HIV and ID Observations

September 10th, 2025

When Required Learning Modules Surprise You (In a Good Way)

Like most clinicians, I have a checkered history with required online learning modules. You know the drill: click play, get lectured in monotone about hand hygiene or fire safety, then spend the next 8 minutes desperately searching for the fast-forward button, hoping it’s not disabled. My personal low point (or high point, depending on your […]

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September 4th, 2025

End-of-Summer Musings — Hepatitis B, Dalbavancin, Alpha-Gal, and More

The last time I did one of these quick “musings” posts, I listed 21, and someone asked me, “Why 21?” The answer — obviously — is that I originally planned on writing 20, but then had to add a 21st, just because that’s exactly how many points you need to win a ping pong game. […]

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August 29th, 2025

Watching the Chaos at the CDC — with Sadness and Alarm

Throughout my career as an infectious diseases doctor, the CDC has been a rock-solid source. Need reliable data on an outbreak? The CDC. Need thoughtful, evidence-based guidelines? The CDC. Need an authoritative reference for a consult question or to steer a colleague or trainee to the right place? The CDC. Need the latest, most accurate […]

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August 16th, 2025

Anal Cancer Screening in HIV: When Guidelines Get Ahead of the Evidence

Should every person with HIV over age 35 (if MSM or transgender woman) or 45 (everyone else) have an anal Pap smear, a digital anal rectal exam (DARE), and possibly a high-resolution anoscopy every 1–2 years? According to recent guidelines, yes. But here’s the problem: we don’t know if this screening effort actually prevents cancer. […]

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August 6th, 2025

Does the Fact That AI Is Brilliant at Writing “Learning Objectives” Prove They’re Not Really Needed?

Recently, I was invited to speak at a primary care conference on a terrific topic: “Can’t Miss Diagnoses in ID for the PCP.” Love it. So many great examples come to mind — endocarditis, Lemierre syndrome, vertebral osteomyelitis, acute HIV. A wonderful opportunity to teach about the “rare but there” diagnoses hidden among everyday outpatient […]

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August 2nd, 2025

The Short Political Half-life of a Medical Contrarian

In early May, I wrote about the surprising FDA appointment of Dr. Vinay Prasad to lead the FDA’s Center for Biologics Evaluation and Research.  Prasad is a UCSF hematologist-oncologist known for his views on COVID-19, oncology clinical trials, and his sometimes sharp-elbowed communication style, in particular directed at people with whom he disagrees. My goal was […]

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July 25th, 2025

Who Gets Sent to ID Clinic? A Field Guide to Outpatient Referrals

Sometimes people ask me what kind of cases get referred to ID doctors in the outpatient setting. Despite what the latest television series might suggest, it’s rarely suspected Ebola (fortunately) or Tsutsugamushi fever — a disease that is much more fun to say by its Japanese name than its common one, scrub typhus. (In Japanese, “tsutsuga” […]

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July 17th, 2025

Ceftriaxone Is a Narrow Antibiotic Now — and Other Musings

In no particular order, 20 things I’ve found interesting lately — a mix of ID (mostly), language quirks, clinical stuff, even tennis, and an apology (#21) at the very end. Bonus videos embedded because we all need a break. 1. Isn’t it amazing how, over time, an antibiotic once considered “broad spectrum” later becomes the […]

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July 12th, 2025

The Patient Did Well — So the Insurance Company Won’t Pay

Sometimes, you can predict a bad outcome. Examples: Proposing marriage after an awkward first date — and doing so over gas station nachos. Moving to a Cambridge apartment with no off-street parking, then buying a Tesla Cybertruck. Trying to recruit for ID fellowships from a group of cosmetic dermatologists. But predicting what happens in clinical […]

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July 7th, 2025

Two Pandemics, Compared: Reflections on HIV and COVID-19

“Dr. Sax, what’s it like to have lived through two pandemics as an ID doctor?” The question came from a brand-new intern during afternoon sign-out. I took a breath — because wow, were they different. HIV: It Felt Like A Calling, One Miraculously Rewarded I started my internship in 1987, six years after the first […]

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