa-like feel,” said Dr. Sarah Mezban. “Not going for a mammogram, sitting in a room and you’re worried about the outcome of your mammogram. We wanted the patient to have a relaxed experience.”

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Patients are given heated robes when they visit VHC Health, and mood lighting emits from the new Siemens mammography machine.

“As a patient, you want your mind to go somewhere else,” Mezban said. “And I think the calming lights that you see with the machine is very nice feature.”

She calls the machines a game changer. They’re equipped with a wider angle that creates more detailed 3D images.

They also use AI technology.

“The artificial intelligence [is] basically a machine that was fed a lot of the mammograms with the accurate findings in them. And [they] learn to pick up the morphology or the shape, so it will pick up anything that is round, anything that is a star shape, or if there are any calcifications,” Mezban explained. “It will highlight those at the end of the exam, and it will draw attention to kind of look back and compare.”

Studies show routine mammograms save lives, reducing breast cancer deaths in the U.S. by nearly 40% since 1990.

With the new machines VHC Health is using, patients no longer need to hold their breath, and can even control the amount of compression on their own, adjusting it to their comfort level.

“I thought I would be a lot more nervous than I really was,” Batistas said. “I wasn’t nervous at all. The light was changing. The tech was wonderful.”

“I’m not putting it off anymore,” Batistas said. “I’m coming every year.”

The U.S. Preventive Services Task Force recommends that women get regular mammograms starting at age 40. Those with high risk or a family history of breast cancer may need to be screened sooner, and should have a conversation with their doctor.

The new study, published Wednesday in Neurology, found that having either high or low levels of high-density lipoprotein, or HDL, cholesterol, may increase the risk of dementia in older adults. It’s more evidence showing that keeping HDL cholesterol within a certain range is important for cardiovascular and brain health.  

“The relationship between HDL cholesterol and dementia is more complex than we previously thought,” said the study’s lead author, Erin Ferguson, a doctoral student studying epidemiology at the University of California San Francisco. “While the magnitude of this relationship is relatively small, it’s important,”

The results show a correlation between HDL cholesterol and dementia, but do not prove that low or high levels of the lipid directly caused dementia. The study, which was supported by the National Institute on Aging and the National Institutes of Health, included more than 184,000 adults with an average age of 70. None had dementia when the study began. Researchers used a combination of surveys and electronic records from the Kaiser Permanente Northern California health plan to track cholesterol levels, health behaviors and whether someone developed dementia over about 13 years. During that time, just more than 25,000 people developed dementia. 

The Centers for Disease Control and Prevention recommends people keep their total cholesterol at about 150 mg/dL, or milligrams per deciliter of blood, with LDL at or below 100 mg/dL. Low-density lipoprotein, or LDL, cholesterol, has long been recognized for its often deadly impact on the cardiovascular system. 

Read the full story on NBCNews.com here.

Developed by Japanese drugmaker Eisai Co. and U.S. biotechnology firm Biogen Inc., the drug’s approval in Japan comes two months after it was endorsed by the U.S. Food and Drug Administration.

Leqembi is for patients with mild dementia and other symptoms in the early stages of Alzheimer’s disease, and the first medicine that can modestly slow their cognitive decline.

Prime Minister Fumio Kishida, who announced Japan’s approval of Leqembi on Monday, called it “a breakthrough” and said that the “treatment of dementia has now entered a new era.”

Kishida has pledged to step up support for the growing number of dementia patients and their families and is due to launch a panel this week to discuss measures for a dementia-friendly society.

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According to the health ministry, Japan’s number of dementia patients who are 65 years of age or older will rise to 7 million in 2025, from the current 6 million.

The drug, however, does not work for everyone and — as with other Alzheimer’s drugs that target plaques in the brain — can cause dangerous side effects such as brain swelling and bleeding in rare cases.

Eisai said it will conduct a post-marketing special use survey in all patients administered the drug until enough data is collected from unspecified number of patients under Japanese health ministry procedures.

The drug will be partially covered by health insurance and is expected to be ready for clinical use by the end of the year. The price is yet to be decided but is expected to be expensive, Kyodo News agency reported.

Eisai is committed to delivering Leqembi to people who need it and their families “as a new treatment,” said Haruo Naito, the company’s CEO.

“We aim to create impact on issues surrounding dementia in Japanese society,” he said.

The well-being of Finnish people has sparked great interest in the country and its practices. And Finland is offering guidance on how to be happier, free of charge.

Back in March, the country’s tourism department, Visit Finland, announced an offer for 10 people to visit the country and embark on their take of a masterclass on happiness.

Visit Finland reports that they received over 150,000 applications from all around the world for the unique opportunity. In an attempt to reach as many people as possible, they decided to also offer the masterclass for free in a virtual format.

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“This masterclass will take you a step closer with insights from five coaches under four core themes: Nature & Lifestyle, Health & Balance, Design & Everyday and Food & Wellbeing,” the course, which became available online on September 14, states.

In hopes of “finding my inner Finn,” I watched all five lessons of the course, and these are my biggest takeaways.

Here’s what I learned from Finland’s happiness masterclass

1. Connecting with nature is important for your mental health, no matter where you live

As someone who lives in a city, I thought reaping nature’s benefits would be virtually impossible for me without traveling far. However, the course taught me that having a relationship with nature doesn’t have to look like being in the forest or sailing on a river; it’s more about being in tune with our five senses as we walk outside to do the simple things like grabbing a coffee or commuting to work.

Without pausing and intentionally paying attention to the beauty around me, I was denying myself the easiest way to boost my happiness: connecting with nature.

Finland is ahead of the game because they have a law called “Everyman’s Rights” which grants people the right to roam and stay overnight in nature, regardless of land ownership. Many Finnish people camp frequently, walk and bike in nature and simply embrace all that nature has to offer.

“It’s true that even a small amount of time spent in nature reduces your stress, clears your mind, gives you experiences and lets you connect with yourself in ways that only nature can do,” Mikaela Creutz, a hiker and nature lover, says during the masterclass.

2. It’s better to have enough than to want for more

I’ll be the first to admit that I view myself as a go-getter, and it’s something that I’ve taken much pride in. But there is a downside to always aiming higher and wanting more, according to April Rinne, an author and speaker who teaches about the importance of embracing change and uncertainty.

“When we’re focused on more, we’re actually never able to find enough,” says Rinne during the course. “The goalpost keeps changing.”

Rinne defines “enough” as balance, harmony and sufficiency. Embracing “enough” means “having all that you need to thrive, but not carrying around excess,” she adds.

“That includes knowing that you are enough just as you are, and you always have been — rather than ‘I will only be happy when I achieve this goal or make this amount of money or can get this particular product.'”

My goal moving forward is to honor where I am in life. Instead of focusing too much on everything else I want, I’ll aim to simply be open to the possibilities that are on the horizon. Not only can this take a huge weight off of my shoulders, but it’ll likely also allow me to feel happier about what I have now.

3. The way you design your space can impact your mental health

Initially, I wasn’t sure what I’d gain from the lesson about design because it didn’t seem to me that it would be essential to happiness. Yet, hearing design professional, Taina Snellman-Langenskiöld, talk about how much our homes and the spaces we visit frequently affect our well-being was fascinating.

“In Finnish, we have an old saying that a poor man cannot afford bad quality,” Snellman-Langenskiöld says in the course.

And you may be surprised to hear that “good” quality for her doesn’t mean the most expensive things. Sometimes, things can have more value to us because we made them with our own hands or the materials used to make them were sustainable and better for our planet.

Snellman-Langenskiöld suggests using design to improve your lifestyle by:

• Only buying meaningful objects that will stand the test of time and always be appealing to you
• Making beautiful things and surrounding yourself with them
• “Taking nature in” by having plants and buying yourself flowers
• Thinking about how you can design your space to make your life easier and more functional

She leaves viewers with this last piece of advice to consider: “Meaningfulness in design is one of the keys to happiness.”

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The 58-year-old Navy veteran was facing near-certain death from heart failure but other health problems meant he wasn’t eligible for a traditional heart transplant, according to doctors at University of Maryland Medicine.

“Nobody knows from this point forward. At least now I have hope and I have a chance,” Lawrence Faucette, from Frederick, Maryland, said in a video recorded by the hospital before Wednesday’s operation. “I will fight tooth and nail for every breath I can take.”

While the next few weeks will be critical, doctors were thrilled at Faucette’s early response to the pig organ.

“You know, I just keep shaking my head – how am I talking to someone who has a pig heart?” Dr. Bartley Griffith, who performed the transplant, told The Associated Press. He said doctors are feeling “a great privilege but, you know, a lot of pressure.”

The same Maryland team last year performed the world’s first transplant of a genetically modified pig heart into another dying man, David Bennett, who survived just two months.

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There’s a huge shortage of human organs donated for transplant. Last year, there were just over 4,100 heart transplants in the U.S., a record number but the supply is so tight that only patients with the best chance of long-term survival get offered one.

Attempts at animal-to-human organ transplants have failed for decades, as people’s immune systems immediately destroyed the foreign tissue. Now scientists are trying again using pigs genetically modified to make their organs more humanlike.

Recently, scientists at other hospitals have tested pig kidneys and hearts in donated human bodies, hoping to learn enough to begin formal studies of what are called xenotransplants.

To make this new attempt in a living patient outside of a rigorous trial, the Maryland researchers required special permission from the Food and Drug Administration, under a process reserved for certain emergency cases with no other options.

It took over 300 pages of documents filed with FDA, but the Maryland researchers made their case that they’d learned enough from their first attempt last year – even though that patient died for reasons that aren’t fully understood – that it made sense to try again.

And Faucette, who retired as a lab technician at the National Institutes of Health, had to agree that he understood the procedure’s risks.

In a statement his wife, Ann Faucette, said: “We have no expectations other than hoping for more time together. That could be as simple as sitting on the front porch and having coffee together.”

What’s different this time: Only after last year’s transplant did scientists discover signs of a pig virus lurking inside the heart – and they now have better tests to look for hidden viruses. They also made some medication changes.

Possibly more important, while Faucette has end-stage heart failure and was out of other options, he wasn’t as near death as the prior patient.

