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PubMed2000

Men with coronary artery disease have lower levels of androgens than men with normal coronary angiograms.

AIMS: High androgen levels are presumed by many to explain the male predisposition to coronary artery disease. However, natural androgens inhibit male atherosclerosis(1). Our aim was to determine whether levels of androgens differ between men with and without coronary artery disease. METHODS AND RESULTS: Ninety male subjects (60 with positive, and 30 with negative coronary angiograms) were recruited. Early morning, fasting blood samples were taken from each patient and free, total and bioavailable testosterone, sex hormone binding globulin, oestradiol, and lipids were measured. Bioavailable testosterone was assayed using a modified technique. Free androgen index was calculated. Men with coronary artery disease had significantly lower levels of free testosterone (mean (standard deviation)); 47.95 (13.77) vs 59.87 (26. 05) pmol. l(-1), P=0.027), bioavailable testosterone; 2.55 (0.77) vs 3.26 (1.18) nmol. l(-1), P=0.005 and free androgen index; 37.8 (10. 4) vs 48.47 (18.3), P=0.005, than controls. After controlling for differences in age and body mass index the differences in free androgen index and bioavailable testosterone remained statistically significant (P=0.008 and P=0.013, respectively). CONCLUSION: Men with coronary artery disease have significantly lower levels of androgens than normal controls, challenging the preconception that physiologically high levels of androgens in men account for their increased relative risk for coronary artery disease.

Adult↗
PubMed1992

Serum levels of steroid hormones in men with varicocele and oligospermia as compared to normozoospermic men.

In order to assess the contribution of individual steroidogenic organs to over-all steroid biosynthesis, the basal plasma levels of six hormonal steroids, reflecting the function of gonads and adrenals, as well as both gonadotropins and prolactin, have been determined in 63 oligo- and/or asthenozoospermic men with palpable varicocele, confirmed in each case by sonography. The values obtained were compared with the results of a group of age-matched normospermic men without endocrine disorders. Insignificantly lower levels of testosterone accompanied by significantly lower levels of dihydrotestosterone, slightly decreased LH but increased FSH undistinguishable concentrations of cortisol in patients with varicocele were in agreement with previous findings. Higher levels of an exclusively adrenal androgen 11 beta-hydroxyandrostenedione in men with varicocele indicate increased activity of the adrenal cortex. Significantly higher basal levels of 17 alpha-hydroxyprogesterone in the patient group (p < 0.001), so far not unequivocally proved, evidence for suggested decreased enzyme activity of C17-20 lyase in the testis in at least some of men with varicocele.

17-alpha-Hydroxyprogesterone↗
PubMed2006

Screening for chlamydia and gonorrhoea in men who have sex with men in clinical and non-clinical settings.

BACKGROUND: There are few published data on the rate of chlamydia and gonorrhoea infection in men who have sex with men (MSM). Our aim was to determine the rate of positive chlamydia and gonorrhoea tests in this population in the Australian Capital Territory (ACT). METHODS: Results of all chlamydia and gonorrhoea tests generated by Canberra Sexual Health Centre between June 2001 and September 2003, including those from outreach clinics, were reviewed (audit one). Between September 2003 and April 2004, Canberra Sexual Health Centre outreach program staff and a general practitioner with a high caseload of MSM offered screening of the throat, urethra and rectum to all MSM, irrespective of their reported participation in unprotected anal intercourse. Chlamydia and gonorrhoea test results generated during this period were reviewed (audit two). RESULTS: In the first audit, 1086 specimens from 314 individuals were tested and 30/314 (9.6%, 95% CI 6.6-13.4) men were positive for chlamydia in one or more anatomical site. A total of 306 specimens from 118 individuals were tested for gonorrhoea. Of these, eight (6.8%, 95% CI 3.0-12.9) individuals tested positive. In the second audit, 16 of 157 men (10.2%, 95% CI 9.5-16.0) tested positive for chlamydia and 4/155 (2.6%, 95% CI 0.7-6.5) tested positive for gonorrhoea. The rectum was the most commonly infected anatomical site for both infections. The overall proportions of positive chlamydia and gonorrhoea tests were 36/471 (7.6%, 95% CI 5.4-10.4) and 12/273 (4.4%, 95% CI 2.2-7.6) respectively. CONCLUSIONS: These data, collected in a range of settings, indicate high rates of chlamydia and gonorrhoea in MSM in the ACT and provide support for annual testing, particularly of the rectum, in this population.

Adolescent↗
PubMed2004

The impact of alcohol use on the sexual scripts of HIV-positive men who have sex with men.

