Science
An AI app claims it can detect sexually transmitted infections. Doctors say it's a disaster
Late last month, the San Francisco-based startup HeHealth announced the launch of Calmara.ai, a cheerful, emoji-laden website the company describes as “your tech savvy BFF for STI checks.”
The concept is simple. A user concerned about their partner’s sexual health status just snaps a photo (with consent, the service notes) of the partner’s penis (the only part of the human body the software is trained to recognize) and uploads it to Calmara.
In seconds, the site scans the image and returns one of two messages: “Clear! No visible signs of STIs spotted for now” or “Hold!!! We spotted something sus.”
Calmara describes the free service as “the next best thing to a lab test for a quick check,” powered by artificial intelligence with “up to 94.4% accuracy rate” (though finer print on the site clarifies its actual performance is “65% to 96% across various conditions.”)
Since its debut, privacy and public health experts have pointed with alarm to a number of significant oversights in Calmara’s design, such as its flimsy consent verification, its potential to receive child pornography and an over-reliance on images to screen for conditions that are often invisible.
But even as a rudimentary screening tool for visual signs of sexually transmitted infections in one specific human organ, tests of Calmara showed the service to be inaccurate, unreliable and prone to the same kind of stigmatizing information its parent company says it wants to combat.
A Los Angeles Times reporter uploaded to Calmara a broad range of penis images taken from the Centers for Disease Control and Prevention’s Public Health Image Library, the STD Center NY and the Royal Australian College of General Practitioners.
Calmara issued a “Hold!!!” to multiple images of penile lesions and bumps caused by sexually transmitted conditions, including syphilis, chlamydia, herpes and human papillomavirus, the virus that causes genital warts.
Screenshots, with genitals obscured by illustrations, show that Calmara gave a “Clear!” to a photo from the CDC of a severe case of syphilis, left, uploaded by The Times; the app said “Hold!!!” on a photo, from the Royal Australian College of General Practitioners, of a penis with no STIs.
(Screenshots via Calmara.ai; photo illustration by Los Angeles Times)
But the site failed to recognize some textbook images of sexually transmitted infections, including a chancroid ulcer and a case of syphilis so pronounced the foreskin was no longer able to retract.
Calmara’s AI frequently inaccurately identified naturally occurring, non-pathological penile bumps as signs of infection, flagging multiple images of disease-free organs as “something sus.”
It also struggled to distinguish between inanimate objects and human genitals, issuing a cheery “Clear!” to images of both a novelty penis-shaped vase and a penis-shaped cake.
“There are so many things wrong with this app that I don’t even know where to begin,” said Dr. Ina Park, a UC San Francisco professor who serves as a medical consultant for the CDC’s Division of STD Prevention. “With any tests you’re doing for STIs, there is always the possibility of false negatives and false positives. The issue with this app is that it appears to be rife with both.”
Dr. Jeffrey Klausner, an infectious-disease specialist at USC’s Keck School of Medicine and a scientific adviser to HeHealth, acknowledged that Calmara “can’t be promoted as a screening test.”
“To get screened for STIs, you’ve got to get a blood test. You have to get a urine test,” he said. “Having someone look at a penis, or having a digital assistant look at a penis, is not going to be able to detect HIV, syphilis, chlamydia, gonorrhea. Even most cases of herpes are asymptomatic.”
Calmara, he said, is “a very different thing” from HeHealth’s signature product, a paid service that scans images a user submits of his own penis and flags anything that merits follow-up with a healthcare provider.
Klausner did not respond to requests for additional comment about the app’s accuracy.
Both HeHealth and Calmara use the same underlying AI, though the two sites “may have differences at identifying issues of concern,” co-founder and CEO Dr. Yudara Kularathne said.
“Powered by patented HeHealth wizardry (think an AI so sharp you’d think it aced its SATs), our AI’s been battle-tested by over 40,000 users,” Calmara’s website reads, before noting that its accuracy ranges from 65% to 96%.
“It’s great that they disclose that, but 65% is terrible,” said Dr. Sean Young, a UCI professor of emergency medicine and executive director of the University of California Institute for Prediction Technology. “From a public health perspective, if you’re giving people 65% accuracy, why even tell anyone anything? That’s potentially more harmful than beneficial.”
