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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.

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

STD Awareness: Syphilis Treatment Through the Ages

The spiral-shaped bacteria that causes syphilis.

When syphilis first descended upon Europe, questions surrounded this mysterious scourge. Was it a punishment from God? Was it introduced by a hated Other? Was it caused by the stars’ alignment or the presence of “bad air”? We now know that syphilis is not caused by supernatural forces, foreigners, or a harmful atmosphere, but rather by a species of corkscrew-shaped bacteria called Treponema pallidum, which is spread by sexual contact — vaginal, anal, or oral sex — in which one person comes into contact with a syphilis sore.


Thanks to penicillin, we don’t have to go back to the “good old days” of puke chalices, antivenereal underpants, and rat poison.


Before good treatments were developed in the 20th century, syphilis was the most feared STD out there. Its initial symptoms can include a painless sore filled with a highly infectious liquid. As the infection spreads, lesions and rashes might appear on the soles of the feet or the palms of the hand. After these first waves of symptoms, the infection enters a latent phase, which can lull people into a false sense of security, thinking the disease has disappeared. Unfortunately, 15 percent of people with untreated syphilis reach the late stage, which can occur up to 20 years after initial infection, and includes severe damage to the nervous system, brain, heart, or other organs, and can be fatal.

These days, a shot of penicillin is all it takes to cure syphilis. Back in the day, though, there were myriad “treatments” for syphilis — but they were highly toxic and ineffective. Unfortunately, thanks to the latent phase of syphilis, it often seemed like these treatments did work, which probably explains why folks tortured themselves with them for centuries. If only penicillin had been around: Countless people would have been spared the unpleasant — and often fatal — quackery that syphilis attracted. Continue reading

Why Periods? False Hopes, Popes, and the “Grandfathered” Withdrawal Bleed

The birth control pill and other hormonal contraception are popular. Menstrual periods are not. Hormonal contraception can be used to suppress menstruation — so why isn’t this method, called “continuous contraception,” more popular?

For decades, packets of birth control pills have typically contained 21 “active” pills and seven “placebo” pills. These placebos — sugar pills — trigger bleeding (which most people think of as a menstrual period, even though it’s technically called a withdrawal bleed). Because menstruation is natural, some people think this withdrawal bleed must somehow be healthier. But there are actually no health benefits — and it might also increase risk for pregnancy.


There is no reason to have a period when on the birth control pill — unless you want one.


Last month, British medical guidelines were revised to recommend continuous use of the birth control pill — that is, with no week-long “break” designed to trigger a withdrawal bleed. We could have been skipping our periods since the Pill was introduced in 1960 — so why is it only now that we are coming to see them as optional?

A flurry of recent articles has touted a rather conspiratorial claim: that the monthly bleed was included in an attempt to make the Pill more palatable to the pope. The Telegraph quoted reproductive health expert John Guillebaud: “John Rock devised [the week of placebo pills] because he hoped that the pope would accept the Pill and make it acceptable for Catholics to use. Rock thought if it did imitate the natural cycle then the pope would accept it.”

Many journalists, pundits, and bloggers have expressed outrage that we’ve been putting up with decades of unnecessary bleeding (and all the attendant pain, headaches, and missed work) just because of an unsuccessful attempt to appease the pope before most women of reproductive age were even born. But the history of the placebo week is more complicated. Continue reading

STD Awareness: How Common Is Herpes?

Those of you with an eye for weird news might have noticed recent headlines about wild monkeys in Florida suffering from a herpes epidemic.

Two things in that sentence might have tripped you up. One, Florida has wild monkeys? Yup. In the late 1930s, after a Tarzan movie was wrapped, three male and three female rhesus monkeys were released into the Florida wilds, giving rise to an estimated 1,000 monkeys roaming the Sunshine State today.


Both oral herpes and genital herpes are on the decline.


The second thing that might have given you pause: Monkeys can get herpes? Yes again! The Herpesviridae family is huge, with at least 100 members infecting mammals, birds, reptiles, bony fish, amphibians, and oysters — even dinosaurs are thought to have been infected by herpesviruses! The virus has been evolving alongside us since before the dawn of humanity, so it knows us like the back of its hand (metaphorically speaking), allowing it to stow away in our bodies and hide from the immune system.

The “Tarzan” monkeys suffer from a type of herpesvirus called herpes B, which can be deadly in humans, though it’s rare — just try not to find yourself on the receiving end of a monkey bite or scratch. Not so rare in humans are human herpesviruses, of which there are eight types. Types 1 and 2 — aka herpes simplex virus (HSV) 1 and 2 — can both cause genital herpes, one of the most common sexually transmitted diseases (STDs). HSV-1 mostly causes cold sores, but can also infect the genitals to cause genital herpes, while HSV-2 mostly causes genital herpes, but can also infect the facial area to cause cold sores. (A little confusing, I know.) Continue reading

STD Awareness: The Long Road to a Chlamydia Vaccine

Earlier this year, television personality John Oliver was the butt of an elaborate prank orchestrated by actor Russell Crowe. It started with an auctioned jock strap, and ended with Crowe funding the John Oliver Koala Chlamydia Ward at the Australia Zoo. If you want the full story, check out the video below (beware explicit language).

Despite Oliver playing it for laughs, koala chlamydia is very real and very serious. At least half of wild koalas are infected with a chlamydia type that’s related to the human version. As in humans, koalas can transmit these bacteria through sexual contact. And, similar to the havoc it wreaks in our species, in koalas chlamydia can cause blindness, urinary tract infections, and female infertility — and can be passed from mother to infant. Along with other factors, chlamydia is said to be responsible for plummeting koala populations in many parts of Australia. Continue reading