The literature on alcohol use has failed to form a consensus on the association between alcohol use and unsafe sex among samples of men who have sex with men (MSM). Although drinking behavior may not be causally related to unsafe sex, it is possible that alcohol use plays a role in sexual scripts. In this paper, we assessed the role that alcohol use plays in the sexual experiences of HIV-seropositive MSM in terms of sexual script theory. An ethnically diverse sample (81% men of color) of HIV-positive MSM with alcohol use disorders from the New York City metropolitan area was recruited from a variety of settings frequented by such men. A critical incident measure was used to qualitatively assess contextual issues regarding participants' most recent incident of unsafe sex while under the influence of alcohol. Qualitative analysis revealed three basic sexual scripts involving alcohol: routine, spontaneous, and taboo. Each script had its own sources of risk for unsafe sex. Interventions targeting alcohol use and unsafe sex should be sensitive to the role that alcohol plays in the sexual scripts of HIV-positive MSM.

Adult↗
PubMed1988

Zinc in sperm chromatin and chromatin stability in fertile men and men in barren unions.

The stability and the content of zinc of the chromatin were studied in spermatozoa from ten men with unexplained infertility, and in spermatozoa from five fertile donors. A positive relation was found between zinc in sperm nuclei (X-ray microanalysis) and the resistance of the chromatin to decondense in sodium dodecylsulfate (SDS). The infertile men had lower degree of sperm chromatin stability and lower sperm zinc content than the fertile donors. A subgroup of the infertile men, which all had minor clinical signs of prostatic inflammatory reaction, had the lowest content of zinc in the chromatin and the lowest degree of chromatin stability. A low content of nuclear zinc would impair the structural stability of the chromatin and thereby increase the vulnerability of the male genome. This mechanism may be one explanation for the reduced fertility of the men with minor inflammation of the prostate.

Chromatin↗
PubMedDate not supplied

Anodyspareunia in men who have sex with men: prevalence, predictors, consequences and the development of DSM diagnostic criteria.

In a sample of men who have sex with men (N = 404), 55 (14%) experienced anodyspareunia, frequent and severe pain during receptive anal sex. Most men with anodyspareunia described their pain as life-long, experienced psychological distress as a result, and avoided anal sex for periods of time. Men with anodyspareunia reported that psychological factors were the primary contributing cause of their pain. The findings contradict the myth that pain is a necessary consequence of receptive anal sex and show that anodyspareunia is similar to dyspareunia in women in terms of prevalence, mental health consequences, and contributing factors. Clinical criteria were developed to assist clinicians in diagnosing anodyspareunia.

Adult↗
PubMed1991

A case-control study of dietary carotene in men with lung cancer and in men with other epithelial cancers.

Dietary carotene intake during the year before diagnosis was estimated for 96 men with lung cancer, 75 men with other epithelial cancers, and 97 hospital controls. Relative to those of men in the lowest third of carotene intake (less than 1,683 micrograms/day), the smoking-adjusted odds ratios for men in the middle (1,683-2,698 micrograms/day) and upper (greater than 2,698 micrograms/day) thirds of carotene intake were 0.67 and 0.45, respectively, for lung cancer (one-sided test for trend, p = 0.048) and 0.63 and 0.65, respectively, for other epithelial cancers (one-sided test for trend p = 0.074). The protective effect of estimated dietary carotene intake was considerably stronger than was the effect of total intake of carotene-rich vegetables and fruits (grams per day), providing some evidence that the protective factor is carotene itself rather than another component of vegetables and fruits.

Aged↗
PubMed2005

Sexual risk behaviors and substance use among alcohol abusing HIV-positive men who have sex with men.

An ethnically diverse sample (79.0% men of color) of HIV seropositive (HIV+) men who have sex with men (MSM) with alcohol use disorders from the New York City metropolitan area was recruited from a variety of settings frequented by such men. Data were collected using quantitative assessments and calendar based techniques at the baseline assessment of a longitudinal study assessing the relationship between alcohol and substance use and sexual risk behaviors as well as alcohol use and HIV disease progression. Data were selected on a sample of 253 HIV+ MSM (mean age = 38.55, SD = 6.73). Of these, the majority of participants (80.2%, n=203) reported engaging in sexual behaviors with casual partners. In terms of sexual behaviors that put partners at greatest risk for HIV transmission, unprotected anal insertive intercourse was most likely to occur with unknown status casual partners (46.8%, n=95) than with either HIV negative casual partners (19.2%, n=39) or with HIV+ casual partners (40.8%, n=83). Further, bivariate analyses indicated significant relationships between the use of several substances and sexual behaviors that put partners at greatest risk for HIV transmission, as well as a significant positive relationship between drinks per drinking day and viral load.