Kularathne said the accuracy range “highlights the complexity of detecting STIs and other visible conditions on the penis, each with its unique characteristics and challenges.” He added: “It’s important to understand that this is just the starting point for Calmara. As we refine our AI with more insights, we expect these figures to improve.”
On HeHealth’s website, Kularathne says he was inspired to start the company after a friend became suicidal after “an STI scare magnified by online misinformation.”
“Numerous physiological conditions are often mistaken for STIs, and our technology can provide peace of mind in these situations,” Kularathne posted Tuesday on LinkedIn. “Our technology aims to bring clarity to young people, especially Gen Z.”
Calmara’s AI also mistook some physiological conditions for STIs.
The Times uploaded a number of images onto the site that were posted on a medical website as examples of non-communicable, non-pathological anatomical variations in the human penis that are sometimes confused with STIs, including skin tags, visible sebaceous glands and enlarged capillaries.
Calmara identified each one as “something sus.”
Such inaccurate information could have exactly the opposite effect on young users than the “clarity” its founders intend, said Dr. Joni Roberts, an assistant professor at Cal Poly San Luis Obispo who runs the campus’s Sexual and Reproductive Health Lab.
“If I am 18 years old, I take a picture of something that is a normal occurrence as part of the human body, [and] I get this that says that it’s ‘sus’? Now I’m stressing out,” Roberts said.
“We already know that mental health [issues are] extremely high in this population. Social media has run havoc on people’s self image, worth, depression, et cetera,” she said. “Saying something is ‘sus’ without providing any information is problematic.”
Kularathne defended the site’s choice of language. “The phrase ‘something sus’ is deliberately chosen to indicate ambiguity and suggest the need for further investigation,” he wrote in an email. “It’s a prompt for users to seek professional advice, fostering a culture of caution and responsibility.”
Still, “the misidentification of healthy anatomy as ‘something sus’ if that happens, is indeed not the outcome we aim for,” he wrote.
Users whose photos are issued a “Hold” notice are directed to HeHealth where, for a fee, they can submit additional photos of their penis for further scanning.
Those who get a “Clear” are told “No visible signs of STIs spotted for now . . . But this isn’t an all-clear for STIs,” noting, correctly, that many sexually transmitted conditions are asymptomatic and invisible. Users who click through Calmara’s FAQs will also find a disclaimer that a “Clear!” notification “doesn’t mean you can skimp on further checks.”
Young raised concerns that some people might use the app to make immediate decisions about their sexual health.
“There’s more ethical obligations to be able to be transparent and clear about your data and practices, and to not use the typical startup approaches that a lot of other companies will use in non-health spaces,” he said.
In its current form, he said, Calmara “has the potential to further stigmatize not only STIs, but to further stigmatize digital health by giving inaccurate diagnoses and having people make claims that every digital health tool or app is just a big sham.”
HeHealth.ai has raised about $1.1 million since its founding in 2019, co-founder Mei-Ling Lu said. The company is currently seeking another $1.5 million from investors, according to PitchBook.
Medical experts interviewed for this article said that technology can and should be used to reduce barriers to sexual healthcare. Providers including Planned Parenthood and the Mayo Clinic are using AI tools to share vetted information with their patients, said Mara Decker, a UC San Francisco epidemiologist who studies sexual health education and digital technology.
But when it comes to Calmara’s approach, “I basically can see only negatives and no benefits,” Decker said. “They could just as easily replace their app with a sign that says, ‘If you have a rash or noticeable sore, go get tested.’”
Science
49ers coach Kyle Shanahan shows performance-enhancing smelling salts aren’t just for players
Football leans on tradition, providing convenient cover for the NFL’s lenient stance on smelling salts, ammonia crystals that players believe enhance performance when inhaled.
Does the olfactory exhilaration also enhance play-calling, amplifying one’s grasp of X’s and O’s?
Kyle Shanahan apparently believes so.
The San Francisco 49ers coach was caught by a Fox television camera moments before a playoff game Sunday against the Philadelphia Eagles taking several whiffs from a small packet before handing it to an assistant.
Earlier this season, the San Francisco Chronicle reported that 49ers players created a system to make sure everyone has immediate access to smelling salts during games. General manager John Lynch and Shanahan are users, according to the story, which stated that Shanahan “isn’t opposed to the occasional whiff.”