By Friday, his new heart was functioning well without any supportive machinery, the hospital said.

“It’s just an amazing feeling to see this pig heart work in a human,” said Dr. Muhammad Mohiuddin, the Maryland team’s xenotransplantation expert. But, he cautioned, “we don’t want to predict anything. We will take every day as a victory and move forward.”

This kind of single-patient “compassionate use” can provide some information about how the pig organ works but not nearly as much as more formal testing, said Karen Maschke, a research scholar at the Hastings Center who is helping develop ethics and policy recommendations for xenotransplant clinical trials. That FDA allowed this second case “suggests that the agency is not ready to permit a pig heart clinical trial to start,” Mashke added.

The pig heart, provided by Blacksburg, Virginia-based Revivicor, has 10 genetic modifications – knocking out some pig genes and adding some human ones to make it more acceptable to the human immune system.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

But Stafford, a maternal-fetal medicine physician at the University of Texas Health Sciences Center in Houston, quickly realized something was wrong: She couldn’t find a heartbeat. The unborn baby boy had already died in the womb. 

Soon after, the mother’s syphilis test — given to all women before delivery — came back positive. The infection had been silently passed from mother to son.

It’s a death, Stafford said, that could’ve been prevented with early detection and a shot of penicillin. 

Syphilis, a sexually transmitted infection, was nearly eliminated in the U.S. at the beginning of the 21st century but has made a dramatic comeback. In 2022, the Centers for Disease Control and Prevention reported more than 200,000 syphilis cases — the highest counts since 1950. Congenital syphilis has similarly increased tenfold over the past decade, the CDC says, even though 90% of cases are fully preventable.

Syphilis in the U.S.

More than 200,000 cases were reported in 2022, the most since 1950.

The return of syphilis is the result, experts say, of poorly funded prevention programs over the past two decades and difficulties in diagnosis; syphilis is referred to as the “great imitator” because its symptoms can vary so widely. Most people don’t show symptoms or know they’re infected, and even if they do visit the doctor’s office, there’s no guarantee they’ll be properly diagnosed.

Stafford said her patient didn’t have the resources to seek prenatal care, and no doctor or public health worker had ever told her that she should get tested for syphilis. So, when the patient noticed a small rash on her belly, she didn’t think too much about it, Stafford added.

“There’s a lot of people who are seen in private practice, hospital ERs, or walk-in centers, and those clinicians are not necessarily thinking of syphilis, they’re not necessarily getting a sexual history,” said Dr. Kenneth Mayer, an infectious disease physician and medical research director of the Fenway Institute in Boston. With a generation of doctors who saw few, if any, syphilis cases during their training, Mayer said that “the issue is tests not being done in the first place.”

The all-encompassing nature of the Covid pandemic added fuel to this fire, as public health departments redirected STI resources toward fighting the coronavirus.

“The solutions for controlling syphilis are relatively straightforward. We’re not talking about high tech approaches or a novel therapeutic,” said Dr. Dave Chokshi, chair of the Common Health Coalition and a former New York City Commissioner of Health. “It simply revolves around closing gaps in testing and treatment.”

As syphilis cases surge, doctors and public health officials are starting to develop innovative and sometimes unconventional strategies to screen people for syphilis and curb the spread of the disease. 

Most often, that comes down to figuring out how to get people tested, a task that’s far easier said than done.

Spreading the word about syphilis

Given these challenges, some public health departments have launched eye-popping awareness campaigns, trying to raise the alarm among both the public and health care providers. 

A few years ago, Donna Fox, the HIV and STI manager at the Toledo-Lucas County Health Department in Ohio, noticed that about one-fifth of syphilis cases in the area were among people who reported paying for sex. 

So, trying to be proactive — and a bit provocative — Fox and her team ran billboards across the county in 2022 saying, “Paying for Sex? Get Tested!”

“We had to go bold, and we had to get to the point,” she said. The pushback was inevitable — “you might have to say something to your 10-year-old who can read,” Fox conceded — but the impact was measurable. From 2021 through 2022, the number of syphilis appointments scheduled via the county health department jumped by almost 50%, and syphilis cases dropped by 12%, she said.

Of course, syphilis doesn’t just spread among sex workers, so last year, Fox’s team broadened the campaign, keeping the same look and feel but instead saying “Syphilis is Serious” with “Spreading Locally!” overlaid over the side.

Other billboard campaigns across the country have featured giant bloodshot, infected eyes with the blurry words “Eye Syphilis is Serious” and a black silhouette of a pregnant woman with a red belly saying “Syphilis Can Be Fatal to Your Baby.” While these billboards are factually true, Mayer describes how this kind of fear-based campaign, or “loss frame,” draws lots of attention but may not be particularly effective at motivating behavioral changes for STIs.

“We’re not telling anybody not to have sex,” Fox said. “We’re telling people to have safe sex,” and to get tested afterward.

The sex positivity message isn’t just for the public. The Toledo-Lucas health department also launched an educational campaign for clinicians, reminding them to take a sexual history of all patients — since the county saw syphilis in people ages 15 to 72 last year — and to order a blood test if they suspect an STI, since the standard “pee in a cup” test can’t detect syphilis.

“Many physicians haven’t seen syphilis, and they’ve got a million things to know,” Fox said. “If we don’t talk to the physicians, we’re not going to get the testing we need done.”

Stafford, the maternal-fetal medicine doctor in Houston, has taken a more hands-on approach. Texas mandates syphilis testing for pregnant women at three points — during their first prenatal visit, around the 28-week mark and before delivery — but in reality, these tests are often missed. So, last year, Stafford launched an alert in UTHealth’s electronic medical records, prompting providers to test their pregnant patients for syphilis at each of the prescribed times. The simple tweak helped increase screening rates from 2% to 47% at all three timepoints, while decreasing congenital syphilis cases by half.

Chokshi sees this as another good example of the public health and health care systems working hand-in-hand, with the former “setting the parameters of what standard of care should look like” and hospitals making it a reality. 

Make syphilis testing convenient

Beyond greater awareness, access to testing and treatment needs to be quick, easy and convenient, Chokshi said. 

Indian Country has led the way on this, partly by necessity: American Indian and Alaska Natives have the highest syphilis rates of any racial or ethnic group, almost seven times higher than white people. 

As such, tribes across the U.S. have turned to incentives, giving people $10 gift cards if they come in for STI testing or treatment, said Jessica Leston, founder of the Raven Collective, an Indigenous public health organization.

“We’re just helping people pay for gas and child care and get food on their table,” Leston said. At Cass Lake Indian Hospital’s pharmacy in rural Minnesota, the strategy increased STI testing tenfold, according to one study, with over 70% of the patients who got a test not having a primary care provider.

In 2023, a coalition of tribal communities partnered with Johns Hopkins School of Medicine to ramp up a program called I Want the Kit, which sends at-home STI test kits in the mail. The tests come in unmarked envelopes with instructions on how to collect a sample and send back the test. Results come back in a week or two, and patients are linked to health care resources if the test comes back positive.

Even with these programs, syphilis testing can be overshadowed by more immediate concerns.

In California, for example, half of pregnant women with syphilis reported methamphetamine use, and a quarter were homeless. In the state’s rural Shasta County, near the Oregon border, almost 100% of pregnant woman with syphilis similarly have a substance use disorder and 90% are unhoused, said Trojan Carvajal,
a supervising public health nurse in the county’s STI unit.

In April 2023, Shasta County launched the CommUNITY Mobile Care Clinic, an RV retrofitted with a reception area and two exam rooms, bringing STI tests and treatments to the county’s most vulnerable — from homeless camps to pop-ups with the local LBGTQ community center. Importantly, there’s no STI branding on the mobile clinic itself, allowing people to feel more comfortable walking in to get tested.

Last year, one-third of all syphilis tests performed by Shasta County were done through the mobile clinic, according to Jai Winchell, a community education specialist with the county’s public health department. These people would likely have never sought syphilis services otherwise, Winchell said, but with this mobile clinic crisscrossing the county and arriving at their doorsteps, they can get tested and treated in just 30 minutes.

Piggybacking syphilis services

Shasta County’s mobile clinic also offers other services, including test strips for deadly drugs like fentanyl and xylazine, naloxone to reverse overdoses and referrals to addiction counselors, as well as water, snacks and dental kits, Winchell said. The idea is to address overlapping concerns together, while also attracting those who wouldn’t have considered STI testing, if not for the package deal.

This approach also helps build trust, said Dr. Arlene Seña, an infectious diseases physician at the University of North Carolina Chapel Hill, showing how mobile clinic staff are invested in you as a person with various needs, rather than a singular problem to be solved. “It might be more costly, but it’s also much, much more effective and helpful to the community,” Seña said.

Syphilis services can also be integrated with general health care services. In March, Stafford launched a rapid testing program at two Houston hospitals aimed at all pregnant women admitted to the emergency department. The program, called Preg-Out, was set up on an opt-out basis, so everyone got tested unless they refused. It took about 15 minutes, and women were offered prenatal care regardless of the result.

“We noticed that pregnant patients, especially those that end up having a child with congenital syphilis, often frequent the ED and don’t get tested,” Stafford said. In the three-month pilot, Stafford said testing rates for pregnant women increased twelvefold, with about 35% of their partners wanting to get tested as well. 

Other hospitals have implemented opt-out screening programs for all patients, including Grady Memorial Hospital in Atlanta in one of their urgent care centers and the University of Chicago in their emergency department. Not every hospital has the resources to test everyone, Seña said, so she believes prioritizing pregnant patients, as done in Houston, can be a high-impact first step.

“You can’t just rely on public health departments to do the brunt of the work for STI recognition and prevention,” she said. “You have to go hand in hand with other providers in the community.”

The future ahead

The U.S. got syphilis rates down before, but that was in the 1990s, when HIV was ravaging through America. 

“What changed behavior then was lethal, hard-to-treat disease,” said Mayer, from Fenway Health. “Now, you have a generation of people who may be less informed,” leading to lower rates of condom use and STI screening rates. 

