About Anna C.

Anna first volunteered for Planned Parenthood as a high school student in the 1990s. Since then, she has received a bachelor’s degree from UC Berkeley and a master's degree in epidemiology from the University of Arizona. As an ode to her fascination with microbes, she writes the monthly STD Awareness series, as well as other pieces focusing on health and medicine.

STD Awareness: Do IUDs and Implants Prevent STDs?

Highly effective birth control methods, namely intrauterine devices (IUDs) and implants, have received a lot of well-deserved attention in recent years. They are as effective at preventing pregnancy as permanent sterilization, but can be stopped at any time, and can last from three to 12 years. They are the contraceptive of choice for female family-planning providers, who should know a thing or two about choosing an optimal birth control method. They are fantastic options for teenagers and others hoping to delay pregnancy for at least a few years. And the best news is that, for now anyway, these pricey birth control methods are still available at no cost to Americans covered by Medicaid or health insurance.


For the best protection against unintended pregnancy and STDs, combine condoms with IUDs or contraceptive implants.


If IUDs and implants prevented sexually transmitted diseases (STDs), they would pretty much be perfect — but, alas, like most forms of birth control, they don’t protect you from viruses, bacteria, and other bugs that can be passed from person to person through sex. To reduce their risk for STD exposure, sexually active people must employ other strategies, including (1) being in a mutually monogamous relationship with a person who does not have STDs; (2) being vaccinated before becoming sexually active to receive protection from hepatitis B virus and human papillomavirus (HPV), two sexually transmitted viruses; and, last but definitely not least, (3) condoms, condoms, condoms!

A study published this month looked at college students using IUDs and implants and found that most of them didn’t use condoms the last time they had vaginal sex — 57 percent of women who were not using IUDs or implants used a condom, compared to only 24 percent of women who were using IUDs or implants. That’s not too surprising if pregnancy prevention were the only concern, but condoms are an important addition for anyone seeking to reduce their STD risk. Continue reading

STD Awareness: Prevention vs. Punishment

Before antibiotics, syphilis could kill and gonorrhea was responsible for most cases of infertility. Both diseases could spread from husband to wife to baby, potentially destroying families. So you’d think medical breakthroughs in prevention and cures would be welcomed with open arms.

The actual history, like the humans who create it, is much more complicated.


Compassion, rather than fear and guilt, should guide medical practice.


During World War I, sexually transmitted diseases were a huge problem — second only to the 1918 flu pandemic in the number of sick days they caused (7 million, if you’re counting). The Roaring Twenties saw a sexual revolution, and by World War II, the military was once more fretting about losing manpower to debilitating infections that drew men away from the front lines and into the sick bays.

The armed forces did what it could to suppress prostitution and distract soldiers with recreational activities. But the human sex drive could not be contained: The vast majority of U.S. soldiers were having sex — even an estimated half of married soldiers were not faithful to their wives during WWII. Victory depended on soldiers’ health, so during both WWI and WWII, the military provided its sexually active soldiers with “prophylaxis,” medical treatments that could reduce risk for venereal disease — or VD, as sexually transmitted diseases were called back then.

Anyone who thinks condoms are a hassle or “don’t feel good” should read medical historian Allan M. Brandt’s description of a WWI-era prophylactic station, which soldiers were instructed to visit after sexual contact: Continue reading

STD Awareness: Is There a Vaccine for Syphilis?

Before antibiotics, syphilis was the most feared sexually transmitted disease (STD) out there. It was easy to get, quack cures were ineffective and often unpleasant, and it could lead to blindness, disfigurement, dementia, and even death. Syphilis rates were highest during World War II, and plummeted when penicillin became widely available later in the 1940s. By 2000, syphilis rates hit an all-time low, and many scientists thought the United States was at the dawn of the complete elimination of syphilis.

What a difference an antibiotic makes. Image: CDC

Unfortunately, it soon became apparent that syphilis wasn’t ready to go out without a fight. Since 2000, syphilis rates have nearly quadrupled, climbing from 2.1 to 7.5 per 100,000 people by 2015 — the highest they have been since 1994. If you look at the above graph, you might think syphilis rates have been pretty stable over the past 20 years — but if you zoom in, the fact that we’re in the midst of an epidemic becomes more clear.

