STD Awareness: The Curious Case of Chancroid

Haemophilus ducreyi arrange themselves in parallel rows, which researchers have called “railroad tracks,” “schools of fish,” and “fingerprints.” Image: Mike Miller, CDC

Earlier this year, I asked a room full of scientists and medical professionals to raise their hands if they’d ever heard of chancroid. Everyone sat there, motionless, confused by the odd syllables I had uttered — shan kroyd. If you’ve never heard of chancroid, you’re not alone.

Chancroid is a sexually transmitted disease (STD) brought to you by Haemophilus ducreyi, a type of bacteria that can pass through microscopic tears in the skin during sexual contact. When one partner is infected, there is a 1 in 3 chance the other will become infected. An infection can cause painful sores and swollen lymph nodes, most often in the genital region. About half of people with chancroid infections will experience “buboes,” or swollen lymph glands that might rupture. Before it could be cured with antibiotics, a persistent infection could cause permanent skin damage.


Humanity can make chancroid the first STD to go extinct.


One reason you probably haven’t heard of chancroid is that, in the developed world at least, it has mostly disappeared. In fact, researchers believe chancroid can be completely wiped off the planet — which would make it the first STD ever to be forced into extinction. How amazing would that be?

Chancroid has been hopping from loin to loin since at least the days of the ancient Greeks, and was common until the 20th century, when rates began to decline. Thanks to antibiotics, U.S. chancroid rates decreased 80-fold between 1947 and 1997, all but vanishing by the late 1950s. It was virtually unheard of until there was another spike in the 1980s, correlating with the crack epidemic. But, since 1987, cases have been steadily declining. Continue reading

STD Awareness: Is Gonorrhea Becoming “Impossible” to Treat?

Image: National Institute of Allergy and Infectious Disease

Health authorities have been worried about it for a long time now, and we’ve been following it on our blog since 2012. The boogeyman? Antibiotic-resistant gonorrhea, a strain of the sexually transmitted bacteria that is becoming more and more difficult to treat. Higher doses of the drug will be needed to cure stubborn cases of gonorrhea — until the doses can no longer be increased. Then, untreatable gonorrhea could be a reality.


“Little now stands between us and untreatable gonorrhea.”


The World Health Organization (WHO), in a press release last month, finally used the word “impossible” when describing treatment of antibiotic-resistant gonorrhea, referring to documented cases of gonorrhea that were “untreatable by all known antibiotics.” Worse, these cases are thought to be the proverbial “tip of the iceberg,” as there aren’t good data on antibiotic-resistant gonorrhea in many developing countries, where gonorrhea is more prevalent and epidemics could be spreading under the radar. Adding to this problem is the fact that gonorrhea rates are climbing worldwide, which is thought to be due to a number of factors, including the decline in condom use, the frequent absence of symptoms, inadequate treatment, and increasing urbanization and travel.

What will happen if gonorrhea can’t be cured? Your infection could clear up on its own, after a lengthy battle with your immune system, but we don’t know a lot about how long this could take (weeks? months? never?). Unfortunately, despite your immune system’s best efforts, gonorrhea doesn’t go out without a fight. Gonorrhea can lead to pelvic inflammatory disease, which can cause tissue damage to the reproductive organs resulting in infertility, ectopic pregnancy, and chronic pain. It can also cause scarring that blocks sperm’s movement out of the testes, resulting in epididymitis, which is associated with infertility, chronic scrotal pain, and testicular shrinkage. Furthermore, gonorrhea increases risk for HIV transmission and can be passed to a baby during childbirth. The CDC estimates that, in the United States alone, untreatable gonorrhea could cause 75,000 cases of pelvic inflammatory disease, 15,000 cases of epididymitis, and 222 extra HIV infections over a 10-year period. Worldwide, where gonorrhea and HIV disproportionately affect developing countries, these problems could get even more out of control. Continue reading

STD Awareness: Gonorrhea’s Latest Dubious Honor

Wanted: Scientists who can develop novel antibiotics

A few years ago, the Centers for Disease Control and Prevention (CDC) put out a “greatest hits” list of antibiotic-resistant pathogens. More recently, in late February, the World Health Organization (WHO) followed suit with a dirty-dozen list of 12 “superbugs,” which was composed mostly of potentially fatal microbes that are becoming increasingly impervious to the drugs that once easily killed them. These are the bacteria WHO believes represent the greatest microbial threat to human health, and the list was compiled in the hopes of providing direction — and motivation — to pharmaceutical researchers who are desperately needed to develop new antibiotics.


Investing in antibiotic development now will save lives later.


A quick primer on antibiotic resistance: Antibiotics kill living organisms called bacteria, but like all living organisms, bacteria can evolve. Just as giraffes evolve longer and longer necks that allow them to eat more and more leaves, so too do bacteria evolve resistance to antibiotics. For example, a resistant bacterium can evolve the ability to spit out the drug before it has a chance to kill it, or it can evolve structural changes to its cell wall that make it impossible for the drug to attach to it.

One superbug, classified as an “urgent threat” by the CDC and a “high priority” by WHO, stands out from the pack. Unlike the other bacteria in these lists, an untreated infection with this bug isn’t thought to be deadly — but it still wreaks enough havoc to merit special attention from such esteemed bodies as the CDC and WHO. That bug is Neisseria gonorrhoeae, and you have one guess what disease it causes. (If you said gonorrhea, you guessed right.) Continue reading

May 17 Is IDAHOT: The International Day Against Homophobia, Transphobia, and Biphobia

The following guest post comes to us via Kelley Dupps, public policy manager for Planned Parenthood Advocates of Arizona.