Adult↗
PubMed1999

Awareness and utilization of the hepatitis B vaccine among young men in the Ann Arbor area who have sex with men.

The authors conducted a preliminary assessment of hepatitis B vaccination rates among men 18- to 37-years-old who have sex with men in a college town to determine what proportion were willing to be vaccinated. Participants, who were sampled in gay bars, gay advocacy groups, a swim team, and a dance club, completed a 25-item questionnaire. Sixty-seven percent were aware of the hepatitis B vaccine, yet only 22% had received the full series of three injections; only 37% had been tested for the virus. On a scale of 1 to 10 for willingness to be vaccinated (10 being most willing), 58% indicated a 10 (M = 8.5). Thirty percent indicated they received safer sex information from university health services, and 14% reported they had received hepatitis B vaccination information there. Hepatitis B vaccination of men who have sex with men in college towns should be a high priority for university health services.

Adolescent↗
PubMed2005

Men who have sex with men (MSM) in public sex environments (Pses): a systematic review of quantitative literature.

We systematically review quantitative research relating to the sexual behaviours of MSM in PSEs. We examine the methodological rigour of these studies to determine an appropriate framework for future PSE-based research and quantify sexual behavioural trends therein. Medline, BIDS, Web of Science and recent HIV/AIDS conferences were searched according to a systematic inclusion criteria. Nine papers were included for review. Recruitment of participants' outwith PSE settings, and low response rates (6%) of participants contacted in situ, question the validity and generalizability of current evidence. Most PSE users were gay or bisexually identified and half of men in the gay community reported recent PSE use. Around 10% of men reported casual status-unknown/serodiscordant unprotected anal intercourse (UAI) within PSEs. HIV testing rates amongst PSE users were similar to the wider gay community, though the proportion of men who tested positive was twice as high. Rates of casual UAI suggest that PSEs represent important sites for HIV prevention. However, since extant evidence is scant and methodologically flawed, further research is urgent. Such work must recruit participants in situ, and obtain satisfactory response rates, to be generalizable to the wider population of men who cruise.

HIV Infections↗
PubMed2003

Characteristics of HIV antiretroviral treatments, access and adherence in an ethnically diverse sample of men who have sex with men.

Data regarding HIV antiretroviral treatment regimens, access to treatment and medical care, and adherence to medications were collected as part of the Seropositive Urban Men's Study, a formative study of HIV-positive men who have sex with men. Participants (N = 456) were recruited from AIDS service organizations, mainstream gay venues and public/commercial sex environments. The sample was 94% gay or bisexually-identified; 29% were African American, 24% Latino and 30% white. The majority (71%) indicated being on antiretroviral treatment, and most were taking a protease inhibitor/nucleoside reverse transcriptase inhibitor combination. African American men in New York City were less likely to be on treatment. Among those on treatment (n = 322), 51% reported at least one day in which they had missed a dose of their medication and the mean number of days in which a dose was missed (in the past 30 days) was 1.72. Multivariate analyses indicated that avoidant coping, frequency of drinking alcohol and difficulty in communicating with sex partners about HIV were related to days of missed doses, suggesting the need or desire to escape from the reality of life with HIV as a potential explanation for poor adherence.

Adult↗
PubMed2006

Elevated risk for tobacco use among men who have sex with men is mediated by demographic and psychosocial variables.

Men who have sex with men (MSM) may be more likely to smoke than general population men. Such population comparisons typically do not control for demographic differences and have not tested reasons for MSMs' greater tobacco use. We compared MSM with general population men in data that allowed us to control demographic differences, and hypothesized that MSM would report more tobacco use, due to elevated levels of three psychosocial variables that generally predict tobacco use: depression symptoms, alcohol use, and limited health access. Data were from a 2001 survey of MSM in Chicago (n = 817) and from the 2001 National Health Interview Study (n = 7,783). Significantly more MSM used tobacco, particularly younger MSM. Depression symptoms, alcohol use, and limited health access were more common among MSM and partially accounted for their elevated smoking risk. The lower health access and greater vulnerability of MSM to depression and alcohol use contributed to their higher smoking rate and must be considered in further smoking research and prevention. Younger MSM show very high rates of smoking and are a particular intervention target. Limitations of this cross-sectional study are noted.

Adolescent↗
PubMed2005

Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003.

