Will St. John’s Wort Affect Birth Control?

st-johns-wortHerbal remedies are very popular around the world. Many people prefer them to pharmaceuticals because they believe herbs can elicit positive results without serious side effects. However, plants produce a wide variety of chemicals at varying concentrations, and might have a number of effects on your body, both good and bad. Furthermore, since herbal supplements are not evaluated by the FDA for safety or effectiveness, consumers often don’t have ready access to evidence about herbal products. We can’t even be sure that they contain the ingredients that are listed on the label!


St. John’s wort might decrease the effectiveness of birth control pills, and might be unsafe during pregnancy.


One popular herb is St. John’s wort, or Hypericum perforatum. While the scientific evidence is mixed at best, many people believe that St. John’s wort can be used as an antidepressant. However, people often treat themselves with herbal supplements without guidance from a medical doctor or pharmacist — and without knowing whether or not these herbs are safe to use with any medications they might be taking.

Over the millennia, plants have evolved all sorts of powerful chemicals, such as toxins, to defend themselves against insects and other predators. For this reason, we can’t assume that plants only contain inert chemicals that won’t affect us or interact with the chemicals in other drugs and supplements we use. St. John’s wort, in fact, contains chemicals that interfere with other medications. It has been banned in France, and other countries require or are considering warning labels on St. John’s wort products so consumers can be aware of possible drug interactions. Continue reading

STD Awareness: Is Bacterial Vaginosis a Sexually Transmitted Disease?

Not to scale: Gardnerella vaginalis under a microscope. Image: K.K. Jefferson/Virginia Commonwealth University

Gardnerella vaginalis under a microscope. Image: K.K. Jefferson/Virginia Commonwealth University

Bacterial vaginosis, or BV, is the most common vaginal infection among people 15 to 44 years of age. It’s caused by an overgrowth of harmful bacteria, such as Gardnerella vaginalis. A healthy vagina hosts thriving populations of Lactobacillus bacteria species, but when these “good” bacteria are crowded out by certain types of “bad” bacteria, the vaginal ecosystem can be shifted, causing BV.

There is a lot of confusion about BV. Is it a sexually transmitted disease (STD)? What are the symptoms? How can you avoid it?

All good questions. Let’s examine them one by one.

Is BV an STD?

The consensus seems to be that BV isn’t officially an STD, but even reliable sources have somewhat contradictory information. Planned Parenthood doesn’t list BV as an STD on their informational webpages. The Centers for Disease Control and Prevention (CDC) does include BV on their STD website, but also says that “BV is not considered an STD.”

On the other hand, the Office on Women’s Health says that “BV can … be caused by vaginal, oral, or anal sex” and that “you can get BV from male or female partners.” And there’s an entire chapter devoted to BV in the premier medical textbook on STDs, and its authors say that, while sexually inexperienced females can get BV, “the weight of evidence supports sexual transmission” of G. vaginalis, the bacteria species most famously implicated in BV infections.

The same webpage on which the CDC declared BV not to be an STD also says that it can be transferred between female sexual partners. Indeed, women who have sex with women have higher rates of BV. Since vaginal fluid could spread BV, partners can change condoms when a sex toy is passed from one to another, and use barriers like dental dams when engaging in cunnilingus (oral contact with the female genitalia) or rimming (oral contact with the anus).

What about heterosexual transmission? Continue reading

What Do We Know About Herbal Remedies and Menstrual Cramps? (Spoiler Alert: Not Much.)

herbalWhen I was entering adulthood and suffering from severe menstrual cramps, I suffered without relief for far too long. And I am certainly not alone in this experience. The most common gynecological disorder is dysmenorrhea — painful menstrual cramps — which strikes an estimated 90 percent of reproductive-age females. Furthermore, around 40 percent of American women use some form of complementary and alternative medicine, or CAM. “CAM” is a catchall for approaches to health care that fall outside of the mainstream. Given the popularity of CAM and the ubiquity of dysmenorrhea, it was no surprise that I experienced painful cramps, nor was it shocking that I tried a few herbal remedies, which are a type of CAM.


“Natural” doesn’t necessarily mean safe or effective, so be critical.


During my second year of college, at the age of 19, a friend recommended a couple of herbal remedies to add to my cramp-fighting arsenal. I tried them, but it was difficult to know if they really worked. My pain varied so wildly cycle to cycle that I had no way of knowing if I was just having a “good month” when I initially tried these products. Although I thought they worked at first, after I had accumulated more menstrual cycles under my belt, I started to wonder if my cramps were really any less painful. On average, I still seemed to be missing just as much school and work as before — but I wasn’t sure.

