The author of this title contributed several quality ideas for the cover, including the idea of using a grapefruit, which we ended up landing on. The inside of a grapefruit resembles the rash in Lyme disease (if you squint a little) and it also relates to the queer aspect of this work, as fruit is often used to represent the "forbidden fruit" of the "sin" of being queer in religious contexts. There were several other covers created that we didn't end up using and I've included my favorites below. 

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As for the lettering, I wanted the text on the cover to be designed by someone queer. Finding a lack of queer typeface designers and honoring the letter aspect, I asked a queer roommate to use her own handwriting. (My handwriting is not nice enough, otherwise I would have done it myself, as a queer designer.)

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For this title I designed the cover, a postcard, a web banner, and the full interior. I've also included two covers that were not chosen as well as the  the logo for the series this book is in, the Walt McDonald First-Book Prize, redesigned by me around the same time as this project.