BACKGROUND: The Centers for Disease Control and Prevention developed screening and diagnostic testing guidelines for chlamydia and gonorrhea at urethral, rectal, and pharyngeal sites for men who have sex with men (MSM). However, in most clinical settings, rectal chlamydial testing is not performed for MSM, and primarily sexually transmitted disease (STD) clinics alone perform routine rectal and pharyngeal gonorrhea screening for asymptomatic men. METHODS: We evaluated the prevalence of rectal, urethral, and pharyngeal chlamydial and gonococcal infections among MSM seen at the municipal STD clinic and the gay men's community health center. We also determined the proportion of asymptomatic rectal infections, described the patterns of single and multiple anatomic sites of infection, and evaluated the proportion of chlamydial infections that would be missed and not treated if MSM were not routinely tested for chlamydia. We tested specimens using previously validated nucleic acid amplification tests (NAATs). RESULTS: The prevalence of infection varied by anatomic site (chlamydia: rectal, 7.9%; urethral, 5.2%; and pharyngeal, 1.4%; for gonorrhea, rectal, 6.9%; urethral, 6.0%; and pharyngeal, 9.2%). Approximately 85% of rectal infections were asymptomatic supporting the need for routine screening. Because 53% of chlamydial infections and 64% of gonococcal infections were at nonurethral sites, these infections would be missed and not treated if only urethral screening was performed. In addition, >70% of chlamydial infections would be missed and not treated if MSM were tested only for gonorrhea. CONCLUSIONS: Because these infections enhance both HIV transmission and susceptibility, clinical settings serving MSM should evaluate the prevalence of chlamydial and gonococcal infections by anatomic site using validated NAATs.

Adult↗
PubMed2005

Surfing new territory: club-drug use and risky sex among Hispanic men who have sex with men recruited on the Internet.

The Internet presents unique and growing opportunities for conducting HIV/ STD research. This article reports on the first 171 participants enrolled in an ongoing study examining use of the Internet to recruit Hispanic men who have sex with men (HMSM) living in an AIDS epicenter to participate in community-based studies. First, it describes initial success with chatroom recruitment. Second, it compares the demographic, psychosocial, and sexual risk practices among HMSM recruited through the Internet who had used club drugs in the last 6 months and those who had not. In 2 months, 211 hours were spent recruiting in chatrooms; 735 chatroom users were engaged. Researchers used a scripted dialogue to describe the study and to invite chatroom users to visit the study's community sites for screening and enrollment. One hundred and seventy-six men came to the community sites; 172 (98%) were eligible and completed an audio-computer assisted self-interview. In the last 6 months, 48.5% of the sample had used club drugs [defined as cocaine, crystal methamphetamines (crystal), amyl nitrites (poppers), Ecstasy, gamma-hydroxybutyrate (GHB), ketamine (Special K), and Viagra]. The proportion of men reporting use of each drug was: cocaine (15.8%), crystal (11.7%), poppers (31.6%), Ecstasy (14%), GHB (3.5%), Special K (3.5%), and Viagra (19.3%). In multivariate analyses, having higher number of sex partners, having higher social isolation scores, and having engaged in unprotected receptive anal intercourse were significantly associated with club-drug use. These initial findings suggest that high-risk HMSM can be successfully recruited through chatroom dialogues to participate in community-based HIV studies. The alarmingly high rates of club-drug use and risky sexual practices among HMSM underscore the need for effective HIV preventive interventions for this population.

Adult↗
PubMed2005

Race/ethnic differences in HIV prevalence and risks among adolescent and young adult men who have sex with men.

The prevalence of HIV infection is disproportionately higher in both racial/ethnic minority men who have sex with men (MSM) and in men under the age of 25, where the leading exposure category is homosexual contact. Less is known, however, about patterns of HIV prevalence in young racial/ethnic minority MSM. We analyzed data from the Young Men's Survey (YMS), an anonymous, cross-sectional survey of 351 MSM in Baltimore and 529 MSM in New York City, aged 15-22, to determine whether race/ethnicity differences exist in the prevalence of HIV infection and associated risk factors. Potential participants were selected systematically at MSM-identified public venues. Venues and associated time periods for subject selection were selected randomly on a monthly basis. Eligible and willing subjects provided informed consent and underwent an interview, HIV pretest counseling, and a blood draw for HIV antibody testing. In multivariate analysis, adjusted for city of recruitment and age, HIV seroprevalence was highest for African Americans [adjusted odds ratio (AOR) = 12.5], intermediate for those of "other/mixed" race/ethnicity (AOR = 8.6), and moderately elevated for Hispanics (AOR = 4.6) as compared to whites. Stratified analysis showed different risk factors for HIV prevalence in each ethnic group: for African Americans, these were history of sexually transmitted diseases (STDs) and not being in school; for Hispanics, risk factors were being aged 20-22, greater number of male partners and use of recreational drugs; and for those of "other/mixed" race/ethnicity, risk factors included injection drug use and (marginally) STDs. These findings suggest the need for HIV prevention and testing programs which target young racial/ethnic minority MSM and highlight identified risk factors and behaviors.