Is the NFL OK with this? The answer is a qualified yes.
Ahead of the 2025 season, the league’s head, neck and spine committee recommended that teams end the longtime practice of providing smelling salts to players. The decision was prompted by a U.S. Food and Drug Administration warning about the potential side effects of inhaling ammonia, which include lung damage and masking signs of a concussion.
Players all but panicked. George Kittle, the 49ers All-Pro tight end, jumped on an NFL Network broadcast to proclaim that smelling salts were crucial to his performance.
“I’m a regular user of smelling salts, taking them for a boost of energy before every offensive drive,” he said. “We have got to figure out a middle ground here, guys. Somebody help me out.”
The NFL came to his rescue, saying smelling salts — also known as ammonia inhalants, or AIs — were not banned. Teams could no longer provide them, but players could bring their own. It’s a compromise that may or may not pass the smell test. Either way, it’s not just the 49ers using them.
An ESPN Magazine piece in 2017 reported that “just a few minutes into the game, the Cowboys have discarded so many capsules that the area in front of their bench looks like the floor of a kid’s bedroom after trick-or-treating.”
Bottom line, legions of NFL players believe AIs enhance performance. They do so by irritating the linings of the nose and lungs, triggering a reflex that increases breathing rate and blood flow, fostering alertness.
Their effectiveness was discovered long before football was invented. Craft beer drinkers know Pliny the Elder as the inspiration for his namesake double IPA. The noted Roman naturalist and historian was indeed an early expert in fermentation, yet he also wrote about “sal ammoniac” — yes, smelling salts — in his encyclopedic work “Natural History,” published in 79 A.D.
Their popularity spread through Europe until, in Victorian tradition, they were used to rouse ladies after fainting spells. Later they were used in battle, with British medics supplying World War II soldiers with a whiff of the substance that doctors say triggers the body’s “fight-or-flight” response.
These days, the Federal Aviation Administration requires that U.S. airlines carry smelling salts onboard in case a pilot needs to be awakened after fainting. Blocking and tackling on a flight, however, remains strictly forbidden.
The NFL’s middling position isn’t curious. Experts say it’s an attempt to reduce liability in case of concussions or other medical complications. But it is their constant use that concerns doctors.
“The use of smelling salts in sports is definitely not their intended use,” Dr. Laura Boxley, a neuropsychologist at Ohio State’s Wexner Medical Center, told NPR. “What’s happening with some athletes is they’re using them with much higher frequency than their intended use.”
Given the relative safety of the sidelines, Shanahan isn’t in danger of a brain-rattling concussion. Shortly after the NFL ceased supplying AIs, he was asked by a reporter whether he had concerns about their prevalence.
“I mean, I don’t,” Shanahan replied with a grin. “If someone gives me one, I’ll take a smell of the salt. I’m not too worried about it. I like to take one to wake myself up and lock myself in.”
Science
AI windfall helps California narrow projected $3-billion budget deficit
SACRAMENTO — California and its state-funded programs are heading into a period of volatile fiscal uncertainty, driven largely by events in Washington and on Wall Street.
Gov. Gavin Newsom’s budget chief warned Friday that surging revenues tied to the artificial intelligence boom are being offset by rising costs and federal funding cuts. The result: a projected $3-billion state deficit for the next fiscal year despite no major new spending initiatives.
The Newsom administration on Friday released its proposed $348.9-billion budget for the fiscal year that begins July 1, formally launching negotiations with the Legislature over spending priorities and policy goals.
“This budget reflects both confidence and caution,” Newsom said in a statement. “California’s economy is strong, revenues are outperforming expectations, and our fiscal position is stable because of years of prudent fiscal management — but we remain disciplined and focused on sustaining progress, not overextending it.”
Newsom’s proposed budget did not include funding to backfill the massive cuts to Medicaid and other public assistance programs by President Trump and the Republican-led Congress, changes expected to lead to millions of low-income Californians losing healthcare coverage and other benefits.
“If the state doesn’t step up, communities across California will crumble,” California State Assn. of Counties Chief Executive Graham Knaus said in a statement.