However, it’s also a time of innovation. In June, the CDC recommended doxycycline post-exposure prophylaxis for high-risk groups — essentially, a morning after pill for STIs. If taken within 72 hours of condomless sex, so-called DoxyPEP reduces syphilis rates by over 70%, and Fenway Health, where half of patients are LGBTQ, has already begun ramping up distribution, Mayer said. Meanwhile, other researchers like Seña have been working on developing a syphilis vaccine, but that’s probably several years down the line.

“Our task right now is to arrest the growth in cases,” said Chokshi, from the Common Health Coalition, and he’s optimistic that these innovative awareness, testing and treatment campaigns can do that. But permanently bending the syphilis curve will require scaling these efforts nationally and promoting greater coordination between health care and public health.

“There’s no reason that the endgame can’t be, once again, trying to eliminate syphilis — this historic scourge that is completely preventable and treatable,” Chokshi said.

This article first appeared on NBCNews.com. Read more from NBC News here:

• A Gazan girl’s pink rollerblades become an image of tragedy and desperation
• Biden officials ‘watered down’ warnings about crumbling security before Afghan withdrawal, new House GOP report says
• Liz Cheney says it’s ‘not enough’ for anti-Trump Republicans to vote for someone other than Harris

But Stafford, a maternal-fetal medicine physician at the University of Texas Health Sciences Center in Houston, quickly realized something was wrong: She couldn’t find a heartbeat. The unborn baby boy had already died in the womb. 

Soon after, the mother’s syphilis test — given to all women before delivery — came back positive. The infection had been silently passed from mother to son.

It’s a death, Stafford said, that could’ve been prevented with early detection and a shot of penicillin. 

Syphilis, a sexually transmitted infection, was nearly eliminated in the U.S. at the beginning of the 21st century but has made a dramatic comeback. In 2022, the Centers for Disease Control and Prevention reported more than 200,000 syphilis cases — the highest counts since 1950. Congenital syphilis has similarly increased tenfold over the past decade, the CDC says, even though 90% of cases are fully preventable.

Syphilis in the U.S.

More than 200,000 cases were reported in 2022, the most since 1950.

The return of syphilis is the result, experts say, of poorly funded prevention programs over the past two decades and difficulties in diagnosis; syphilis is referred to as the “great imitator” because its symptoms can vary so widely. Most people don’t show symptoms or know they’re infected, and even if they do visit the doctor’s office, there’s no guarantee they’ll be properly diagnosed.

Stafford said her patient didn’t have the resources to seek prenatal care, and no doctor or public health worker had ever told her that she should get tested for syphilis. So, when the patient noticed a small rash on her belly, she didn’t think too much about it, Stafford added.

“There’s a lot of people who are seen in private practice, hospital ERs, or walk-in centers, and those clinicians are not necessarily thinking of syphilis, they’re not necessarily getting a sexual history,” said Dr. Kenneth Mayer, an infectious disease physician and medical research director of the Fenway Institute in Boston. With a generation of doctors who saw few, if any, syphilis cases during their training, Mayer said that “the issue is tests not being done in the first place.”

The all-encompassing nature of the Covid pandemic added fuel to this fire, as public health departments redirected STI resources toward fighting the coronavirus.

“The solutions for controlling syphilis are relatively straightforward. We’re not talking about high tech approaches or a novel therapeutic,” said Dr. Dave Chokshi, chair of the Common Health Coalition and a former New York City Commissioner of Health. “It simply revolves around closing gaps in testing and treatment.”

As syphilis cases surge, doctors and public health officials are starting to develop innovative and sometimes unconventional strategies to screen people for syphilis and curb the spread of the disease. 

Most often, that comes down to figuring out how to get people tested, a task that’s far easier said than done.

Spreading the word about syphilis

Given these challenges, some public health departments have launched eye-popping awareness campaigns, trying to raise the alarm among both the public and health care providers. 

A few years ago, Donna Fox, the HIV and STI manager at the Toledo-Lucas County Health Department in Ohio, noticed that about one-fifth of syphilis cases in the area were among people who reported paying for sex. 

So, trying to be proactive — and a bit provocative — Fox and her team ran billboards across the county in 2022 saying, “Paying for Sex? Get Tested!”

“We had to go bold, and we had to get to the point,” she said. The pushback was inevitable — “you might have to say something to your 10-year-old who can read,” Fox conceded — but the impact was measurable. From 2021 through 2022, the number of syphilis appointments scheduled via the county health department jumped by almost 50%, and syphilis cases dropped by 12%, she said.

Of course, syphilis doesn’t just spread among sex workers, so last year, Fox’s team broadened the campaign, keeping the same look and feel but instead saying “Syphilis is Serious” with “Spreading Locally!” overlaid over the side.

Other billboard campaigns across the country have featured giant bloodshot, infected eyes with the blurry words “Eye Syphilis is Serious” and a black silhouette of a pregnant woman with a red belly saying “Syphilis Can Be Fatal to Your Baby.” While these billboards are factually true, Mayer describes how this kind of fear-based campaign, or “loss frame,” draws lots of attention but may not be particularly effective at motivating behavioral changes for STIs.

“We’re not telling anybody not to have sex,” Fox said. “We’re telling people to have safe sex,” and to get tested afterward.

The sex positivity message isn’t just for the public. The Toledo-Lucas health department also launched an educational campaign for clinicians, reminding them to take a sexual history of all patients — since the county saw syphilis in people ages 15 to 72 last year — and to order a blood test if they suspect an STI, since the standard “pee in a cup” test can’t detect syphilis.

“Many physicians haven’t seen syphilis, and they’ve got a million things to know,” Fox said. “If we don’t talk to the physicians, we’re not going to get the testing we need done.”

Stafford, the maternal-fetal medicine doctor in Houston, has taken a more hands-on approach. Texas mandates syphilis testing for pregnant women at three points — during their first prenatal visit, around the 28-week mark and before delivery — but in reality, these tests are often missed. So, last year, Stafford launched an alert in UTHealth’s electronic medical records, prompting providers to test their pregnant patients for syphilis at each of the prescribed times. The simple tweak helped increase screening rates from 2% to 47% at all three timepoints, while decreasing congenital syphilis cases by half.

Chokshi sees this as another good example of the public health and health care systems working hand-in-hand, with the former “setting the parameters of what standard of care should look like” and hospitals making it a reality. 

Make syphilis testing convenient

Beyond greater awareness, access to testing and treatment needs to be quick, easy and convenient, Chokshi said. 

Indian Country has led the way on this, partly by necessity: American Indian and Alaska Natives have the highest syphilis rates of any racial or ethnic group, almost seven times higher than white people. 

As such, tribes across the U.S. have turned to incentives, giving people $10 gift cards if they come in for STI testing or treatment, said Jessica Leston, founder of the Raven Collective, an Indigenous public health organization.

“We’re just helping people pay for gas and child care and get food on their table,” Leston said. At Cass Lake Indian Hospital’s pharmacy in rural Minnesota, the strategy increased STI testing tenfold, according to one study, with over 70% of the patients who got a test not having a primary care provider.

In 2023, a coalition of tribal communities partnered with Johns Hopkins School of Medicine to ramp up a program called I Want the Kit, which sends at-home STI test kits in the mail. The tests come in unmarked envelopes with instructions on how to collect a sample and send back the test. Results come back in a week or two, and patients are linked to health care resources if the test comes back positive.

Even with these programs, syphilis testing can be overshadowed by more immediate concerns.

In California, for example, half of pregnant women with syphilis reported methamphetamine use, and a quarter were homeless. In the state’s rural Shasta County, near the Oregon border, almost 100% of pregnant woman with syphilis similarly have a substance use disorder and 90% are unhoused, said Trojan Carvajal,
a supervising public health nurse in the county’s STI unit.

In April 2023, Shasta County launched the CommUNITY Mobile Care Clinic, an RV retrofitted with a reception area and two exam rooms, bringing STI tests and treatments to the county’s most vulnerable — from homeless camps to pop-ups with the local LBGTQ community center. Importantly, there’s no STI branding on the mobile clinic itself, allowing people to feel more comfortable walking in to get tested.

Last year, one-third of all syphilis tests performed by Shasta County were done through the mobile clinic, according to Jai Winchell, a community education specialist with the county’s public health department. These people would likely have never sought syphilis services otherwise, Winchell said, but with this mobile clinic crisscrossing the county and arriving at their doorsteps, they can get tested and treated in just 30 minutes.

Piggybacking syphilis services

Shasta County’s mobile clinic also offers other services, including test strips for deadly drugs like fentanyl and xylazine, naloxone to reverse overdoses and referrals to addiction counselors, as well as water, snacks and dental kits, Winchell said. The idea is to address overlapping concerns together, while also attracting those who wouldn’t have considered STI testing, if not for the package deal.

This approach also helps build trust, said Dr. Arlene Seña, an infectious diseases physician at the University of North Carolina Chapel Hill, showing how mobile clinic staff are invested in you as a person with various needs, rather than a singular problem to be solved. “It might be more costly, but it’s also much, much more effective and helpful to the community,” Seña said.

Syphilis services can also be integrated with general health care services. In March, Stafford launched a rapid testing program at two Houston hospitals aimed at all pregnant women admitted to the emergency department. The program, called Preg-Out, was set up on an opt-out basis, so everyone got tested unless they refused. It took about 15 minutes, and women were offered prenatal care regardless of the result.

“We noticed that pregnant patients, especially those that end up having a child with congenital syphilis, often frequent the ED and don’t get tested,” Stafford said. In the three-month pilot, Stafford said testing rates for pregnant women increased twelvefold, with about 35% of their partners wanting to get tested as well. 

Other hospitals have implemented opt-out screening programs for all patients, including Grady Memorial Hospital in Atlanta in one of their urgent care centers and the University of Chicago in their emergency department. Not every hospital has the resources to test everyone, Seña said, so she believes prioritizing pregnant patients, as done in Houston, can be a high-impact first step.

“You can’t just rely on public health departments to do the brunt of the work for STI recognition and prevention,” she said. “You have to go hand in hand with other providers in the community.”

The future ahead

The U.S. got syphilis rates down before, but that was in the 1990s, when HIV was ravaging through America. 