Pride flags in Reykjavík. Photo: Dave

Pride flags in Reykjavík. Photo: Dave

Tomorrow marks the annual celebration of IDAHOT — the International Day Against Homophobia, Transphobia, and Biphobia. Established in 2004, the day was originally focused on combating homophobia and quickly began to consolidate with other identity groups. Transphobia was included in the title in 2009 and biphobia was included in 2015 to acknowledge the unique challenges faced by the trans and bisexual communities. In actuality, all expressions of sexuality and gender are acknowledged and celebrated: queer, asexual, and pansexual. IDAHOT is commemorated each May 17 — the day the World Health Organization (WHO) removed homosexuality as a mental disease from the WHO Standards of Care in 1990.


No one is free until we are all free.


IDAHOT is a day both to celebrate LGBTQI identities worldwide, but also to draw attention to the violence and discrimination LGBQI communities face. LGBTQI (lesbian, gay, bisexual, transgender, queer, and intersex) people have more visibility, and with that comes increased violence and discrimination. This year, more than 130 countries are scheduled to participate — nearly 40 of those participating countries criminalize same-sex relationships. Interestingly, participating countries like Egypt, Russia, and Ghana are just a few of the countries around the world that punish same-sex attraction, behavior, and relationships — often by harassment, arrest, imprisonment, public humiliation, and even death.

This year’s theme for IDAHOT is mental health and well being. Individuals who identify as LGBTQI are often overlooked and left out of health systems around the world. Research has shown individuals in the LGBTQI community drink more alcohol, smoke more tobacco, and are at unique and increased risks for cancer, HIV, and other significant health events. Most LGBTQI folks are not aware of these risks and do not see a health care provider on a regular basis. Continue reading

World AIDS Day: Fighting the Stigma Is Half the Battle

RibbonThey say words can never hurt you, but in certain parts of the world, there are three letters that can take away everything dear to you: HIV.

Can you imagine having your family disown you? What if doctors refused to treat you, even with basic care? What would it feel like if you were not allowed to pursue any form of education? How about if you had no possibility of a future with a romantic partner?


We will never make strides in preventing HIV transmission until we confront the taboos that surround it.


This is reality for millions of men, women, and children in sub-Saharan Africa who have been diagnosed with HIV/AIDS. As of 2013, that number was 24.7 million, which accounts for the vast majority of the world’s total reported cases, which by 2014 approached 37 million people, 2.6 million of whom were children. In 2013 alone, 1.5 million sub-Saharan Africans were newly infected. Since the first case was reported in 1981, a certain stigma has always lingered around the disease. Many in the United States refer to it as the “gay disease” or accuse those infected of bestiality. They may say that someone who has been diagnosed should avoid intimacy, believing that a person with HIV is incapable of functional relationships without infecting their partner. In Africa, the implications are even more harsh. Often believed to be a “curse from God,” many regions exile an infected person from their community.

Worse, the stigma does not stop with individuals. It bleeds into the legal, political, and economic arenas as well. This is true worldwide. Some places have prosecuted women for transmitting the virus to their child, or have prosecuted individuals for not disclosing their positive status even if they have reached an undetectable viral load through antiretroviral therapy (ART). The discrimination surrounding a positive diagnosis is cited as the primary hurdle in addressing prevention and care. Continue reading

Mythbusting: Does Abortion Cause Breast Cancer?

breast-examNew England Journal of Medicine. Journal of the American Medical Association. Annals of Internal MedicineJournal of American Physicians and Surgeons.

One of these things is not like the others, one of these things just doesn’t belong. But how can most laypeople differentiate between these medical journals? The dry, pithy titles seem to tell you exactly what’s underneath their covers. So if I told you that, according to a study in the Journal of American Physicians and Surgeons, abortion increases risk for breast cancer, would you believe me? Well, why not? The Association of American Physicians and Surgeons (AAPS), which publishes the journal, sounds legit.


Health decisions must be guided by reliable evidence, and when agenda-driven policies misinform, patients cannot make informed decisions.


Except that AAPS is infamous for its agenda-driven views, and its journal is used to deny climate change and the dangers of secondhand smoking, promote the debunked idea that vaccines cause autism, advocate for closed borders in overtly racist anti-immigration pieces, reject the causal relationship between HIV and AIDS, and perpetuate a far-right political worldview. The organization opposes any government involvement in health care, including the FDA, Medicare, the Affordable Care Act, and regulation of the medical profession.

Medical journals, like all scientific journals, are where researchers share and critique each other’s work. Before anything is published it undergoes “peer review,” in which experts evaluate studies for quality — good study design, reasonable interpretation of results, etc. The Journal of American Physicians and Surgeons, however, has been criticized for placing ideology over the presentation of meticulously gathered scientific evidence, and is not indexed in academic databases like MEDLINE. In 2007, AAPS joined conservative organizations in filing a lawsuit against the FDA, arguing against emergency contraception’s over-the-counter status. So, when the journal publishes articles purporting a link between abortion and breast cancer, we should all be raising our eyebrows in collective skepticism.

You might have heard abortion opponents’ claims that abortion can raise one’s risk for breast cancer later in life. So let’s get something out of the way right now: The very best scientific evidence does not support a link between abortion and breast cancer. Prominent medical organizations, including the National Cancer Institute, the American Cancer Society, the American Congress of Obstetricians and Gynecologists, and the World Health Organization, have all examined the entirety of the research and found that the largest and most methodologically sound studies fail to reveal a link between abortion and breast cancer. Yet still opponents of abortion include this factoid in misinformation campaigns to instill fear into people making difficult, private decisions, often during periods of vulnerability. Continue reading