The governor is expected to revise the plan in May using updated revenue projections after the income tax filing deadline, with lawmakers required to approve a final budget by June 15.
Newsom did not attend the budget presentation Friday, which was out of the ordinary, instead opting to have California Director of Finance Joe Stephenshaw field questions about the governor’s spending plan.
“Without having significant increases of spending, there also are no significant reductions or cuts to programs in the budget,” Stephenshaw said, noting that the proposal is a work in progress.
California has an unusually volatile revenue system — one that relies heavily on personal income taxes from high-earning residents whose capital gains rise and fall sharply with the stock market.
Entering state budget negotiations, many expected to see significant belt tightening after the nonpartisan Legislative Analyst’s Office warned in November that California faces a nearly $18-billion budget shortfall. The governor’s office and Department of Finance do not always agree, or use the LAO’s estimates.
On Friday, the Newsom administration said it is projecting a much smaller deficit — about $3 billion — after assuming higher revenues over the next three fiscal years than were forecast last year. The gap between the governor’s estimate and the LAO’s projection largely reflects differing assumptions about risk: The LAO factored in the possibility of a major stock market downturn.
“We do not do that,” Stephenshaw said.
Among the key areas in the budget:
Science
California confirms first measles case for 2026 in San Mateo County as vaccination debates continue
Barely more than a week into the new year, the California Department of Public Health confirmed its first measles case of 2026.
The diagnosis came from San Mateo County, where an unvaccinated adult likely contracted the virus from recent international travel, according to Preston Merchant, a San Mateo County Health spokesperson.
Measles is one of the most infectious viruses in the world, and can remain in the air for two hours after an infected person leaves, according to the CDPH. Although the U.S. announced it had eliminated measles in 2000, meaning there had been no reported infections of the disease in 12 months, measles have since returned.
Last year, the U.S. reported about 2,000 cases, the highest reported count since 1992, according to CDC data.
“Right now, our best strategy to avoid spread is contact tracing, so reaching out to everybody that came in contact with this person,” Merchant said. “So far, they have no reported symptoms. We’re assuming that this is the first [California] measles case of the year.”
San Mateo County also reported an unvaccinated child’s death from influenza this week.
Across the country, measles outbreaks are spreading. Today, the South Carolina State Department of Public Health confirmed the state’s outbreak had reached 310 cases. The number has been steadily rising since an initial infection in July spread across the state and is now reported to be connected with infections in North Carolina and Washington.
Similarly to San Mateo’s case, the first reported infection in South Carolina came from an unvaccinated person who was exposed to measles while traveling internationally.
At the border of Utah and Arizona, a separate measles outbreak has reached 390 cases, stemming from schools and pediatric centers, according to the Utah Department of Health and Human Services.
Canada, another long-standing “measles-free” nation, lost ground in its battle with measles in November. The Public Health Agency of Canada announced that the nation is battling a “large, multi-jurisdictional” measles outbreak that began in October 2024.
If American measles cases follow last year’s pattern, the United States is facing losing its measles elimination status next.
For a country to lose measles-free status, reported outbreaks must be of the same locally spread strain, as was the case in Canada. As many cases in the United States were initially connected to international travel, the U.S. has been able to hold on to the status. However, as outbreaks with American-origin cases continue, this pattern could lead the Pan American Health Organization to change the country’s status.
In the first year of the Trump administration, officials led by Health Secretary Robert F. Kennedy Jr. have promoted lowering vaccine mandates and reducing funding for health research.
In December, Trump’s presidential memorandum led to this week’s reduced recommended childhood vaccines; in June, Kennedy fired an entire CDC vaccine advisory committee, replacing members with multiple vaccine skeptics.
Experts are concerned that recent debates over vaccine mandates in the White House will shake the public’s confidence in the effectiveness of vaccines.
“Viruses and bacteria that were under control are being set free on our most vulnerable,” Dr. James Alwine, a virologist and member of the nonprofit advocacy group Defend Public Health, said to The Times.
According to the CDPH, the measles vaccine provides 97% protection against measles in two doses.
Common symptoms of measles include cough, runny nose, pink eye and rash. The virus is spread through breathing, coughing or talking, according to the CDPH.
Measles often leads to hospitalization and, for some, can be fatal.
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