“What changed behavior then was lethal, hard-to-treat disease,” said Mayer, from Fenway Health. “Now, you have a generation of people who may be less informed,” leading to lower rates of condom use and STI screening rates. 

However, it’s also a time of innovation. In June, the CDC recommended doxycycline post-exposure prophylaxis for high-risk groups — essentially, a morning after pill for STIs. If taken within 72 hours of condomless sex, so-called DoxyPEP reduces syphilis rates by over 70%, and Fenway Health, where half of patients are LGBTQ, has already begun ramping up distribution, Mayer said. Meanwhile, other researchers like Seña have been working on developing a syphilis vaccine, but that’s probably several years down the line.

“Our task right now is to arrest the growth in cases,” said Chokshi, from the Common Health Coalition, and he’s optimistic that these innovative awareness, testing and treatment campaigns can do that. But permanently bending the syphilis curve will require scaling these efforts nationally and promoting greater coordination between health care and public health.

“There’s no reason that the endgame can’t be, once again, trying to eliminate syphilis — this historic scourge that is completely preventable and treatable,” Chokshi said.

This article first appeared on NBCNews.com. Read more from NBC News here:

• A Gazan girl’s pink rollerblades become an image of tragedy and desperation
• Biden officials ‘watered down’ warnings about crumbling security before Afghan withdrawal, new House GOP report says
• Liz Cheney says it’s ‘not enough’ for anti-Trump Republicans to vote for someone other than Harris

Patient Jenni Davis from Lisbon, Ohio, is the first person in the country to be given the experimental vaccine, aimed at fighting cancer and keeping it from returning.

In February 2018, Davis found a lump on her breast. Tests soon led to a final diagnosis of triple negative breast cancer, a type of the disease which is notoriously hard to treat.

“When I was diagnosed, a lot of fear, a lot of questions,” she said. “What if? What’s going to happen?”

The mother of three was treated at the Cleveland Clinic and underwent a double mastectomy and several rounds of chemo and radiation.

After her treatment was over, she heard about the hospital’s breast cancer vaccine trial and immediately enrolled.

“I was just so fearful of recurrence that I wanted something so badly. So, to me, it wasn’t something I had to go back and forth with,” Davis said.

“The vaccine has been under research for over 20 years,” Dr. Amit Kumar, CEO of Anixa Biosciences, said.

Kumar added that the shot has been successfully studied in lab animals for decades, but this is the very first human trial.

The vaccine works by training the immune system to target and destroy cells that produce a milk protein that appears in breast cancer cells, stopping those cells from growing.

“The immune system should be able to destroy those early cancer cells as they arise, so those cancer cells never have a chance to become a large tumor mass,” Kumar said. “We expect that within five years, the vaccine will be available for people who have had breast cancer and are in danger of recurrence.”

After three rounds of the vaccine with no serious complications, Davis is hopeful. The patient remains cancer-free and excited about the possibility this new development could hold for others.

“Down the road, you know, to potentially wipe out triple negative breast cancer all together is amazing, and I’m so thankful I get to be a part of it,” Davis said.

The early results of the trial are encouraging, and while doctors are currently focused on triple negative breast cancer, they believe this vaccine could prevent other types of breast cancer in the future.

News4 sends breaking news stories by email. Go here to sign up to get breaking news alerts in your inbox.

But Stafford, a maternal-fetal medicine physician at the University of Texas Health Sciences Center in Houston, quickly realized something was wrong: She couldn’t find a heartbeat. The unborn baby boy had already died in the womb. 

Soon after, the mother’s syphilis test — given to all women before delivery — came back positive. The infection had been silently passed from mother to son.

It’s a death, Stafford said, that could’ve been prevented with early detection and a shot of penicillin. 

Syphilis, a sexually transmitted infection, was nearly eliminated in the U.S. at the beginning of the 21st century but has made a dramatic comeback. In 2022, the Centers for Disease Control and Prevention reported more than 200,000 syphilis cases — the highest counts since 1950. Congenital syphilis has similarly increased tenfold over the past decade, the CDC says, even though 90% of cases are fully preventable.

Syphilis in the U.S.

More than 200,000 cases were reported in 2022, the most since 1950.

The return of syphilis is the result, experts say, of poorly funded prevention programs over the past two decades and difficulties in diagnosis; syphilis is referred to as the “great imitator” because its symptoms can vary so widely. Most people don’t show symptoms or know they’re infected, and even if they do visit the doctor’s office, there’s no guarantee they’ll be properly diagnosed.

Stafford said her patient didn’t have the resources to seek prenatal care, and no doctor or public health worker had ever told her that she should get tested for syphilis. So, when the patient noticed a small rash on her belly, she didn’t think too much about it, Stafford added.

“There’s a lot of people who are seen in private practice, hospital ERs, or walk-in centers, and those clinicians are not necessarily thinking of syphilis, they’re not necessarily getting a sexual history,” said Dr. Kenneth Mayer, an infectious disease physician and medical research director of the Fenway Institute in Boston. With a generation of doctors who saw few, if any, syphilis cases during their training, Mayer said that “the issue is tests not being done in the first place.”

The all-encompassing nature of the Covid pandemic added fuel to this fire, as public health departments redirected STI resources toward fighting the coronavirus.

“The solutions for controlling syphilis are relatively straightforward. We’re not talking about high tech approaches or a novel therapeutic,” said Dr. Dave Chokshi, chair of the Common Health Coalition and a former New York City Commissioner of Health. “It simply revolves around closing gaps in testing and treatment.”

As syphilis cases surge, doctors and public health officials are starting to develop innovative and sometimes unconventional strategies to screen people for syphilis and curb the spread of the disease. 

Most often, that comes down to figuring out how to get people tested, a task that’s far easier said than done.

Spreading the word about syphilis

Given these challenges, some public health departments have launched eye-popping awareness campaigns, trying to raise the alarm among both the public and health care providers. 

A few years ago, Donna Fox, the HIV and STI manager at the Toledo-Lucas County Health Department in Ohio, noticed that about one-fifth of syphilis cases in the area were among people who reported paying for sex. 

So, trying to be proactive — and a bit provocative — Fox and her team ran billboards across the county in 2022 saying, “Paying for Sex? Get Tested!”

“We had to go bold, and we had to get to the point,” she said. The pushback was inevitable — “you might have to say something to your 10-year-old who can read,” Fox conceded — but the impact was measurable. From 2021 through 2022, the number of syphilis appointments scheduled via the county health department jumped by almost 50%, and syphilis cases dropped by 12%, she said.

Of course, syphilis doesn’t just spread among sex workers, so last year, Fox’s team broadened the campaign, keeping the same look and feel but instead saying “Syphilis is Serious” with “Spreading Locally!” overlaid over the side.

Other billboard campaigns across the country have featured giant bloodshot, infected eyes with the blurry words “Eye Syphilis is Serious” and a black silhouette of a pregnant woman with a red belly saying “Syphilis Can Be Fatal to Your Baby.” While these billboards are factually true, Mayer describes how this kind of fear-based campaign, or “loss frame,” draws lots of attention but may not be particularly effective at motivating behavioral changes for STIs.

“We’re not telling anybody not to have sex,” Fox said. “We’re telling people to have safe sex,” and to get tested afterward.

The sex positivity message isn’t just for the public. The Toledo-Lucas health department also launched an educational campaign for clinicians, reminding them to take a sexual history of all patients — since the county saw syphilis in people ages 15 to 72 last year — and to order a blood test if they suspect an STI, since the standard “pee in a cup” test can’t detect syphilis.

“Many physicians haven’t seen syphilis, and they’ve got a million things to know,” Fox said. “If we don’t talk to the physicians, we’re not going to get the testing we need done.”

Stafford, the maternal-fetal medicine doctor in Houston, has taken a more hands-on approach. Texas mandates syphilis testing for pregnant women at three points — during their first prenatal visit, around the 28-week mark and before delivery — but in reality, these tests are often missed. So, last year, Stafford launched an alert in UTHealth’s electronic medical records, prompting providers to test their pregnant patients for syphilis at each of the prescribed times. The simple tweak helped increase screening rates from 2% to 47% at all three timepoints, while decreasing congenital syphilis cases by half.

Chokshi sees this as another good example of the public health and health care systems working hand-in-hand, with the former “setting the parameters of what standard of care should look like” and hospitals making it a reality. 

Make syphilis testing convenient

Beyond greater awareness, access to testing and treatment needs to be quick, easy and convenient, Chokshi said. 

Indian Country has led the way on this, partly by necessity: American Indian and Alaska Natives have the highest syphilis rates of any racial or ethnic group, almost seven times higher than white people. 

As such, tribes across the U.S. have turned to incentives, giving people $10 gift cards if they come in for STI testing or treatment, said Jessica Leston, founder of the Raven Collective, an Indigenous public health organization.

“We’re just helping people pay for gas and child care and get food on their table,” Leston said. At Cass Lake Indian Hospital’s pharmacy in rural Minnesota, the strategy increased STI testing tenfold, according to one study, with over 70% of the patients who got a test not having a primary care provider.

In 2023, a coalition of tribal communities partnered with Johns Hopkins School of Medicine to ramp up a program called I Want the Kit, which sends at-home STI test kits in the mail. The tests come in unmarked envelopes with instructions on how to collect a sample and send back the test. Results come back in a week or two, and patients are linked to health care resources if the test comes back positive.

Even with these programs, syphilis testing can be overshadowed by more immediate concerns.

In California, for example, half of pregnant women with syphilis reported methamphetamine use, and a quarter were homeless. In the state’s rural Shasta County, near the Oregon border, almost 100% of pregnant woman with syphilis similarly have a substance use disorder and 90% are unhoused, said Trojan Carvajal,
a supervising public health nurse in the county’s STI unit.

In April 2023, Shasta County launched the CommUNITY Mobile Care Clinic, an RV retrofitted with a reception area and two exam rooms, bringing STI tests and treatments to the county’s most vulnerable — from homeless camps to pop-ups with the local LBGTQ community center. Importantly, there’s no STI branding on the mobile clinic itself, allowing people to feel more comfortable walking in to get tested.

