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: The HIV Epidemic at Home

In the United States, we understand HIV — the virus that causes AIDS — using a common narrative, one that gives us the impression that its deadliest chapters belong in decades past or distant places. It goes like this:

The disease emerged in the 1980s, cutting down young gay men in their primes and blindsiding scientists as they scrambled to unravel the virus’ mysteries. While AIDS initially whipped up mass hysteria among the general public, LGBTQ folks demanded equality, pushing to find treatments and a cure. AIDS activism and scientific research eventually led to the development of antiretroviral drugs, which tamed the plague by turning a death sentence into a chronic disease. Now, with the right medication, people with HIV can live long, healthy lives. The hysteria has died down, as most people realize viral transmission is preventable, and the infection is manageable.

One thing hasn’t changed, however: Just as it was in the 1980s, AIDS is still thought of as a disease of the “other.” Back then, it was a disease of gay men, a population cruelly marginalized by the general public. Today, it’s thought of as a disease of sub-Saharan Africa, where HIV prevalence is highest.

That narrative, however, doesn’t tell the whole story. Right here in our own backyards, the HIV epidemic continues to spread in the face of chilling indifference from those not affected. African-American MSM — men who have sex with men, who may or may not self-identify as gay or bisexual — have an HIV prevalence that exceeds that of any country in the world. In Swaziland, for example, 27 percent of adults are living with HIV/AIDS, but if current transmission rates hold steady, half of African-American MSM are projected to be diagnosed with HIV in their lifetime. Instead of taking this projection as a wake-up call to invest in lifesaving health policies, however, state and federal responses are poised to let it become a self-fulfilling prophecy.

Contrary to racist and homophobic stereotypes, data show that black MSM aren’t more likely to engage in risky sexual behavior, use drugs and alcohol, or withhold their HIV status from partners. So why are they burdened with higher HIV rates? The answer lies beyond mere behavior, embedded in policies and practices that disproportionately harm people based on race, sexuality, and geography. 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

STD Awareness: Are Condoms Really Necessary?

condoms in packetsCondoms are one of the best ways for sexually active people to avoid sexually transmitted diseases (STDs), but many worry that people are becoming more lax about protecting themselves. There are all kinds of myths swirling around about condoms — such as that they aren’t effective or that they kill the mood. And, thanks to anti-HIV medications, some people no longer see condom use as a matter of life or death.

The Centers for Disease Control and Prevention (CDC) recently announced that 2014 saw record highs in chlamydia, syphilis, and gonorrhea, which is a stark reminder that condoms protect against more than just HIV. So, even if you’re using medications to protect yourself from HIV, remember that syphilis is making a comeback, and can cause serious damage or even death when untreated, and that gonorrhea is rapidly evolving resistance to the last good drugs we have to treat it. Condoms are just as relevant as ever!

HIV

In 2014, the CDC announced it would start using the term “condomless sex” instead of “unprotected sex” to recognize that people could engage in condom-free sex, but still protect themselves from HIV by using Truvada, or pre-exposure prophylaxis (PrEP). Truvada is the first drug approved by the FDA to prevent HIV, and it can be taken by HIV-negative individuals to help their body ward off the virus before an infection can establish itself. The pill must be taken daily — using it inconsistently reduces its effectiveness. Continue reading

STD Awareness: Gardasil and Gendered Double Standards

male female teens largeDespite the fact that it’s been approved for males for years, Gardasil is still largely seen as a vaccine for girls, and human papillomavirus (HPV) is still thought of by many as a virus that only impacts the female population. The fact of the matter is that HPV can have serious consequence for boys and men, and Gardasil is an important tool in protecting their sexual health. Why, then, does the association between girls and Gardasil persist?


Let’s stop thinking of Gardasil as the cervical cancer vaccine. Gardasil is a cancer vaccine, period.


Before Gardasil’s introduction, the pharmaceutical company Merck launched an HPV-awareness campaign to get a buzz going for their upcoming vaccine. Their talking points could be boiled down to one simple fact: HPV causes cervical cancer. Outside of the medical field, HPV was a little-known virus, and Merck strove to connect HPV and cervical cancer in the public’s mind so that, after it hit the market, Gardasil’s value would be easily recognized.

So the origins of the association between girls and Gardasil lie in its marketing — and the fact that the Food and Drug Administration (FDA) initially only approved its use in females. From its introduction in 2006 until 2009, Gardasil was only FDA-approved for use in girls and women, and its routine use in males was not recommended by the Advisory Committee on Immunization Practices until December 2011.

While Gardasil’s website is currently gender neutral, archives show that before FDA approval for males, it contained photos of young women and female-specific language. This initial focus on female recipients could have “feminized” Gardasil, entrenching its association with girls and women in the cultural imagination. Some scholars say that, by only recommending it for one sex, the FDA implicitly assigned liability for HPV transmission to females, and advertisers framed the woman as a disease vector in taglines targeting females, such as “spread the word, not the disease.” Although a male’s sexual history is a major predictor of a female partner’s HPV status, girls and women were assigned sole responsibility for their HPV status while boys and men were not similarly burdened. Such messages downplayed the male role in HPV transmission as well as HPV’s effect on males. Continue reading