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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: Can I Get Gonorrhea from Kissing?

Not all types of kissing feature the exchange of saliva.

Some pretty depressing news hit a couple of months ago, when headlines proclaimed kissing could allow gonorrhea to jump from one person to another.

We already knew gonorrhea could be transmitted during oral sex — a terrible fact, given that most people don’t use condoms or dental dams during oral sex. And we knew that oral gonorrhea is more likely to develop drug resistance, which could be helping to drive the possibly untreatable gonorrhea of the near future.


Mouth-to-mouth kissing could be transmitting gonorrhea right under our noses — literally.


Gonorrhea is most famous as an infection of the cervix or the urethra. But the bacteria that cause gonorrhea can thrive in other warm, moist areas of your body — not just the reproductive tract, but also in the mouth, throat, eyes, and anus. Unprotected oral sex can allow those bacteria to travel in either direction between one person’s genitals and another person’s throat.

But what about mouth-to-mouth kissing, like French kissing? Is that enough to allow these bacteria to hitch a ride from one mouth to another? Previous research, using a mathematical model, estimated that mouth-to-mouth contact might be a significant — and underappreciated — mode of gonorrhea transmission. But that was a mathematical model, a sophisticated equation using what we know about a population’s gonorrhea prevalence and sexual behavior to estimate how frequently the infection is transmitted from one mouth to another. Continue reading

STD Awareness: Trichomoniasis, the Pear-Shaped, Blood-Sucking, Silent Scourge

What’s shaped like a pear, hangs with a posse of bacteria, and is a silent scourge upon millions of urogenital tracts? I hope you guessed Trichomonas vaginalis, the single-celled parasite that causes trichomoniasis, or trich (pronounced “trick”). Trich is the most common curable sexually transmitted disease out there — currently afflicting around 3.7 million Americans and 156 million Earthlings.


These single-celled creatures pack a punch, but the body fights back.


When trich causes symptoms, sufferers might experience vaginal discharge (which sometimes has a bad odor), penile burning or discharge, spotting, and itching or swelling in the genital area. But around 70 percent of infections have no symptoms at all, making it a mostly “silent” disease. Based on the totality of the evidence, the Centers for Disease Control and Prevention (CDC) doesn’t currently recommend routine screening for trich in people without symptoms.

But it’s the subject of some debate. Since both symptoms and screenings are rare, and the disease isn’t reportable, some health experts worry that trich could be doing a lot of damage right under our noses. An infection during pregnancy could increase risk for preterm labor or low birth weight. It can increase risk for both acquiring and transmitting HIV from or to a partner. Women with trich are more likely to acquire an HIV infection when sexually exposed to the virus — in fact, one study estimated that 6.2 percent of all HIV infections among U.S. women could be attributed to trich. It’s also easier to catch HIV from a man with trich than from a man without trich. Continue reading

STD Awareness: Searching for an HIV Vaccine

Ever since the dawn of the AIDS era, researchers have worked nonstop to develop an HIV vaccine. In 1984, Margaret Heckler of the U.S. Department of Health and Human Services famously (over)promised that a vaccine would be ready for testing in two years. But it’s taken much, much longer. This Saturday, May 18, is HIV Vaccine Awareness Day, a celebration of the patients, community members, and scientists who are hard at work bringing this vaccine into existence.


Only one vaccine — still in the experimental stage — has shown any effectiveness against HIV.


Hiding from the Immune System

Vaccines are inspired by our own bodies’ ability to fight disease. Usually, when our immune system encounters a threat, it takes note of the viral “antigens,” which are like facial features — a button nose, say, or dramatically arched eyebrows — that make it instantly recognizable. It creates “antibodies,” weapons that can target those antigens like guided missiles. Often, the immune system can remember the distinguishing facial features so it’s ready to attack if the enemy ever returns — giving us immunity, possibly for life.

Vaccines take advantage of our natural ability to create these immune memories by exposing our immune systems to antigens without actually exposing us to infectious viruses. Think of it as a “wanted” poster that helps the immune system recognize “bad guys” before it actually sees them on the street, enabling it to attack and destroy them before they cause disease. Continue reading

Enjoying the Condom of Today While Waiting for the Condom of the Future

When the “consent condom” was introduced last month, it made a minor media splash. The developers of this new condom, packaged in a box that required four hands to open, sought to place the concept of consent at the center of all sexual interactions.

Almost as soon as it grabbed its first headlines, however, the consent condom attracted criticism from multiple sources. Is consent an ongoing dialogue rather than a one-time agreement? Can’t consent be revoked? Do these condoms marginalize people with disabilities that preclude them from opening the box? Couldn’t a rapist force a victim to help open the box, or enlist the assistance of an accomplice? Could they be used as misleading evidence against claims of sexual assault?


With STD rates skyrocketing, more people need to learn how to get the most from condoms — the most protection, the most comfort, and the most pleasure.


Despite the negative reaction, the fact remains that the consent condom succeeded in one goal: provoking public dialogue about the complexity and primacy of consent. It isn’t likely to be a commercial success: Even if a few are sold as novelties, a condom that comes with built-in obstacles doesn’t seem destined for popularity. After all, if regular condoms were too tricky for the inept baby boomers on Seinfeld to master, a complicated gadget requiring four coordinated hands to spring loose probably isn’t going to be a breeze for millennials.