Last year, one-third of all syphilis tests performed by Shasta County were done through the mobile clinic, according to Jai Winchell, a community education specialist with the county’s public health department. These people would likely have never sought syphilis services otherwise, Winchell said, but with this mobile clinic crisscrossing the county and arriving at their doorsteps, they can get tested and treated in just 30 minutes.

Piggybacking syphilis services

Shasta County’s mobile clinic also offers other services, including test strips for deadly drugs like fentanyl and xylazine, naloxone to reverse overdoses and referrals to addiction counselors, as well as water, snacks and dental kits, Winchell said. The idea is to address overlapping concerns together, while also attracting those who wouldn’t have considered STI testing, if not for the package deal.

This approach also helps build trust, said Dr. Arlene Seña, an infectious diseases physician at the University of North Carolina Chapel Hill, showing how mobile clinic staff are invested in you as a person with various needs, rather than a singular problem to be solved. “It might be more costly, but it’s also much, much more effective and helpful to the community,” Seña said.

Syphilis services can also be integrated with general health care services. In March, Stafford launched a rapid testing program at two Houston hospitals aimed at all pregnant women admitted to the emergency department. The program, called Preg-Out, was set up on an opt-out basis, so everyone got tested unless they refused. It took about 15 minutes, and women were offered prenatal care regardless of the result.

“We noticed that pregnant patients, especially those that end up having a child with congenital syphilis, often frequent the ED and don’t get tested,” Stafford said. In the three-month pilot, Stafford said testing rates for pregnant women increased twelvefold, with about 35% of their partners wanting to get tested as well. 

Other hospitals have implemented opt-out screening programs for all patients, including Grady Memorial Hospital in Atlanta in one of their urgent care centers and the University of Chicago in their emergency department. Not every hospital has the resources to test everyone, Seña said, so she believes prioritizing pregnant patients, as done in Houston, can be a high-impact first step.

“You can’t just rely on public health departments to do the brunt of the work for STI recognition and prevention,” she said. “You have to go hand in hand with other providers in the community.”

The future ahead

The U.S. got syphilis rates down before, but that was in the 1990s, when HIV was ravaging through America. 

“What changed behavior then was lethal, hard-to-treat disease,” said Mayer, from Fenway Health. “Now, you have a generation of people who may be less informed,” leading to lower rates of condom use and STI screening rates. 

However, it’s also a time of innovation. In June, the CDC recommended doxycycline post-exposure prophylaxis for high-risk groups — essentially, a morning after pill for STIs. If taken within 72 hours of condomless sex, so-called DoxyPEP reduces syphilis rates by over 70%, and Fenway Health, where half of patients are LGBTQ, has already begun ramping up distribution, Mayer said. Meanwhile, other researchers like Seña have been working on developing a syphilis vaccine, but that’s probably several years down the line.

“Our task right now is to arrest the growth in cases,” said Chokshi, from the Common Health Coalition, and he’s optimistic that these innovative awareness, testing and treatment campaigns can do that. But permanently bending the syphilis curve will require scaling these efforts nationally and promoting greater coordination between health care and public health.

“There’s no reason that the endgame can’t be, once again, trying to eliminate syphilis — this historic scourge that is completely preventable and treatable,” Chokshi said.

This article first appeared on NBCNews.com. Read more from NBC News here:

• A Gazan girl’s pink rollerblades become an image of tragedy and desperation
• Biden officials ‘watered down’ warnings about crumbling security before Afghan withdrawal, new House GOP report says
• Liz Cheney says it’s ‘not enough’ for anti-Trump Republicans to vote for someone other than Harris

Surgeon Hari Priya Bandi was performing a biopsy through a hole in the 64-year-old patient’s skull at Canberra Hospital last year when she used forceps to pull out the parasite, which measured 8 centimeters, or 3 inches.

“I just thought: ‘What is that? It doesn’t make any sense. But it’s alive and moving,’” Bandi was quoted Tuesday in The Canberra Times newspaper.

“It continued to move with vigor. We all felt a bit sick,” Bandi added of her operating team.

The creature was the larva of an Australian native roundworm not previously known to be a human parasite, named Ophidascaris robertsi. The worms are commonly found in carpet pythons.

Bandi and Canberra infectious diseases physician Sanjaya Senanayake are authors of an article about the extraordinary medical case published in the latest edition of the journal Emerging Infectious Diseases.

Senanayake said he was on duty at the hospital in June last year when the worm was found.

“I got a call saying: ‘We’ve got a patient with an infection problem. We’ve just removed a live worm from this patient’s brain,’” Senanayake told Australian Broadcasting Corp.

The woman had been admitted to the hospital after experiencing forgetfulness and worsening depression over three months. Scans showed changes in her brain.

A year earlier, she had been admitted to her local hospital in southeast New South Wales state with symptoms including abdominal pain, diarrhea, a dry cough and night sweats.

Senanayake said the brain biopsy was expected to reveal a cancer or an abscess.

“This patient had been treated … for what was a mystery illness that we thought ultimately was a immunological condition because we hadn’t been able to find a parasite before and then out of nowhere, this big lump appeared in the frontal part of her brain,” Senanayake said.

“Suddenly, with her (Bandi’s) forceps, she’s picking up this thing that’s wriggling. She and everyone in that operating theater were absolutely stunned,” Senanayake added.

Six months after the worm was removed, the patient’s neuropsychiatric symptoms had improved but persisted, the journal article said.

She had returned home but remains under medical observation. Details of her current condition have not been made public.

The worms’ eggs are commonly shed in snake droppings which contaminate grass eaten by small mammals. The life cycle continues as other snakes eat the mammals.

The woman lives near a carpet python habitat and forages for native vegetation called warrigal greens to cook.

While she had no direct contact with snakes, scientists hypothesize that she consumed the eggs from the vegetation or her contaminated hands.

The Centers for Disease Control and Prevention expects updated Covid vaccines from Pfizer, Moderna and Novavax to be available to the public in mid-September, an agency official told reporters Thursday. 

That amounts to the most specific timeline to date. Federal officials have said the new shots could arrive around September. CDC Director Mandy Cohen had previously provided a later timeline, telling NPR that the vaccines could be available by the “early October time frame.”

Those shots still need approvals from the Food and Drug Administration and the CDC, which will set eligibility guidelines for the jabs. An independent panel of advisors to the CDC is meeting on Sept. 12 to vote on a recommendation for those guidelines. 

Officials from the CDC and FDA said the agencies will encourage Americans to receive an updated Covid shot and other key vaccines ahead of the fall, when respiratory viruses typically begin to spread more widely. That includes the annual flu shot and recently approved jabs that protect older adults and infants from respiratory syncytial virus.

“Our goal, our imperative, our task is to make sure we’re using those tools,” the CDC official said. “Vaccination is going to continue to be key this year because immunity wanes and because the Covid-19 virus continues to change.”

The arrival of updated vaccines offers some reassurance to Americans as the U.S. sees a slight uptick in Covid cases and hospitalizations. But those metrics remain below the summer peak that strained hospitals last year, the CDC official noted. 

The current surge appears to be fueled by newer strains of the virus like EG.5, or Eris, an omicron subvariant that accounted for 17.3% of all cases as of last week, according to the CDC. 

Pfizer, Moderna and Novavax designed their updated vaccines to target the omicron subvariant XBB.1.5, which is slowly declining in prevalence nationwide. But initial trial data from all three drugmakers suggest the new shots will still protect against EG.5. 

“One of the manufacturers have already made it clear that when testing their vaccine against the EG.5 that it looks like the neutralization is robust,” an FDA official told reporters Thursday. 

But it’s unclear how well the new shots will protect against another new omicron strain of the virus called BA.2.86, which has been identified in a very small number of cases in the U.S., U.K., Denmark and Israel.

“I think it’s too early to know for sure about BA.2.86 in terms of exact data,” the FDA official said, adding that more information will be available in the coming weeks. 

However, the official noted that the new vaccines will likely protect against any severe outcomes from catching the Covid virus.

Last week, the World Health Organization and the CDC said they are tracking BA.2.86 because it has 36 mutations that distinguish it from XBB.1.5. So far, there is no evidence that BA.2.86 spreads faster or causes more serious infections than previous versions. 

That’s how the body of Maurice “Mo” Miller started its journey to a sunny corner of NYU Langone Health’s intensive care unit — and became part of the quest to one day ease the nation’s transplant shortage with organs from animals.

“He always wanted to help people,” said Miller-Duffy, who struggled with the choice but is proud of her brother’s last act. “This tragic death, this fast short death — something good has come out of it.”

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Surgeons replaced Miller’s kidneys with one from a genetically modified pig on July 14. Then doctors and nurses cared for the deceased man like they would a living patient while anxiously ticking off the days.

Remarkably, over a month later the new organ is performing all the bodily functions of a healthy kidney — the longest a pig kidney has ever worked in a person. Now the countdown is on to see if the kidney can last into September, a second month.

The Associated Press got an inside look at the challenges of experiments with the dead that may help bring animal-to-human transplants closer to reality.

___

Getting an organ transplant today is a long shot. More than 100,000 people are on the national waiting list, most who need a kidney. Thousands die waiting. Thousands more who could benefit aren’t even added to the list.

“I had seven cardiac arrests before I even was sick enough” to qualify for a new heart, said Dr. Robert Montgomery, chief of NYU Langone’s transplant institute. He’s a kidney transplant surgeon — and was lucky enough to get his own heart transplant in 2018.

Filling the gap, he’s convinced, will require using animal organs.

After decades of failed attempts, now pigs genetically modified so their organs are more humanlike are renewing interest in so-called xenotransplantation. Last year, University of Maryland surgeons tried to save a dying man with a pig heart — and he survived for two months.

Montgomery is getting more practice on the dead before taking a chance with a living patient. A handful of prior experiments at NYU and the University of Alabama at Birmingham have kept pig kidneys and hearts working in donated bodies for a few days to a week, avoiding the immediate rejection that doomed many earlier attempts.

But the most common kind of organ rejection develops over a month. That pig heart in Maryland worked great for nearly 50 days until abruptly faltering. Watching how pig kidneys reach those timepoints in donated bodies could offer vital lessons — but how long could Montgomery expect a family to turn over their loved one?

