Image-based screening app looks for STIs, finds controversy

“Pics vanish quicker than Snapchat. So yeah, your secrets? They’re locked in our crypt, no trace, no trail.”

This is some of the copy behind sexual health startup HeHealth’s newly-launched, AI-enabled penis picture diagnostic platform, Calmara. Yes, you read that right.

Their claim? 

“Dating app users can now use AI to weed out daters with STI,” the HeHealth blog declares.

We’re all for STI diagnosis and prevention. Just recently, we discussed how medtech innovations are fighting STI stigma.

But is this app too good to be true? Some critics say yes.

Illustration by Mary Delaney
Illustration by Mary Delaney

How does the Calmara app work?

HeHealth hopes their product can help users keep their health in mind more easily, even in “the heat of the moment.”

They’re specifically aiming to improve health risk assessment in casual sexual encounters. 

“One story that stood out to us was when a urologist friend couldn't recognize HPV warts on her casual partner and had to consult her textbooks,” the HeHealth blog about Calmara reads. “If a medical expert struggled, how can we expect young women without medical knowledge to understand sexual health risks? This highlights the common challenge many women face in identifying and comprehending STIs.”

The original HeHealth platform was designed for men—hence the “He.” Users could upload images of their own genitalia for STI symptom identification.

HeHealth claims its algorithm can detect STIs just from a picture of the user’s genitals—much like the algorithms revolutionizing diagnostics in radiology, eye health, or skin cancer detection.

However, HeHealth noticed a lot of their users were actually women, but the platform wasn’t designed for their specific needs. Enter: Calmara.

The app is designed to be used by a woman engaging in a sexual encounter with a male partner. Before getting started, both parties would consent to using Calmara. Then, the users take a picture of the penis and wait for results in 60 seconds.

The Calmara site boasts a 94.4% accuracy rate for a broad spectrum of visual issues. But that’s the key—symptoms need to be visible on camera for the app to identify a possible STI.

To this concern, Calmara’s FAQ section responds: “It's like your first line of defense, not the whole security system. We’re solid at identifying visual cues that might spell out certain STIs, but we can't detect everything, especially not HIV, secondary, tertiary, or latent syphilis, chlamydia, gonorrhea, or trichomonas. Safe sex is still the best policy.”

Not so fast: Privacy and effectiveness concerns

Calmara is getting out ahead of effectiveness criticisms. At least on their site, they encourage users to still practice safe, protected sex. Their technology can’t root out all STIs.

However, this may be understandably worrisome for users who don’t read the fine print. 

STIs are often asymptomatic, so a picture of genitals without detectable physical symptoms may be screened as “clear,” giving users a false sense of security.

This is reminiscent of how we’ve benefitted from—but struggled to communicate the effectiveness of—rapid COVID-19 tests. These are highly specific tests: they’re unlikely to produce a false positive. However, they’re not as highly sensitive: false negatives happen, so it’s still important to take extra precautions.

Plus, neither HeHealth nor Calmara have been cleared by the FDA as a medical test. They’re a wellness digital app, which leaves them in a regulatory gray area that many users might not be aware of. The only public data on the app’s effectiveness is a preprint that has yet to be peer-reviewed.

Another concern raised about Calmara is HeHealth’s privacy claims.

Patient advocates and privacy experts are criticizing HeHealth for its lack of robust protections against nonconsensual pictures or use of the app by minors. The prompt that asks users if they’re over 18 is easy to click past.

It’s wonderful that the app may help users evaluate their sexual health if they’re hesitant or unable to visit a doctor. But it leaves them in murky territory privacy-wise by managing it themselves with the use of an app.

Calmara’s team has already gotten into hot water on their image privacy claims when journalists caught wind of their privacy policy, noting that user information is shared with “service providers and partners who assist in service operation.”

Our perspective: A need for regulation and further conversation

Overall, it’s so challenging to balance the potential benefits of getting an easy-to-use, stigma-reducing product easily into users' hands with the potential harms of delivering potentially ineffective and counseling-free STI diagnostics without solid privacy protections.

We see the vision, but this case study highlights the dangers of regulatory gray areas with AI-enabled products—especially those with lifestyle or wellness designations.

We do hope that patients benefit from tools like Calmara—in that it empowers them to seek out more resources on sexual health. Even if products like this stoke controversy, at least it gets stigmatized health concerns and the surrounding innovation into the conversation.

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