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.
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
Cluster of farmworkers diagnosed with rare animal-borne disease in Ventura County
A cluster of workers at Ventura County berry farms have been diagnosed with a rare disease often transmitted through sick animals’ urine, according to a public health advisory distributed to local doctors by county health officials Tuesday.
The bacterial infection, leptospirosis, has resulted in severe symptoms for some workers, including meningitis, an inflammation of the brain lining and spinal cord. Symptoms for mild cases included headaches and fevers.
The disease, which can be fatal, rarely spreads from human to human, according to the U.S. Centers for Disease Control and Prevention.
Ventura County Public Health has not given an official case count but said it had not identified any cases outside of the agriculture sector. The county’s agriculture commissioner was aware of 18 cases, the Ventura County Star reported.
The health department said it was first contacted by a local physician in October, who reported an unusual trend in symptoms among hospital patients.
After launching an investigation, the department identified leptospirosis as a probable cause of the illness and found most patients worked on caneberry farms that utilize hoop houses — greenhouse structures to shelter the crops.
As the investigation to identify any additional cases and the exact sources of exposure continues, Ventura County Public Health has asked healthcare providers to consider a leptospirosis diagnosis for sick agricultural workers, particularly berry harvesters.
Rodents are a common source and transmitter of disease, though other mammals — including livestock, cats and dogs — can transmit it as well.
The disease is spread through bodily fluids, such as urine, and is often contracted through cuts and abrasions that contact contaminated water and soil, where the bacteria can survive for months.
Humans can also contract the illness through contaminated food; however, the county health agency has found no known health risks to the general public, including through the contact or consumption of caneberries such as raspberries and blackberries.
Symptom onset typically occurs between two and 30 days after exposure, and symptoms can last for months if untreated, according to the CDC.
The illness often begins with mild symptoms, with fevers, chills, vomiting and headaches. Some cases can then enter a second, more severe phase that can result in kidney or liver failure.
Ventura County Public Health recommends agriculture and berry harvesters regularly rinse any cuts with soap and water and cover them with bandages. They also recommend wearing waterproof clothing and protection while working outdoors, including gloves and long-sleeve shirts and pants.
While there is no evidence of spread to the larger community, according to the department, residents should wash hands frequently and work to control rodents around their property if possible.
Pet owners can consult a veterinarian about leptospirosis vaccinations and should keep pets away from ponds, lakes and other natural bodies of water.
Science
Political stress: Can you stay engaged without sacrificing your mental health?
It’s been two weeks since Donald Trump won the presidential election, but Stacey Lamirand’s brain hasn’t stopped churning.
“I still think about the election all the time,” said the 60-year-old Bay Area resident, who wanted a Kamala Harris victory so badly that she flew to Pennsylvania and knocked on voters’ doors in the final days of the campaign. “I honestly don’t know what to do about that.”
Neither do the psychologists and political scientists who have been tracking the country’s slide toward toxic levels of partisanship.
Fully 69% of U.S. adults found the presidential election a significant source of stress in their lives, the American Psychological Assn. said in its latest Stress in America report.
The distress was present across the political spectrum, with 80% of Republicans, 79% of Democrats and 73% of independents surveyed saying they were stressed about the country’s future.
That’s unhealthy for the body politic — and for voters themselves. Stress can cause muscle tension, headaches, sleep problems and loss of appetite. Chronic stress can inflict more serious damage to the immune system and make people more vulnerable to heart attacks, strokes, diabetes, infertility, clinical anxiety, depression and other ailments.
In most circumstances, the sound medical advice is to disengage from the source of stress, therapists said. But when stress is coming from politics, that prescription pits the health of the individual against the health of the nation.
“I’m worried about people totally withdrawing from politics because it’s unpleasant,” said Aaron Weinschenk, a political scientist at the University of Wisconsin–Green Bay who studies political behavior and elections. “We don’t want them to do that. But we also don’t want them to feel sick.”
Modern life is full of stressors of all kinds: paying bills, pleasing difficult bosses, getting along with frenemies, caring for children or aging parents (or both).