“I’m in awe of someone who can make a decision like that at, you know, one of the worst moments in their lives and really think about … humanity,” he said.

____

In Newburgh, New York, an ambulance had raced Miller to the hospital after he collapsed, a mass in his brain. He never woke up from the biopsy, brain-dead at just 57. Next steps were up to his sister, his closest relative.

Miller-Duffy asked about donating his organs but he didn’t qualify. That biopsy had found cancer.

Only then did the organ agency broach whole-body donation. Miller-Duffy wasn’t familiar with that, but the goal of improving kidney transplants, “that kind of struck a chord.” Another brother had died of kidney disease as a toddler. Other relatives have kidney-damaging illnesses or even died on dialysis.

Flipping through family photos, Miller-Duffy recalled how her brother would adopt animals and once took care of a terminally ill friend. Still, she had questions.

In a video call, Montgomery explained the pig transplant to Miller-Duffy and her wife, Sue Duffy — and why it could make a difference. Montgomery’s compassion won them over.

“His body is not being hurt, you know,” Duffy said. “It’s just an incubation for the study to be done.”

____

The experiment served as a rehearsal for one day operating on a living patient. Montgomery finished removing Miller’s own kidneys as a helicopter headed for the hospital’s riverside landing pad. Drs. Jeffrey Stern and Adam Griesemer, fellow NYU surgeons, raced in kidneys they’d removed from a pig bred by Blacksburg, Virginia-based Revivicor.

Sewing a pig kidney into a donated body isn’t much different than a regular transplant, Stern said. Post-surgery immune-suppressing drugs are standard, too.

One twist: Tacked onto the pig’s kidney was its thymus, a gland that trains immune cells — and thus might help protect the organ.

Lots of extra steps come before and after surgery.

First, what pig to use: Some have up to 10 genetic changes but Montgomery is betting one is enough — removal of a single porcine gene that triggers an immediate immune attack.

While the pigs are housed in a germ-free facility, researchers performed extra testing for any hidden infection. Everyone in the operating room must have certain vaccinations and undergo blood tests of their own.

Surgery over, doctors wheeled Miller’s body into the same ICU room where five years earlier Montgomery had recovered from his heart transplant.

Next came more intense testing than living patients could tolerate. Every week doctors biopsy the kidney, putting samples under the microscope to spot any hints of rejection. Blood is continually monitored, the spleen got a peek, and nurses keep close watch that the body is being properly maintained on the ventilator.

The first few weeks, Griesemer checked lab test results and vital signs multiple times a day: “You’re like, OK, hopefully things are still good — but is this the day it starts to turn?”

And they’re shipping biopsy samples to research partners across the country and as far away as France.

“Our staff doesn’t sleep that much,” said Elaina Weldon, a nurse practitioner who oversees the transplant research. But with each passing week, “everybody is really now at the point of, what more can we do? How far can we push?”

She knows firsthand the huge interest: NYU quizzed community groups and religious leaders before embarking on research with donated bodies that might have sounded “a little bit more on the sci-fi side of things.”

Instead, many people wanted to know how soon studies in the living could start, something the Food and Drug Administration will have to decide. Dozens have written Montgomery, eager to participate.

___

Montgomery regularly calls Miller-Duffy and her wife with updates, and invited them to NYU to meet the team. And as the study’s initial one-month deadline approached, he had another ask: It was going so well, could they keep her brother’s body for a second month?

It meant further postponing plans for a memorial service but Miller-Duffy agreed. Her request: That she gets to be there when her brother is finally disconnected from the ventilator.

Whatever happens next, the experiment has changed Sue Duffy’s outlook on organ donation.

“Maybe I don’t need all my organs when I go to heaven,” she said. “Before I was a hard no. … Now I’m a hard yes.”

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

“We’re in a different place,” said Dr. Mandy Cohen, the director of the Centers for Disease Control and Prevention. Widespread immunity from either Covid infection or vaccination, as well as updated booster shots, is reassuring public health officials ahead of the typical cold and flu season.

“I think we’re the most prepared that we’ve ever been,” Cohen said.

Anecdotes about family members, friends and neighbors who test positive for Covid are picking up steam, and Covid-related hospitalizations have been trending upward in recent weeks, according to NBC News data.

Still, the U.S. is nowhere near the level of severe Covid cases it has seen since the beginning of the pandemic.

Read the full story on NBCNews.com here.

This story uses functionality that may not work in our app. Click here to open the story in your web browser.

But Stafford, a maternal-fetal medicine physician at the University of Texas Health Sciences Center in Houston, quickly realized something was wrong: She couldn’t find a heartbeat. The unborn baby boy had already died in the womb. 

Soon after, the mother’s syphilis test — given to all women before delivery — came back positive. The infection had been silently passed from mother to son.

It’s a death, Stafford said, that could’ve been prevented with early detection and a shot of penicillin. 

Syphilis, a sexually transmitted infection, was nearly eliminated in the U.S. at the beginning of the 21st century but has made a dramatic comeback. In 2022, the Centers for Disease Control and Prevention reported more than 200,000 syphilis cases — the highest counts since 1950. Congenital syphilis has similarly increased tenfold over the past decade, the CDC says, even though 90% of cases are fully preventable.

Syphilis in the U.S.

More than 200,000 cases were reported in 2022, the most since 1950.

The return of syphilis is the result, experts say, of poorly funded prevention programs over the past two decades and difficulties in diagnosis; syphilis is referred to as the “great imitator” because its symptoms can vary so widely. Most people don’t show symptoms or know they’re infected, and even if they do visit the doctor’s office, there’s no guarantee they’ll be properly diagnosed.

Stafford said her patient didn’t have the resources to seek prenatal care, and no doctor or public health worker had ever told her that she should get tested for syphilis. So, when the patient noticed a small rash on her belly, she didn’t think too much about it, Stafford added.

“There’s a lot of people who are seen in private practice, hospital ERs, or walk-in centers, and those clinicians are not necessarily thinking of syphilis, they’re not necessarily getting a sexual history,” said Dr. Kenneth Mayer, an infectious disease physician and medical research director of the Fenway Institute in Boston. With a generation of doctors who saw few, if any, syphilis cases during their training, Mayer said that “the issue is tests not being done in the first place.”

The all-encompassing nature of the Covid pandemic added fuel to this fire, as public health departments redirected STI resources toward fighting the coronavirus.

“The solutions for controlling syphilis are relatively straightforward. We’re not talking about high tech approaches or a novel therapeutic,” said Dr. Dave Chokshi, chair of the Common Health Coalition and a former New York City Commissioner of Health. “It simply revolves around closing gaps in testing and treatment.”

As syphilis cases surge, doctors and public health officials are starting to develop innovative and sometimes unconventional strategies to screen people for syphilis and curb the spread of the disease. 

Most often, that comes down to figuring out how to get people tested, a task that’s far easier said than done.

Spreading the word about syphilis

Given these challenges, some public health departments have launched eye-popping awareness campaigns, trying to raise the alarm among both the public and health care providers. 

A few years ago, Donna Fox, the HIV and STI manager at the Toledo-Lucas County Health Department in Ohio, noticed that about one-fifth of syphilis cases in the area were among people who reported paying for sex. 

So, trying to be proactive — and a bit provocative — Fox and her team ran billboards across the county in 2022 saying, “Paying for Sex? Get Tested!”

“We had to go bold, and we had to get to the point,” she said. The pushback was inevitable — “you might have to say something to your 10-year-old who can read,” Fox conceded — but the impact was measurable. From 2021 through 2022, the number of syphilis appointments scheduled via the county health department jumped by almost 50%, and syphilis cases dropped by 12%, she said.

Of course, syphilis doesn’t just spread among sex workers, so last year, Fox’s team broadened the campaign, keeping the same look and feel but instead saying “Syphilis is Serious” with “Spreading Locally!” overlaid over the side.

Other billboard campaigns across the country have featured giant bloodshot, infected eyes with the blurry words “Eye Syphilis is Serious” and a black silhouette of a pregnant woman with a red belly saying “Syphilis Can Be Fatal to Your Baby.” While these billboards are factually true, Mayer describes how this kind of fear-based campaign, or “loss frame,” draws lots of attention but may not be particularly effective at motivating behavioral changes for STIs.

“We’re not telling anybody not to have sex,” Fox said. “We’re telling people to have safe sex,” and to get tested afterward.

The sex positivity message isn’t just for the public. The Toledo-Lucas health department also launched an educational campaign for clinicians, reminding them to take a sexual history of all patients — since the county saw syphilis in people ages 15 to 72 last year — and to order a blood test if they suspect an STI, since the standard “pee in a cup” test can’t detect syphilis.

“Many physicians haven’t seen syphilis, and they’ve got a million things to know,” Fox said. “If we don’t talk to the physicians, we’re not going to get the testing we need done.”

Stafford, the maternal-fetal medicine doctor in Houston, has taken a more hands-on approach. Texas mandates syphilis testing for pregnant women at three points — during their first prenatal visit, around the 28-week mark and before delivery — but in reality, these tests are often missed. So, last year, Stafford launched an alert in UTHealth’s electronic medical records, prompting providers to test their pregnant patients for syphilis at each of the prescribed times. The simple tweak helped increase screening rates from 2% to 47% at all three timepoints, while decreasing congenital syphilis cases by half.

Chokshi sees this as another good example of the public health and health care systems working hand-in-hand, with the former “setting the parameters of what standard of care should look like” and hospitals making it a reality. 

Make syphilis testing convenient

Beyond greater awareness, access to testing and treatment needs to be quick, easy and convenient, Chokshi said. 

Indian Country has led the way on this, partly by necessity: American Indian and Alaska Natives have the highest syphilis rates of any racial or ethnic group, almost seven times higher than white people. 

As such, tribes across the U.S. have turned to incentives, giving people $10 gift cards if they come in for STI testing or treatment, said Jessica Leston, founder of the Raven Collective, an Indigenous public health organization.

“We’re just helping people pay for gas and child care and get food on their table,” Leston said. At Cass Lake Indian Hospital’s pharmacy in rural Minnesota, the strategy increased STI testing tenfold, according to one study, with over 70% of the patients who got a test not having a primary care provider.