Adolescent↗
PubMedDate not supplied

Comparative rates of sexually transmitted diseases among heterosexual men, homosexual men, and heterosexual women.

The prevalences of several sexually transmitted diseases (STD) among patients attending a public STD clinic were determined in a prospective study. Rates of gonorrhea, syphilis, genital herpes, trichomoniasis, nongonococcal urethritis, pediculosis pubis, scabies, and venereal warts were ascertained according to sex, sexual preference, and race. Numbers of cases of diseases not routinely reported to most public health agencies exceeded numbers of cases of diseases that are routinely reported. Rates of gonorrhea were higher among men than among women and higher among blacks than among whites. Syphilis was most common among homosexual men. Trichomoniasis was three times more frequent among blacks than among whites. Rates of nongonococcal urethritis among heterosexual men were almost twice those among homosexual men. Whites were more likely than blacks to have pediculosis pubis, scabies, and venereal warts. STD not routinely reported to most public health agencies are commonly seen in public clinics, and rates vary according to sex, sexual preference, and race.

Black or African American↗
PubMedDate not supplied

Auxotypes of Neisseria gonorrhoeae isolated from heterosexual men, homosexual men, and heterosexual women.

During 1979-1984 we auxotyped 1822 strains of Neisseria gonorrhoeae and recorded the site of isolation and sexual orientation of the patients. Auxotypes were determined by the growth requirements of strains for proline (Pro-), uracil (Ura-), hypoxanthine (Hyx-), citrulline (Cit-), or citrulline replaceable by ornithine (Orn-). Of all isolates from homosexual men, 96% belonged to three auxotypes: nonrequiring (NR), Pro-, or Orn-, and only 1.5% belonged to the Pro-, Cit-, Ura- and Orn-, Ura-, Hyx- auxotypes. Of the isolates from women, 49.9% belonged to these latter two auxotypes. Of the strains isolated from male homosexuals, 19.5% were resistant to 1.0 microgram of erythromycin/ml, whereas only 9.6% of strains from other men and 2.6% of strains from women were resistant to this concentration. We suggest that strains of N. gonorrhoeae infecting homosexual men tend to be less demanding in their nutritional requirements and more resistant to erythromycin than strains infecting heterosexual men and women.

Anal Canal↗
PubMed1997

Sexually transmitted diseases in men who have sex with men. Acquisition of gonorrhea and nongonococcal urethritis by fellatio and implications for STD/HIV prevention.

BACKGROUND AND OBJECTIVES: Despite trends toward safer sex practices in homosexually active men, some such people remain at high risk for acquiring sexually transmitted diseases (STD). This study was designed to assess behavioral and demographic determinants of STD acquisition in men who have sex with men (MSM), to guide prevention interventions. STUDY DESIGN: A cross-sectional medical record review was undertaken of MSM who attended an urban STD clinic from January, 1993 through December, 1994. Gonorrhea, chlamydial infection, Chlamydia-negative nongonococcal urethritis (NGU), and newly documented human immunodeficiency virus (HIV) infection were analyzed in relation to demographic and behavioral variables. RESULTS: Among 1,253 MSM, 196 (15.6%) had nonchlamydial NGU, 105 (8.4%) had gonorrhea, 31 (2.5%) had chlamydial infection, and 162 (12.9%) had known or newly documented HIV infection. Known HIV infection was an independent predictor of urethral gonorrhea (odds ratio [OR] 2.3, 95% confidence interval [CI95] 1.2-4.8). Oral insertive intercourse was independently associated with urethral gonorrhea (OR 4.4, CI95 1.4-13.4) and nonchlamydial NGU (OR 2.2, CI95 1.3-3.7), and receptive anal intercourse was associated with newly documented HIV infection (OR 2.6, CI95 1.3-4.9). Neither number of sex partners nor condom use was associated with any incident STD outcome, including new HIV infection. CONCLUSIONS: MSM who attend STD clinics represent a subgroup of homosexually active men who remain at high risk for STDs, including HIV infection. Fellatio, commonly thought to be a "safe" sexual practice, is an independent risk factor for urethral gonorrhea and nonchlamydial NGU. A history of consistent condom use or of few sex partners should not dissuade clinicians from performing screening tests for HIV and other STDs. Repeated STD screening and counseling about safer sex are indicated for many HIV-infected MSM.

Adult↗