The problem was that I never collected any before-and-after data — I didn’t spend years ranking the severity and duration of my cramps, or keeping track of the hours spent in bed away from school, work, or other obligations. Furthermore, my initial sense of optimism could have colored my perceptions. Since we can be tricked by our own expectations and biases, it is important to have access to quality evidence — gathered in large, methodologically powerful studies.

Raspberry leaf tea was the first herbal remedy I tried. It tasted OK, and the ritualistic nature of drinking a hot beverage from a steaming mug was soothing. But is there any actual evidence that raspberry leaf can help relieve the pain of dysmenorrhea? Although it’s been used therapeutically since at least the 1500s, the only human studies I can find for any gynecological condition examine its use during pregnancy or labor — not for treating menstrual cramps. The only claims for raspberry leaf’s efficacy in treating cramps come from biased sources, like the manufacturers themselves. It seems the tea I drank during my late teen years had word of mouth and marketing going for it, but not much else. Continue reading

STD Awareness: Will Gonorrhea Be Worse Than AIDS?

A scanning electron micrograph of a colony of Neisseria gonorrhoeae, the bacteria that cause gonorrhea. Image: Portland State University

A scanning electron micrograph of a colony of Neisseria gonorrhoeae, the bacteria that cause gonorrhea. Image: Portland State University

If you’ve been reading the news lately, you might have noticed an odd piece of reportage from CNBC, in which a naturopath claimed that antibiotic-resistant gonorrhea “might be a lot worse than AIDS” and might cause cases of sepsis that could kill “in a matter of days.” This quotation, uttered by a single naturopath, was then exaggerated in sources such as the United Kingdom’s Daily Mail, which ran the headline “Doctors warn that antibiotic-resistant strain of gonorrhea could be ‘worse than AIDS.'” In fact, the only person making this claim was one naturopath, not a doctor, and certainly not plural “doctors.”

There’s a lot to unpack here. First is the alarmism in the original CNBC article, and its dependence on an unreliable source. Second is the issue of antibiotic-resistant gonorrhea itself, which is a very serious public health problem. Thirdly, let’s look at the naturopath’s claim, which is that antibiotic-resistant gonorrhea could unleash a plague worse than AIDS and kill its victims in a matter of days.


Claims that antibiotic-resistant gonorrhea will be “worse than AIDS” are greatly exaggerated.


Alan Christianson, the naturopath behind the hyperbolic claims of super-virulent gonorrhea, does not seem to be an actual expert in infectious disease (his website lists “natural endocrinology” and “male menopause” among his specialties), nor is he a medical doctor. The article identifies him as a “doctor of naturopathic medicine,” but what does that mean?

Naturopaths are not medical doctors, and degrees in naturopathic medicine aren’t awarded by institutions accredited by the Association of Medical Colleges, the body that accredits medical schools. Naturopathy is a philosophy that is not generally supported by scientific evidence, but rather is based in “a belief in the healing power of nature,” according to the National Center for Complementary and Alternative Medicine. It was developed in the 1800s and today encompasses many modalities of alternative medicine, including homeopathy and herbalism. For these reasons, it is odd that a journalist quoted a naturopath on the potential of antibiotic-resistant gonorrhea rather than someone more qualified, such as a microbiologist or epidemiologist. Continue reading

AIDS Denialism: Conspiracy Theories Can Kill

This scanning electron micrograph from 1989 reveals HIV particles (colored green) emerging from an infected cell. Image: CDC’s C. Goldsmith, P. Feorino, E.L. Palmer, W.R. McManus

We’ve all heard various conspiracy theories; we may or may not find them credible, and we might chalk up opposing viewpoints to simple differences in opinion. Sometimes, however, conspiratorial narratives are woven around matters of life and death — and in such cases, the spread of such ideas can influence dangerous changes in behavior and even government policy.

AIDS denialism is based on the idea that human immunodeficiency virus (HIV) does not cause AIDS. Although the existence of HIV and its causal connection to AIDS has been thoroughly demonstrated by scientists, denialists either reject the existence of HIV altogether, or cast it as a harmless virus that doesn’t cause illness. Denialism often relies upon rhetorical strategies that are superficially convincing but intellectually hollow, including the cherry-picking of evidence, appeals to unreliable “experts,” and untestable claims. Denialists also might cite early AIDS research from the mid-1980s while ignoring more up-to-date findings and improved medical procedures. Such rhetoric creates a sense of legitimate debate in an area where there is none, and the only new evidence welcomed into the discourse is that which confirms preconceived notions.


Health decisions must be shaped by the best available evidence, and when denialism misinforms, one cannot make an informed decision.