In 2023, a coalition of tribal communities partnered with Johns Hopkins School of Medicine to ramp up a program called I Want the Kit, which sends at-home STI test kits in the mail. The tests come in unmarked envelopes with instructions on how to collect a sample and send back the test. Results come back in a week or two, and patients are linked to health care resources if the test comes back positive.

Even with these programs, syphilis testing can be overshadowed by more immediate concerns.

In California, for example, half of pregnant women with syphilis reported methamphetamine use, and a quarter were homeless. In the state’s rural Shasta County, near the Oregon border, almost 100% of pregnant woman with syphilis similarly have a substance use disorder and 90% are unhoused, said Trojan Carvajal,
a supervising public health nurse in the county’s STI unit.

In April 2023, Shasta County launched the CommUNITY Mobile Care Clinic, an RV retrofitted with a reception area and two exam rooms, bringing STI tests and treatments to the county’s most vulnerable — from homeless camps to pop-ups with the local LBGTQ community center. Importantly, there’s no STI branding on the mobile clinic itself, allowing people to feel more comfortable walking in to get tested.

Last year, one-third of all syphilis tests performed by Shasta County were done through the mobile clinic, according to Jai Winchell, a community education specialist with the county’s public health department. These people would likely have never sought syphilis services otherwise, Winchell said, but with this mobile clinic crisscrossing the county and arriving at their doorsteps, they can get tested and treated in just 30 minutes.

Piggybacking syphilis services

Shasta County’s mobile clinic also offers other services, including test strips for deadly drugs like fentanyl and xylazine, naloxone to reverse overdoses and referrals to addiction counselors, as well as water, snacks and dental kits, Winchell said. The idea is to address overlapping concerns together, while also attracting those who wouldn’t have considered STI testing, if not for the package deal.

This approach also helps build trust, said Dr. Arlene Seña, an infectious diseases physician at the University of North Carolina Chapel Hill, showing how mobile clinic staff are invested in you as a person with various needs, rather than a singular problem to be solved. “It might be more costly, but it’s also much, much more effective and helpful to the community,” Seña said.

Syphilis services can also be integrated with general health care services. In March, Stafford launched a rapid testing program at two Houston hospitals aimed at all pregnant women admitted to the emergency department. The program, called Preg-Out, was set up on an opt-out basis, so everyone got tested unless they refused. It took about 15 minutes, and women were offered prenatal care regardless of the result.

“We noticed that pregnant patients, especially those that end up having a child with congenital syphilis, often frequent the ED and don’t get tested,” Stafford said. In the three-month pilot, Stafford said testing rates for pregnant women increased twelvefold, with about 35% of their partners wanting to get tested as well. 

Other hospitals have implemented opt-out screening programs for all patients, including Grady Memorial Hospital in Atlanta in one of their urgent care centers and the University of Chicago in their emergency department. Not every hospital has the resources to test everyone, Seña said, so she believes prioritizing pregnant patients, as done in Houston, can be a high-impact first step.

“You can’t just rely on public health departments to do the brunt of the work for STI recognition and prevention,” she said. “You have to go hand in hand with other providers in the community.”

The future ahead

The U.S. got syphilis rates down before, but that was in the 1990s, when HIV was ravaging through America. 

“What changed behavior then was lethal, hard-to-treat disease,” said Mayer, from Fenway Health. “Now, you have a generation of people who may be less informed,” leading to lower rates of condom use and STI screening rates. 

However, it’s also a time of innovation. In June, the CDC recommended doxycycline post-exposure prophylaxis for high-risk groups — essentially, a morning after pill for STIs. If taken within 72 hours of condomless sex, so-called DoxyPEP reduces syphilis rates by over 70%, and Fenway Health, where half of patients are LGBTQ, has already begun ramping up distribution, Mayer said. Meanwhile, other researchers like Seña have been working on developing a syphilis vaccine, but that’s probably several years down the line.

“Our task right now is to arrest the growth in cases,” said Chokshi, from the Common Health Coalition, and he’s optimistic that these innovative awareness, testing and treatment campaigns can do that. But permanently bending the syphilis curve will require scaling these efforts nationally and promoting greater coordination between health care and public health.

“There’s no reason that the endgame can’t be, once again, trying to eliminate syphilis — this historic scourge that is completely preventable and treatable,” Chokshi said.

This article first appeared on NBCNews.com. Read more from NBC News here:

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Scientists around the country are racing to learn how to use animal organs to save human lives, and bodies donated for research offer a remarkable rehearsal.

The latest experiment announced Wednesday by NYU Langone Health marks the longest a pig kidney has functioned in a person, albeit a deceased one -– and it’s not over. Researchers are set to track the kidney’s performance for a second month.

“Is this organ really going to work like a human organ? So far it’s looking like it is,” Dr. Robert Montgomery, director of NYU Langone’s transplant institute, told The Associated Press.

“It looks even better than a human kidney,” Montgomery said on July 14 as he replaced a deceased man’s own kidneys with a single kidney from a genetically modified pig — and watched it immediately start producing urine.

The possibility that pig kidneys might one day help ease a dire shortage of transplantable organs persuaded the family of Maurice “Mo” Miller from upstate New York to donate his body for the experiment. He’d died suddenly at 57 with a previously undiagnosed brain cancer, ruling out routine organ donation.

“I struggled with it,” his sister, Mary Miller-Duffy, told the AP about her decision. But he liked helping others and “I think this is what my brother would want. So I offered my brother to them.”

“He’s going to be in the medical books, and he will live on forever,” she added.

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Attempts at animal-to-human transplants, or xenotransplantation, have failed for decades as people’s immune systems attacked the foreign tissue. Now researchers are using pigs genetically modified so their organs better match human bodies.

Last year with special permission from regulators, University of Maryland surgeons transplanted a gene-edited pig heart into a dying man who was out of other options. He survived only two months before the organ failed for reasons that aren’t fully understood but that offer lessons for future attempts.

Next, rather than last-ditch efforts, the Food and Drug Administration is considering whether to allow some small but rigorous studies of pig heart or kidney transplants in volunteer patients.

The NYU experiment is one of a string of developments aimed at speeding the start of such clinical trials. Also Wednesday, the University of Alabama at Birmingham reported another important success — a pair of pig kidneys worked normally inside another donated body for seven days.

Kidneys don’t just make urine — they provide a wide range of jobs in the body. In the journal JAMA Surgery, UAB transplant surgeon Dr. Jayme Locke reported lab tests documenting the gene-modified pig organs’ performance. She said the weeklong experiment demonstrates they can “provide life-sustaining kidney function.”

These kinds of experiments are critical to answer remaining questions “in a setting where we’re not putting someone’s life in jeopardy,” said Montgomery, the NYU kidney transplant surgeon who also received his own heart transplant — and is acutely aware of the need for a new source of organs.

More than 100,000 patients are on the nation’s transplant list and thousands die each year waiting.

Maryland’s Dr. Muhammad Mohiuddin cautions that it’s not clear how closely a deceased body will mimic a live patient’s reactions to a pig organ. But he said the research educates the public about xenotransplantation so “people will not be shocked” when it’s time to try again in the living.

Previously, NYU and a team at the University of Alabama at Birmingham had tested pig kidney transplants in deceased recipients for just two or three days. An NYU team also had transplanted pig hearts into donated bodies for three days of intense testing.

But how do pig organs react to a more common human immune attack that takes about a month to form? Only longer testing might tell.

The surgery itself isn’t that different from thousands he’s performed “but somewhere in the back of your mind is the enormity of what you’re doing … recognizing that this could have a huge impact on the future of transplantation,” Montgomery said.

The operation took careful timing. Early that morning Drs. Adam Griesemer and Jeffrey Stern flew hundreds of miles to a facility where Virginia-based Revivicor Inc. houses genetically modified pigs — and retrieved kidneys lacking a gene that would trigger immediate destruction by the human immune system.

As they raced back to NYU, Montgomery was removing both kidneys from the donated body so there’d be no doubt if the soon-to-arrive pig version was working. One pig kidney was transplanted, the other stored for comparison when the experiment ends.

One other trick: Surgeons attached the pig’s thymus to the transplanted kidney in hopes that the gland, which helps train immune cells, would increase human tolerance of the organ. Otherwise, the team is relying on standard immune-suppressing drugs used by today’s transplant patients.

“You’re always nervous,” Griesemer said. To see it so rapidly kickstart, “there was a lot of thrill and lot of sense of relief.”

How long should these experiments last? Alabama’s Locke said that’s not clear -– and among the ethical questions are how long a family is comfortable or whether it’s adding to their grief. Because maintaining a brain-dead person on a ventilator is difficult, it’s also dependent on how stable the donated body is.

In her own experiment, the donated body was stable enough that if the study wasn’t required to end after a week, “I think we could have gone much longer, which I think offers great hope,” she said.

AP video journalist Shelby Lum contributed to this report.

Some anesthesiologists in the U.S. and Canada say they’ve seen growing numbers of patients on the weight-loss drugs who inhaled food and liquid into their lungs while sedated because their stomachs were still full — even after following standard instructions to stop eating for six to eight hours in advance.

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The drugs can slow digestion so much that it puts patients at increased risk for the problem, called pulmonary aspiration, which can cause dangerous lung damage, infections and even death, said Dr. Ion Hobai, an anesthesiologist at Massachusetts General Hospital in Boston.

“This is such a serious sort of potential complication that everybody who takes this drug should know about it,” said Hobai, who was among the first to flag the issue.

Nearly 6 million prescriptions for the class of drugs that include Wegovy and Ozempic were written between January and May in the U.S. for people who don’t have diabetes, according to Komodo Health, a health care technology company. The drugs induce weight loss by mimicking the actions of hormones, found primarily in the gut, that kick in after people eat. They also target signals between the gut and the brain that control appetite and feelings of fullness, and by slowing how fast the stomach empties.

In June, the American Society of Anesthesiologists issued guidance advising patients to skip daily weight-loss medications on the day of surgery and hold off on weekly injections for a week before any sedation procedures. Dr. Michael Champeau, the group’s president, said the action was based on anecdotal reports of problems — including aspiration — from around the country.

