STD Awareness: COVID-19 and Semen

You might have read the headlines earlier this month that the virus that causes COVID-19 has been found in semen. Is that true — and if it is, does that mean COVID-19 can be transmitted sexually?

The short answers to those questions are yes, and we don’t know yet.


Several viruses that aren’t thought of as sexually transmitted can be found in semen.


JAMA recently published a short article about a small study conducted in China. The authors took semen from 38 people who were either recovered from COVID-19 or still in the throes of infection. Of those 38 people, six were found to have the novel coronavirus hiding out in their semen — adding semen to the list of bodily fluids in which the virus can lurk, including saliva, urine, and feces.

This study is too limited to make sweeping generalizations, but it does seem to show that it’s possible — though perhaps not overwhelmingly likely — for someone suffering from COVID-19 to be none the wiser as the virus wends its way to the body’s southern hemisphere, where it can hang out in the testes. Plus, the virus was detected not just in people with active disease, but also in people who had recovered, raising the possibility that someone can carry the virus below the belt even after symptoms are gone. Continue reading

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: Stigma and Sexually Transmitted Diseases

Stigma and disease have always gone hand in hand, with some diseases more stigmatized than others. Over the millennia, people living with diseases ranging from leprosy to AIDS have been burdened by moral judgments, while people with conditions like common colds or Alzheimer’s disease are seen as randomly — and innocently — afflicted.


Even the most “sex-positive” among us might find ourselves inadvertently stigmatizing others.


These days, stigma swirls around the novel coronavirus that causes COVID-19, arising from the fear and anxiety that has recently gripped the world. As reports of hate crimes against people of Asian descent show, some people are confusing vigilance about protecting public health with excuses to lash out at certain populations. This stigma can also show itself in seemingly benign comments, like apologizing for coughing and promising that it’s “only allergies” — which I have seen happen even in conversations taking place in “virtual spaces” like Zoom or Skype, where disease transmission wouldn’t have been possible. The idea is that a COVID-19 infection is shameful, while allergies are socially acceptable.

Probably no set of diseases is more stigmatized than sexually transmitted diseases (STDs) — despite the fact that they’re also some of the most common infections across the spectrum of humanity. In fact, we’re in the midst of an STD epidemic, with tens of millions of cases every year in this country alone. Gynecologist Jen Gunter writes about how an STD diagnosis, like no other disease save cancer, has the unique power to bring a patient to tears. A common STD like herpes or genital warts can make someone feel like “damaged goods.” But clearly it’s not the virus itself that makes someone “damaged goods” — it’s the way it was transmitted. For proof, look at the way people react to infections caused by genetically related viruses, such as the herpesvirus that causes chickenpox or the strains of HPV that cause warts on someone’s fingers or toes.

Using Stigma to Punish

Even the most “sex-positive” among us might find ourselves inadvertently stigmatizing others when we talk about having a “clean” STD test or make people with herpes the butt of a joke. When we do that, we participate in a system that frames STDs as just punishments for engaging in the “wrong” kinds of sexual activities. Continue reading

STD Awareness: When Syphilis Goes North

The bacteria that cause syphilis are shaped like corkscrews. Image: David Cox, CDC

Last month, a “weird” medical case made headlines. An Australian man with unexplained headaches and eye pain got a diagnosis for his mysterious symptoms when his doctors discovered he had syphilis — and the infection had spread to his head. Syphilis had caused both optic nerves to become swollen, triggering pain that worsened whenever he moved his eyes.

It might seem strange that a disease most people associate with below-the-belt symptoms can wreak havoc above the neck, but syphilis is a wanderer that can travel all over the body, sowing chaos wherever it goes.


Syphilis can quickly enter the nervous system and travel to the head, where it can cause blindness, psychiatric problems, and other trouble.


Ocular Syphilis

The bacteria that cause syphilis can be passed from one person to another through contact with a sore, which can appear on or around the mouth, genitals, or anus. Any type of sexual contact, including oral sex, can transmit these bacteria. Sores are painless, contain a highly infectious liquid, and can appear between three weeks to three months after infection. These sores aren’t always visible, which means you can’t tell if someone has syphilis just by looking at them.

Although the bacteria typically land in the mouth, genitals, or anus, they can also be sexually transmitted directly into the eye, causing redness and vision problems. After infection, syphilis sores can appear on the eyelids, tear ducts, and soft tissues around the eyes. Bacteria can also travel to the eye by entering the nervous system and blazing a trail to the optic nerve — no direct contact between the eye and a sore necessary. Continue reading

STD Awareness: Winning One War on Cancer

Cancer starts with the uncontrolled division of cells.

The developed world is in the midst of a huge nosedive in genital warts and cervical “precancer” — all thanks to the human papillomavirus (HPV) vaccine. This simple shot trains the immune system to defend itself against HPV, a virus that causes genital warts and several types of cancer. Most sexually active people will be exposed to it in their lifetimes — it’s even been nicknamed the “common cold” of sexually transmitted infections.

Gardasil 9 protects against seven strains of HPV that collectively cause 90% of cervical cancers and anal cancers, plus the two HPV strains that are jointly responsible for 90% of genital warts. Vaccination also reduces the frequency of “precancers,” which are cellular abnormalities that can be treated before progressing into full-fledged cancer — meaning less time, money, and anxiety spent dealing with follow-up procedures and treatments.


The HPV vaccine is an anti-cancer vaccine.


The vaccine is safe and effective — and when we say “effective,” we mean it could lead to the eradication of HPV, and with it the cancers it causes. A recent analysis of 66 million vaccine recipients published in The Lancet points to plummeting rates of genital warts and precancer. Among teenage girls, there was an 83% drop in HPV-16 and HPV-18 infections (the two strains of HPV that together cause 70% of cervical cancers) — and cervical precancers were cut in half.

The most dramatic gains were made in countries that offered the HPV vaccine to both boys and girls. Additionally, there were even decreases in the HPV strains that aren’t covered by the vaccine — evidence of “cross-protection,” the phenomenon in which the immune system recognizes close relatives of the viruses it has been trained to attack. Even people who did not receive the vaccine were less likely to catch the virus, simply because their risk was reduced if their partners were vaccinated. 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

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.

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