Continue reading

From HPV to Cancer to Dry Mouth

Despite what a lot of people might think, oral sex is sex — not “third base,” not “everything but” — carrying with it the potential for both pleasure and disease transmission. That includes oral transmission of human papillomavirus (HPV), which can lead to head-and-neck cancer (aka oral cancer, aka oropharyngeal cancer). Unfortunately, because so many of us have a lax attitude toward it, fewer people take precautions when engaging in oral sex, and are less likely to use condoms or dental dams.


A head-and-neck cancer epidemic is striking younger people, spurred by HPV.


Head-and-neck cancer — which can strike anywhere from the lips to the larynx, and up into the sinuses and nasal cavity — is caused by several risk factors, chief among them oral infection with HPV. When HPV causes head-and-neck cancer, it usually occurs at the base of the tongue, at the back of the throat, in the tonsils, or in the soft palate.

HPV can be spread by most sexual activities, including vaginal, anal, and oral sex, as well as by rubbing genitals together. Although HPV is most famously associated with cervical cancer, it’s actually driving more cases of head-and-neck cancer in the United States.

It’s Oral, Head, and Neck Cancer Awareness Week — a time to learn about how head-and-neck cancer has changed over the years, what consequences it can have for survivors, and how it can be prevented in the first place.

A Changing Patient Profile

In 2017, scientists reported that oral HPV infections with cancer-causing strains of the virus are five times more common in men than in women, and that, likewise, HPV-associated head-and-neck cancers are more likely to strike men. That same year, researchers also reported that, in the United States, head-and-neck cancer among men has surpassed cervical cancer among women. As the years pass by, head-and-neck cancer rates are expected to continue to skew even more heavily toward the male population. Continue reading

STD Awareness: Can HIV Be Cured Now?

In 1991, when Timothy Ray Brown was in his 20s, he moved from the United States to Europe in search of adventure. His travels brought him to Berlin, where he put down roots and became a translator — but this newfound stability was quickly disrupted. A former boyfriend told him he had been diagnosed with HIV, the virus that causes AIDS, and suggested Brown be tested as well. The results were positive. Brown calculated he had about two more years left to live.

His fortunes changed the next year when antiretroviral drugs transformed HIV from a death sentence to a manageable chronic disease. Life went on. But 10 years later, in 2006, he started noticing changes. While he usually made a 14-mile round trip on his bike to and from work, a quick ride to a café one mile away left him so winded he had to stop halfway through.


We still don’t have an HIV cure that works for everyone.


He was diagnosed with leukemia, a type of cancer that affects certain types of blood cells. He immediately began chemotherapy, a taxing regimen that nearly killed him when an infection forced his doctors to induce a coma. And when the cancer came back, his doctors recommended a bone marrow transplant, which involved wiping out his immune system with drugs and radiation. A year later, after his leukemia came back, he received a second bone marrow transplant. Recovery was grueling. He descended into delirium, nearly went blind, and was temporarily paralyzed. He had to undergo physical therapy to relearn how to walk and talk.

Miraculously, he came out of this near-death experience in full remission from leukemia. But the bone marrow transplants hadn’t just gotten rid of his leukemia. They had gotten rid of his HIV infection, too. The media dubbed him the “Berlin patient.” Continue reading

STD Awareness: The Syphilis Outbreak’s Youngest Victims

Arizona is officially in the midst of a syphilis outbreak that in 2018 claimed the lives of 10 infants. That’s the most babies to die of congenital syphilis in the state’s recent history. In addition to the 10 deaths, another 43 babies were born with syphilis, which can cause severe health problems.

The word “congenital” simply means the baby was born with syphilis after acquiring the infection in the womb. The bacteria that cause syphilis can cross the placenta to reach the fetus — and will do so in 80 percent of pregnancies in which syphilis is untreated. As many as 40 percent of babies infected with syphilis during pregnancy will be stillborn or will die soon after birth. The condition can also cause rashes, bone deformities, severe anemia, jaundice, blindness, and deafness. The good news is that congenital syphilis is almost completely preventable. When it is administered at the appropriate time and at the correct dosage, penicillin is 98 percent effective.


Prenatal care must include screening for syphilis, which can be cured with penicillin but can be deadly if not treated.


Syphilis used to be the most feared STD out there, but rates have been plunging since the discovery of effective antibiotics during the first half of the 20th century. By 2000, syphilis rates hit an all-time low, and many health experts thought the United States was at the dawn of the complete elimination of the disease. But it’s been making a comeback, and between 2013 and 2017 nationwide congenital syphilis rates more than doubled, with the number of affected babies at a 20-year high.

Areas in the southern and western United States have been especially hard hit. Arizona has the sixth-highest congenital syphilis rate in the country, after Louisiana, Nevada, California, Texas, and Florida. Our congenital syphilis rate doubled between 2016 and 2017 — in terms of sheer numbers, most of these cases originated in Maricopa County, but officials say it’s disproportionately affecting rural areas. Gila County, which is east of Phoenix and home to the old mining town Globe, has the highest syphilis rate in the state. Continue reading