The stress that stems from politics isn’t fundamentally different from other kinds of stress. What’s unique about it is the way it encompasses and enhances other sources of stress, said Brett Ford, a social psychologist at the University of Toronto who studies the link between emotions and political engagement.
For instance, she said, elections have the potential to make everyday stressors like money and health concerns more difficult to manage as candidates debate policies that could raise the price of gas or cut off access to certain kinds of medical care.
Layered on top of that is the fact that political disagreements have morphed into moral conflicts that are perceived as pitting good against evil.
“When someone comes into power who is not on the same page as you morally, that can hit very deeply,” Ford said.
Partisanship and polarization have raised the stakes as well. Voters who feel a strong connection to a political party become more invested in its success. That can make a loss at the ballot box feel like a personal defeat, she said.
There’s also the fact that we have limited control over the outcome of an election. A patient with heart disease can improve their prognosis by taking medicine, changing their diet, getting more exercise or quitting smoking. But a person with political stress is largely at the mercy of others.
“Politics is many forms of stress all rolled into one,” Ford said.
Weinschenk observed this firsthand the day after the election.
“I could feel it when I went into my classroom,” said the professor, whose research has found that people with political anxiety aren’t necessarily anxious in general. “I have a student who’s transgender and a couple of students who are gay. Their emotional state was so closed down.”
That’s almost to be expected in a place like Wisconsin, whose swing-state status caused residents to be bombarded with political messages. The more campaign ads a person is exposed to, the greater the risk of being diagnosed with anxiety, depression or another psychological ailment, according to a 2022 study in the journal PLOS One.
Political messages seem designed to keep voters “emotionally on edge,” said Vaile Wright, a licensed psychologist in Villa Park, Ill., and a member of the APA’s Stress in America team.
“It encourages emotion to drive our decision-making behavior, as opposed to logic,” Wright said. “When we’re really emotionally stimulated, it makes it so much more challenging to have civil conversation. For politicians, I think that’s powerful, because emotions can be very easily manipulated.”
Making voters feel anxious is a tried-and-true way to grab their attention, said Christopher Ojeda, a political scientist at UC Merced who studies mental health and politics.
“Feelings of anxiety can be mobilizing, definitely,” he said. “That’s why politicians make fear appeals — they want people to get engaged.”
On the other hand, “feelings of depression are demobilizing and take you out of the political system,” said Ojeda, author of “The Sad Citizen: How Politics is Depressing and Why it Matters.”
“What [these feelings] can tell you is, ‘Things aren’t going the way I want them to. Maybe I need to step back,’” he said.
Genessa Krasnow has been seeing a lot of that since the election.
The Seattle entrepreneur, who also campaigned for Harris, said it grates on her to see people laughing in restaurants “as if nothing had happened.” At a recent book club meeting, her fellow group members were willing to let her vent about politics for five minutes, but they weren’t interested in discussing ways they could counteract the incoming president.
“They’re in a state of disengagement,” said Krasnow, who is 56. She, meanwhile, is looking for new ways to reach young voters.
“I am exhausted. I am so sad,” she said. “But I don’t believe that disengaging is the answer.”
That’s the fundamental trade-off, Ojeda said, and there’s no one-size-fits-all solution.
“Everyone has to make a decision about how much engagement they can tolerate without undermining their psychological well-being,” he said.
Lamirand took steps to protect her mental health by cutting social media ties with people whose values aren’t aligned with hers. But she will remain politically active and expects to volunteer for phone-banking duty soon.
“Doing something is the only thing that allows me to feel better,” Lamirand said. “It allows me to feel some level of control.”
Ideally, Ford said, people would not have to choose between being politically active and preserving their mental health. She is investigating ways to help people feel hopeful, inspired and compassionate about political challenges, since these emotions can motivate action without triggering stress and anxiety.
“We want to counteract this pattern where the more involved you are, the worse you are,” Ford said.
The benefits would be felt across the political spectrum. In the APA survey, similar shares of Democrats, Republicans and independents agreed with statements like, “It causes me stress that politicians aren’t talking about the things that are most important to me,” and, “The political climate has caused strain between my family members and me.”
“Both sides are very invested in this country, and that is a good thing,” Wright said. “Antipathy and hopelessness really doesn’t serve us in the long run.”
Science
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