STD Awareness: COVID-19 and Your Sexual Health

The world has found itself in the clutches of a pandemic, and every day we’re learning about the ripple effects this new virus is having in everyone’s lives, not just the lives of those who cross its path. These devastating consequences include millions of people losing their jobs and hospitals stretched so far past capacity that they can’t adequately treat all their patients.

There are plenty of other downstream effects, too. For example, some people are worried that we could be staring down the barrel of a shortage of a common antibiotic called azithromycin, which cures chlamydia — the most common sexually transmitted bacteria in the world. Nine drug manufacturers recently reported azithromycin shortages to the Federal Drug Administration. With chlamydia rates at a record high, 2020 is a bad time for the antibiotic that cures it to be in short supply. Untreated, chlamydia can cause infertility and chronic pain, and can increase risk for HIV transmission and acquisition.

Apparently, the president of our country, who is not a health expert by any stretch of the imagination, endorsed azithromycin as a treatment for COVID-19 in combination with a drug that treats lupus and arthritis. There isn’t much in the way of evidence that the drug combination recommended by the president actually can treat COVID-19, but there are currently clinical trials underway, so time will tell how effective that regimen actually is. Continue reading

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

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: Is Mouthwash a Match for Gonorrhea’s Superpowers?

Since the 1930s, we’ve enjoyed around eight decades of easily cured gonorrhea — at least in places with easy access to antibiotics — but experts fear those days are numbered. In the past year or so, cases of untreatable gonorrhea have occasionally made headlines.

Thanks to the powers of evolution, some bacteria have acquired the multiple genes necessary to withstand the onslaught of the pills and shots administered by doctors. Gonococci, the bacteria that cause gonorrhea, are starting to win this “arms race” with humans, whose antibiotic arsenals are losing effectiveness. And with gonorrhea on the rise, gonococci may be evolving at an ever-quickening clip.


In 1879, Listerine claimed to cure gonorrhea. Today, scientists are finally testing that claim. We await the results.


Oral Gonorrhea: The Silent Scourge

Many experts believe oral gonorrhea is a key driver of antibiotic resistance. These infections usually don’t cause symptoms, and without symptoms people usually don’t seek treatment. Without treatment, gonococci can hang out in a throat for up to three months.

After transmission by oral sex — and possibly even by kissing  — gonococci can set up camp in the throat, which is an ideal environment for acquiring antibiotic resistance. They might not be causing symptoms, but they’re not sitting there twiddling their thumbs, either. If there’s one thing gonococci love to do, it’s collecting genes like some of us collect trading cards, and the throat is a gathering place for closely related bacteria species that hand out antibiotic-resistance genes for their expanding collections.

Gonococci can easily scavenge DNA from their surroundings — say, from a dead bacterium — and patch long segments of these genes into their own DNA, creating genetic hybrids between themselves and other organisms. Last month, scientists from Indiana University caught this phenomenon on video for the first time.

Continue reading

STD Awareness: Is Chlamydia Bad?

chlamydiaPerhaps your sexual partner has informed you that they have been diagnosed with chlamydia, and you need to get tested, too. Maybe you’ve been notified by the health department that you might have been exposed to chlamydia. And it’s possible that you barely know what chlamydia even is, let alone how much you should be worried about it.

Chlamydia is one of the most common sexually transmitted diseases (STDs) out there, especially among young people. It can be spread by oral, vaginal, and anal sex, particularly when condoms or dental dams were not used correctly or at all. It is often a “silent” infection, meaning that most people with chlamydia don’t experience symptoms — you can’t assume you don’t have it because you feel fine, and you can’t assume your partner doesn’t have it because they look fine. If you’re sexually active, the best way to protect yourself is to know your partner’s STD status and to practice safer sex.


Chlamydia increases risk for HIV, leads to fertility and pregnancy problems, and might increase cancer risk.


The good news about chlamydia is that it’s easy to cure — but first, you need to know you have it! And that’s why it’s important for sexually active people to receive regular STD screening. Left untreated, chlamydia can increase risk of acquiring HIV, can hurt fertility in both males and females, can be harmful during pregnancy, and might even increase risk for a certain type of cancer. So why let it wreak havoc on your body when you could just get tested and take a quick round of antibiotics?

To find out just how seriously you should take chlamydia, let’s answer a few common questions about it.