After hitting an all-time low in 2000, syphilis rates have been increasing nearly every year since.

The epidemic is disproportionately affecting men who have sex with men (MSM), with Arizona seeing a higher-than-average syphilis rate in this group. Additionally, syphilis rates are climbing among women, who have seen a 27 percent bump between 2014 and 2015. And, since women can carry both syphilis and pregnancies, a rise in syphilis in this population also means a rise congenital syphilis (the transmission of syphilis from mother to fetus), which causes miscarriages, stillbirths, preterm births, neonatal death, and birth defects. Ocular syphilis — that is, syphilis infections that spread to the eyes and can lead to blindness — is also on the rise.

Men, women, babies — no one is immune to the grasp of syphilis. Continue reading

Why Do Newborns Need the Hepatitis B Vaccine?

The first vaccine a baby receives — within hours or days of birth — protects them from hepatitis B virus (HBV). In a lot of people’s minds, HBV is associated with drug use and sexual activity — which stigmatizes people who have been infected with HBV or are carriers of the virus. Unfortunately, this stigma causes a lot of people to question why babies even need to be vaccinated against it, often pointing to “Big Pharma” conspiracy theories. A lot of other people are put off by the misconception that the HBV vaccine is made with human blood (it’s not).


May is Hepatitis Awareness Month, a time to learn about a childhood vaccine that’s saved millions of lives.


There are perfectly good reasons to vaccinate babies against HBV, mainly that HBV is the leading cause of liver cancer, itself one of the Top 10 types of cancer worldwide. Nine out of 10 infants born to a mother who is an HBV carrier will develop chronic infections and become carriers themselves — and a quarter of them will die prematurely of liver disease. Babies who develop chronic HBV infections are 63 times more likely to develop liver cancer than non-carriers, a connection that is 2 to 3 times stronger than the link between smoking and lung cancer.

When it comes to HBV, age at infection matters. Most people with chronic HBV infections are exposed at birth or in early childhood, when they are most likely to develop chronic, lifelong infections — whereas only 2 to 6 percent of infected adults will develop chronic infections, with only 15 percent of them eventually dying from liver disease. The fact that chronic infection risk is inversely correlated with age at infection means that birth is the time when a child is the most vulnerable to this virus — hence the importance of vaccinating as early as possible. Continue reading

STD Awareness: Gonorrhea’s Latest Dubious Honor

Wanted: Scientists who can develop novel antibiotics

A few years ago, the Centers for Disease Control and Prevention (CDC) put out a “greatest hits” list of antibiotic-resistant pathogens. More recently, in late February, the World Health Organization (WHO) followed suit with a dirty-dozen list of 12 “superbugs,” which was composed mostly of potentially fatal microbes that are becoming increasingly impervious to the drugs that once easily killed them. These are the bacteria WHO believes represent the greatest microbial threat to human health, and the list was compiled in the hopes of providing direction — and motivation — to pharmaceutical researchers who are desperately needed to develop new antibiotics.


Investing in antibiotic development now will save lives later.


A quick primer on antibiotic resistance: Antibiotics kill living organisms called bacteria, but like all living organisms, bacteria can evolve. Just as giraffes evolve longer and longer necks that allow them to eat more and more leaves, so too do bacteria evolve resistance to antibiotics. For example, a resistant bacterium can evolve the ability to spit out the drug before it has a chance to kill it, or it can evolve structural changes to its cell wall that make it impossible for the drug to attach to it.

One superbug, classified as an “urgent threat” by the CDC and a “high priority” by WHO, stands out from the pack. Unlike the other bacteria in these lists, an untreated infection with this bug isn’t thought to be deadly — but it still wreaks enough havoc to merit special attention from such esteemed bodies as the CDC and WHO. That bug is Neisseria gonorrhoeae, and you have one guess what disease it causes. (If you said gonorrhea, you guessed right.) Continue reading

So Bad, Even Introverts Are Here: The Rally at McSally’s

Planned Parenthood supporters at Rep. Martha McSally’s office in Tucson, March 7, 2017.