If AIDS isn’t caused by HIV, what do denialists claim is behind the unique symptoms that characterize it? Some say that conditions such as malnutrition, or diseases that have been around for a long time, are simply being labeled as AIDS. Other denialists cast antiretroviral drugs as the cause, rather than the preventive treatment, of AIDS. Some claim that AIDS is caused by behavior, such as drug use or promiscuity — with some even saying that an accumulation of semen in the anus can cause AIDS. None of the claims is true — while AIDS can leave someone vulnerable to a wide variety of diseases, and while sharing IV equipment and engaging in unprotected sex can increase risk, there is only one cause: HIV. Continue reading

Can Herpes Be Cured Naturally?

Many of us are infected with herpes simplex virus, which can be transmitted sexually to cause genital herpes. Although herpes is incurable, there are antivirals that can help reduce symptoms. But, because not everyone wants to take pharmaceuticals, a lot of us might seek alternatives in an attempt to treat or even cure our herpes infections.


“Natural” doesn’t necessarily mean safe or effective, so be critical.


For centuries, we have treated herpes in many ways — though not necessarily successfully! In the early 1800s, a British treatment involved placing lint between the tip of the penis and the foreskin. It was claimed that this would cause herpes lesions to heal within 14 days — not coincidentally, this is about how long it takes for them to heal on their own, untreated. Later that century, a London surgeon promoted an arsenic-based solution as a cure for recurrent herpes outbreaks. He presented the cases of a couple of patients. One had been suffering from outbreaks for six years, and after a course of this treatment he allegedly never experienced them again. Another patient had been experiencing recurring outbreaks for four years, and after taking this treatment for a year, his outbreaks “became less and finally cleared altogether.”

We now know that, even without treatment, herpes outbreaks generally become less severe over time, and often stop flaring up completely. When outbreaks do occur, they clear on their own, without treatment. This phenomenon is called “regression to the mean,” and many promoters of bogus remedies rely on it for the appearance that their products work. Because we often think that two things that happen at the same time are related, and that one causes the other, we might attribute the clearing of our herpes lesions to whatever “treatment” we were taking, regardless of whether or not it actually benefited us.

The only way we can know if treatments actually work is to compare them with standard medications or placebos (such as identical-looking sugar pills) in well-designed clinical trials. In such studies, patients are assigned to either medication or placebo at random, which is called “randomization” and is like flipping a coin. And, to protect against introducing bias into the study’s outcomes, trials should be “double-blinded,” meaning that neither researchers nor patients know whether the placebo or the medication under study is being administered. The “miracle cures” you hear about usually haven’t been subjected to such scientific rigor — if they have, the results usually aren’t promising. Continue reading

How to Find Accurate Health Information Online

Does conflicting information on the Internet leave you scratching your head? Image: David Castillo Dominici / FreeDigitalPhotos.net

Does conflicting information on the Internet leave you scratching your head? Image: David Castillo Dominici / FreeDigitalPhotos.net

Did you know only 13 states require that sex education in public schools be medically accurate? This leaves a lot of people in the dark when it comes to making decisions that could have a lasting impact on their lives. Luckily, the Internet can make accurate information about sex accessible. It can also be a dangerous tool if wielded incorrectly, so it’s important to differentiate sources of good information from unreliable sources. An article in the New York Times suggests that the No. 1 way teenagers get their information about sex is through the Internet. Whether or not they receive medically accurate information depends on their search results.


You can’t assume that a product’s legality is evidence of its efficacy.


The Internet is a maze of conflicting information. Most reputable authors will cite their sources, and it’s important that you check them. Online message boards can be filled with anonymous commenters offering opinions, anecdotes, falsehoods, or facts — unless these commenters back their statements up with sources, it may be difficult for you to evaluate their claims. A message board dealing with sexually transmitted diseases (STDs) might seem like an ideal outlet for someone who is concerned about having an STD; other message boards dealing with sex or contraception offer a similar refuge. Users might appreciate the anonymity afforded by such online communities, but it’s important to remember that the people there are also anonymous. The Internet “hive mind” cannot substitute for a professional diagnosis, scientific consensus, or medically sound advice.

Other dubious sources of information might include “alternative health” websites. Many of these practitioners give good advice, like to quit smoking, start exercising, and eat fresh fruits and vegetables. We can’t argue with that. Sometimes, though, these communities can encourage the use of unproven remedies in place of effective treatments. A quick Google search for “natural contraception” can lead you to websites promoting mixtures of herbs for preventing pregnancy, and a search for “herpes cures” might leave you thinking that earwax or homeopathy can stop an outbreak in its tracks. Nonscientific ideas about the immune system also give rise to medically inaccurate statements about vaccines, such as the idea that “natural” HPV infections are preferable to being vaccinated with Gardasil — despite the facts that natural HPV infections might not confer effective immunity against re-infection and can lead to cancer. Continue reading