Can Chlamydia Increase HIV Risk?

Chlamydia does not cause HIV. Chlamydia is caused by a type of bacteria, while HIV is a virus that causes a fatal disease called AIDS. However, many STDs, including chlamydia, can increase risk for an HIV infection, meaning that someone with an untreated chlamydia infection is more likely to be infected with HIV if exposed to the virus. Continue reading

STD Awareness: Can I Use Plastic Wrap as a Dental Dam During Oral Sex?

plastic wrapIf you read this blog — or any sexual health website, really — you’ll probably see dental dams getting a lot of props. A dental dam (not to be confused with a female condom) is a square piece of latex that can cover the vaginal opening or the anus. Anyone wishing to avoid the oral transmission of STDs like herpes, gonorrhea, HPV, syphilis, chlamydia, and intestinal parasites, dental-dam advocates say, should use a latex barrier. Most people, however, have probably never even seen a dental dam, and they are not widely used. Perhaps their unpopularity is related to myths about oral sex being safe sex (it’s not!); perhaps it’s due to dental dams being expensive or difficult to find.


Plastic wrap hasn’t been evaluated by the FDA for STD prevention, and no studies have assessed its effectiveness in reducing disease risk during oral sex.


Some safer-sex aficionados have found ways around that, though. They might cut the tips off of condoms and make incisions along the sides, creating little latex rectangles. An even easier and cheaper option lies in plastic wrap, which many people use as a barrier while performing cunnilingus (oral contact with the female genitalia) or rimming (oral contact with the anus). It is inexpensive, easy to find, odorless, and tasteless, and can be purchased without even a hint of embarrassment (unless perhaps your other purchases include duct tape, cucumbers, and clothes pins). And it can be pulled off the roll in sheets as long as your heart desires!

Planned Parenthood endorses the use of plastic wrap for oral sex when dental dams aren’t available. The Centers for Disease Control and Prevention and AIDS.gov both recommend plastic wrap for use during rimming. Health authorities, such as AIDS.gov and the Idaho Department of Health & Welfare, recommend non-microwavable Saran Wrap, because microwave-safe Saran Wrap has tiny pores to let out steam — which might also let viruses and bacteria through. Continue reading

STD Awareness: Ceftriaxone-Resistant Gonorrhea

Nestled in the throat of a Japanese woman was a collection of clones that scientists abducted from their temporary habitat and christened H041 — a humdrum moniker for a strain of bacteria that would burn headlines in medical journals. Though the bacteria never caused symptoms in their host, they lingered in her throat from at least January until April of 2009, when a swab finally tested negative. Rather than succumbing to repeated bombardment by an antibiotic called ceftriaxone, the infection probably just went away on its own — as oral gonorrhea infections tend to do.


Resistance to ceftriaxone, our last good gonorrhea drug, has been reported in Japan, Australia, Sweden, France, and Spain.


The emergence of antibiotic-resistant gonorrhea is considered one of the most pressing problems in infectious disease — just two years ago, the Centers for Disease Control and Prevention named it an “urgent threat.” We have one remaining first-line gonorrhea treatment left: extended-spectrum cephalosporins, which include cefixime, which is taken orally, and ceftriaxone, which is administered as a shot. Resistance to cefixime was first documented in 1999, leaving ceftriaxone as our best remaining option, and the CDC’s first choice for treating gonorrhea. There are no good alternatives to ceftriaxone remaining, which is why reports of ceftriaxone-resistant gonorrhea are so deeply troubling.

What made H041 special was that it was the first extensively drug-resistant strain of Neisseria gonorrhoeae, the bacteria that cause gonorrhea. With an unusually high level of resistance to ceftriaxone — four to eight times higher than the previous record holder — the strain was also resistant to a slew of other antibiotics: penicillin and its relatives, fluoroquinolones, macrolides, tetracycline, trimethoprim-sulfamethoxazole, chloramphenicol, nitrofurantoin, cefpodoxime, cefixime, ciprofloxacin, and levofloxacin — and had reduced susceptibility to azithromycin to boot.

Another thing that made H041 special — as special as clones can be, anyway — is that it never reappeared. After its discovery, researchers in Kyoto and Osaka intensified their surveillance, trying to uncover it again and track its spread through the population. However, their search for H041 turned up empty handed. But other ceftriaxone-resistant strains have been documented around the world. Continue reading