The Women’s March on Washington, D.C., was an occasion for people to be creative and even humorous with their signs. Quite a few made me laugh — “Ugh, Where Do I Even Start?,” “We’ve Made a Yuge Mistake,” and “I Shouldn’t Have to Write Pussy on a Poster” were among my favorites at Tucson’s sister march. But there was one that not only made me laugh, it also resonated with me: “So Bad, Even Introverts Are Here.” Someone tweeted it from the march in New York City, and last I checked it had 94,000 “likes,” meaning I’m not the only one who could relate.

There has been some criticism leveled at people for whom the Women’s March was their first public protest. Things were already bad enough for us to be rallying in the streets, they say, so what took you so long? While I understand that line of thought, I get a little prickly at the suggestion that attendance at a march or rally is the only way to “do” activism. Yes, the Women’s March in Tucson was my first protest, but it was not my first activism.


I’m glad I expanded the boundaries of my comfort zone and allowed myself to be publicly counted.


As a teenager, I was happiest with volunteer activities that kept me far from the limelight, like stuffing envelopes for Planned Parenthood and the ACLU. Crowds, chants, spectacles — not my thing. I didn’t want to be interviewed by the local news, and I didn’t want my photo in a newspaper. I tried my hand at going door to door, but it filled me with so much anxiety that I never did it again. My activism, such as it was, waned as I buckled down on my studies in university, and it wasn’t until after I moved to Arizona that I started seeking out more opportunities — and explicitly looking for behind-the-scenes work where my introversion and dislike of crowds and cameras wouldn’t hold me back.

While there was plenty of work for people who didn’t mind making cold calls or canvassing neighborhoods, I found adequate demand for my skills — writing, data entry, and even the occasional stuffing of envelopes. I’m glad there are folks who can throw themselves on the front lines, changing hearts and minds on a one-on-one, face-to-face level. I’m glad there are folks who go to marches and wave signs, adding their bodies to the throngs of other people standing against injustice. We need those people. But I always felt perfectly content behind the scenes, contributing in my own quiet way.

Yet on January 21, I found myself in Armory Park in Tucson, joining thousands of Women’s March protesters. And on March 7, I made the split-second decision to show up after work at a spur-of-the-moment protest at Rep. Martha McSally’s office, waving signs to passing cars on Broadway Boulevard.

So what changed? Continue reading

STD Awareness: The Surprising Sexual Transmission of Non-STDs

What is a sexually transmitted disease, or STD? If someone catches their partner’s cold during sex, is that cold an STD? According to the Office on Women’s Health, an STD is “an infection passed from one person to another person through sexual contact.” Unless the cold was passed through sexual contact, rather than mouth-to-mouth contact, it would not be considered an STD. Others say that, for an infection to be considered an STD, its sexual transmission must make it significantly more common in the population. So, a disease like the common cold would probably be just as common even if people never had sex.


MRSA, meningitis, and the virus that causes pinkeye can be transmitted sexually.


However, there are some infections, such as hepatitis C or bacterial vaginosis, whose status as official STDs is controversial. While researchers argue with one another over where to draw the line between an STD and a non-STD, let’s take a look at some bacteria and viruses that can be transmitted sexually, even though they’re not officially categorized as “STDs.”

MRSA: Methicillin-Resistant Staphylococcus aureus

MRSA bursting out of a dead blood cell. Image: Frank DeLeo, NIAID

MRSA bursting out of a dead blood cell. Image: Frank DeLeo, NIAID

You’ve probably heard of MRSA, which is pronounced “mersa” and stands for methicillin-resistant Staphylococcus aureus — a strain of bacteria that is resistant to every antibiotic in the penicillin family, as well as others. S. aureus, or “staph” for short, is the same bacteria responsible for TSS, or toxic shock syndrome, which has most infamously been associated with the use of highly absorbent tampons. But mostly, staph is a common cause of skin infections, which could be deadly in the pre-antibiotic era, but these days usually don’t raise too many eyebrows.

Unfortunately, with the emergence of MRSA, which is difficult to treat with the usual drugs, we might once again have to worry about minor skin infections blossoming into life-threatening conditions. Additionally, MRSA has found a way to hop from person to person via sexual contact, and sexually transmitted MRSA has been documented in both heterosexual and MSM (men who have sex with men) populations. Untreated, it can lead to a form of gangrene in which tissue blackens as it dies. Continue reading