It’s not clear how many patients taking the anti-obesity drugs may be affected by the issue. But because the consequences can be so dire, Hobai and a group of colleagues decided to speak out. Writing in the Canadian Journal of Anesthesia, they called for the drug to be stopped for even longer — about three weeks before sedation.

That accounts for how long semaglutide, the active medication in Wegovy, remains in the body, said Dr. Philip Jones, a Mayo Clinic anesthesiologist who is also deputy editor-in-chief of the journal.

“When 90% of it is gone, which is after three weeks, hopefully everything should go back to normal,” Jones said.

Champeau and Jones both acknowledged there’s not enough evidence to say for certain how long semaglutide should be held to make anesthesia safe. Many patients won’t see providers far enough in advance to stop the drug three weeks before procedures, Champeau noted.

Aspiration occurs in one of every 2,000 to 3,000 operations that require sedation, and almost half of patients who aspirate during surgery develop a related lung injury. But case reports show recent patients on semaglutide had problems even when they stopped food as long as 20 hours before their procedures.

“There’s nothing that says if you fast twice as long, it will be OK,” Champeau said.

Among the several reports detailing potentially serious problems was one of Hobai’s patients, a 42-year-old man in Boston who recently began taking Wegovy, had to be intubated and suffered respiratory failure that put him in intensive care. He aspirated food that remained in his stomach despite fasting for 18 hours.

In Chapel Hill, North Carolina, a 31-year-old-woman on a low dose of Ozempic had fasted for 10 hours before a routine endoscopy prior to bariatric surgery last fall. The procedure had to be stopped because solid food remained in her stomach and she was at high risk for aspiration, the report said.

Since then, doctors have seen dozens of similar cases as use of the weight-loss medication has grown, said Dr. Elisa Lund, an anesthesiologist at the University of North Carolina at Chapel Hill School of Medicine. “It has exponentially increased,” she said.

Hobai is completing a retrospective study of almost 200 patients taking semaglutide. While it’ll be published later this year, the work so far appears to confirm a small study from Brazil, he said. In that study, about a quarter of patients taking semaglutide had residual food in their stomachs during procedures requiring sedation — even after stopping the drug for 10 days.

The American Society of Anesthesiologists advises doctors who are in doubt to treat patients who haven’t paused the drug as if they have full stomachs, which can mean using different types of sedation protocols or delaying procedures, if possible. Jones added that research is urgently needed to update guidelines for doctors and patients.

Novo Nordisk, which makes Ozempic, Wegovy and similar drugs, said the firm’s clinical trial and post-marketing safety data did not show that the medications led to aspiration. But the drugmaker noted that the medications are known to cause delayed emptying of the stomach and that the labels warn of possible gastrointestinal side effects.

Stopping the medications for three weeks can cause problems, too. Patients with diabetes will need another way to control their blood sugar and those seeking to lose weight may regain some, Hobai said.

Hobai suggests that people using Wegovy and similar drugs tell their doctors before sedation and discuss the risks and benefits.

“If you’re taking this drug and you need an operation, you will need to have some extra precautions,” he said.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Eli Lilly CEO Dave Ricks told CNBC’s Jim Cramer on Tuesday his top priority was to meet demand for the company’s drug, Mounjaro, which is currently only approved by the Food and Drug Administration to treat diabetes but is expected to soon be cleared to treat obesity, along with other health conditions.

“It’s my top priority, is expanding the capacity of our ability to make not just Mounjaro but other drugs like it in our pipeline to meet the challenge here,” Ricks said. “People are frustrated when they can’t get their medicine. We understand that, and we’re going to fix that problem.”

Eli Lilly stock surged 15% Tuesday after its better-than-expected earnings report. The drug’s stock — which hit an all-time high of $538 in early trading, according to FactSet — was also bolstered by news that a peer company’s similar diabetes and weight-loss drug could be used to treat cardiovascular issues.

Ricks said the company’s recently opened factory in North Carolina would help increase output, adding that Eli Lilly said last year it planned to double its monthly output by December. He also said the company would soon be launching Mounjaro in a vial as well as in a multiuse pen, which will help increase global supply.

Ricks said he thinks Eli Lilly’s products will help people realize that obesity needs to be treated as an illness, not a just a problem that can be fixed with diet and exercise alone. He likened obesity to depression, noting Eli Lilly’s role in manufacturing Prozac, the depression drug.

“And before we had Prozac, people thought, doctors would tell you, ‘Well, you’re just a little sad.’ We know that’s not true, there’s something called clinical depression,” Ricks said. “We now treat it like a disease. I think in five, 10 years we’ll look back and think about chronic weight management and obesity the same way.”

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An infection with RSV is a coldlike nuisance for most healthy people, but it can be life-threatening for the very young and the elderly. There are no vaccines for babies yet so the new drug, a lab-made antibody that helps the immune system fight off the virus, is expected to fill a critical need.

The drug, developed by AstraZeneca and Sanofi, is expected to be ready in the fall before the RSV season, typically November through March. In the U.S., about 58,000 children younger than 5 are hospitalized for RSV each year and several hundred die.

A panel of outside advisers to the Centers for Disease Control and Prevention recommended the one-time shot for infants born just before or during the RSV season and for those less than 8 months old before the season starts. They also recommended a dose for some 8- to 19-months-olds at higher risk of a serious illness from RSV.

The CDC director signed off on the panel’s recommendations later Thursday.

“We had a terribly bad RSV season last year and I’m thrilled that we have a new tool to protect our infants,” Dr. Mandy Cohen told The Associated Press earlier this week.

The drug, to be sold under the brand name Beyfortus, is expected to cost $495 per dose, and to be covered by insurance. Panelists acknowledged that it will be a challenge at first to give the shot and for providers to be reimbursed by insurers.

In May, the Food and Drug Administration approved two RSV vaccines for older adults from GlaxoSmithKline and Pfizer. In August, the FDA is expected to make a decision on approving Pfizer’s vaccine for pregnant women, with the aim of passing along protection to their newborns.

Although the new drug is not a vaccine, the expert panel also supported including it in Vaccines for Children, a government program providing free immunizations. The American Academy of Pediatrics is urging hospitals to stock Beyfortus so that newborns can get it during RSV season before they go home.

Lupin, the New Jersey-based drugmaker, announced Saturday that it was recalling the batches after tests showed the pills had decreased levels of ascorbic acid, an inactive ingredient, and high levels of a “known impurity.” 

“This could potentially impact the effectiveness of the product which could potentially result in unexpected pregnancy,” the company’s announcement said.

The affected batches were distributed between June 3, 2022 and May 31 of this year and have expiration dates of January or September 2024.

The company did not immediately respond to a request for more information about the impurity in the pill and the role ascorbic acid plays in it. The company has also asked pharmacists and retailers to “discontinue distribution of the recalled product lots immediately.”

Read the full story at NBCNews.com 

When an infection is endemic in a certain region, it means that it’s constantly present at a steady and predictable level.

Florida is at the forefront of the outbreak, with nearly one-fifth of leprosy cases in the US originating from the state, the CDC says.

Central Florida accounted for 81% of cases within the state, the research letter said.

Leprosy, also known as Hansen’s disease, is an ancient disease that can cause damage to the skin and nervous system.

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The disease is caused by a bacteria called Mycobacterium leprae, which can attack the nerves, causing a loss of sensation in the affected areas.

When left untreated, leprosy can also cause blindness, ulcers, disfigurements, and more.

The disease dates back to 600 B.C. and was considered devastating for many years. Isolation treatments on remote islands off the coasts of Hawaii, Louisiana and Massachusetts were used to treat those who suffered from leprosy, and to limit exposure to others.

With the advancement of modern medicine came a cure for leprosy, and the disease is now treatable by antibiotics.

Early diagnosis is key, though, as antibiotics cannot reverse nerve damage.

Leprosy in the US is most common (80-90%) among immigrants, especially from Mexico, the Florida Department of Health says.

Infection is rare as 95% of people around the world are naturally immune to leprosy. However, as many as 2 million people are permanently disabled as a result of the disease, the CDC says.

The disease is spread by prolonged contact with someone who is infected, but experts have also placed the blame on armadillos.

The barrel-shaped mammals are found frequently across Florida – and they’re also the only animal in the world known to spread leprosy, the CDC says.

It’s not known exactly how leprosy spreads between people, but the best way to avoid the infection is to avoid prolonged contact with an infected person – or an armadillo.

New research, published Tuesday in the journal Pediatrics, confirms a phenomenon known as the “allergic march” — a pattern that describes the way allergies tend to develop and progress in children, beginning in infancy through age 3.

The study, which analyzed medical records data collected between 1999 and 2020 from more than 200,000 children, found that kids tended to be first diagnosed with eczema, also called atopic dermatitis, at 4 months, on average. Next came diagnoses of food allergies that cause symptoms that range from hives to anaphylaxis — a life-threatening allergic reaction that affects the whole body and can cause the airways to swell and close — and asthma, both around 13 months old. At 26 months, the study found, children developed allergic rhinitis, or hay fever. In rare cases, children may go on to develop a fifth allergy, called eosinophilic esophagitis, by 35 months old.

Dr. Stanislaw Gabryszewski, a fellow in the Division of Allergy and Immunology at Children’s Hospital of Philadelphia who led the study, said the “allergic march” doesn’t mean every child who has eczema will develop every allergy described.

“Each child is different. Some may have one, others may have a couple, others may have all of them,” he said.

Read the full story on NBCNews.com

All the infected patients were older than 60, and each had a compromised immune system, the Washington Department of Health said in a statement Friday. They were all hospitalized, it said.

Four patients were treated in Pierce County, home of the state’s third-largest city, Tacoma, and one was treated in adjacent Thurston County, state health officials said.

Though genetic fingerprinting known as genome sequencing helped health professionals conclude the infections most likely had the same origin, the department had yet to trace the outbreak to a common food source, the department said.

The bacteria can be found on food preparation surfaces, fresh, unpasteurized cheese, leafy greens, and cold cuts, as well as in raw milk.

The bacteria is easily defeated by heating food to 165 degrees or higher.

Read the full story on NBCNews.com here.