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PubMedDate not supplied

Etiologies of postgonococcal urethritis in homosexual and heterosexual men: roles of Chlamydia trachomatis and Ureaplasma urealyticum.

Before treatment for urethral gonorrhea, Chlamydia trachomatis was isolated from 18% and Ureaplasma urealyticum from 37% of 121 men. C. trachomatis was recovered from none of 18 homosexual men who had gonorrhea and from 22 of 95 heterosexual men who had gonorrhea (P less than 0.05). After treatment with a penicillin, postgonococcal urethritis occurred significantly more often in heterosexual than in homosexual men (P less than 0.002). Postgonococcal urethritis developed in all men from whom C. trachomatis was isolated. Among men without U. urealyticum infection, postgonococcal urethritis was significantly associated with C. trachomatis infection (P less than 0.02). Among men without C. trachomatis infection, postgonococcal urethritis was less closely associated with U. urealyticum infection (0.1 greater than P greater than 0.05). Postgonococcal urethritis was least frequent among men who had neither C. trachomatis nor U. urealyticum infection.

Chlamydia Infections↗
PubMedDate not supplied

Amebic liver abscess in a homosexual man.

A case report of a 36-year-old black homosexual man with right upper- and lower-quadrant abdominal pain is presented. When exploratory surgery for appendicitis was performed, an abscess, consistent with an amebic abscess, was encountered in the right lobe of the liver. This abscess was evacuated, and a drain was placed. A serum sample taken at the time of surgery showed high titers of antibody to Entamoeba histolytica; metronidazole therapy was instituted, and the patient made an uneventful recovery. Since amebiasis is epidemic in the gay community, health care personnel should be aware of the various modes of transmission, as well as of the diagnoses, optimal management, and indications for surgery in patients with amebic liver abscess. It is noted that amebic liver abscess appears to be a less frequent complication of amebiasis among the male homosexual population than among other groups.

Adult↗
PubMedDate not supplied

Enteric pathogenic protozoa in homosexual men from San Francisco.

The prevalence of enteric protozoa was studied in a survey conducted among 150 male homosexual patients in San Francisco. All patients were from a private practice in internal medicine. Each was asked to complete a questionnaire and to submit multiple stool specimens for examination. Of this group, 47% were positive for one or more potentially pathogenic intestinal protozoa; Entamoeba histolytica was found in 36%, Entamoeba hartmanni in 35%, Giardia lamblia in 5%, and Dientamoeba fragilis in 1.3%. Symptoms were unreliable as a diagnostic index of intestinal protozoan infection. Colonization rates could not be correlated with any specific sexual technique. The large number of homosexuals at risk, combined with the potential for difficulties in diagnosis and contact-tracing, indicate the possibility that enteric pathogenic protozoa will cause future health problems in this population.

Adult↗
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

In vitro inhibition of growth of Neisseria gonorrhoeae by Neisseria meningitidis isolated from the pharynx of homosexual men.

Despite the high prevalence of pharyngeal gonorrhea and of meningococcal carriage among homosexual men, Neisseria gonorrhoeae and Neisseria meningitidis are rarely co-isolated from the throat. Forty-seven meningococcal isolates from the pharynx of homosexual men were examined, by a lawn-spotting method, for their ability to inhibit N. gonorrhoeae in vitro. Eight (17%) of the meningococcal isolates were inhibitory when tested against gonococci from the same patient, while 31 (66%) were inhibitory when tested against N. gonorrhoeae strain 650 (T1). The colonial type T1 of a given strain was, in all cases tested, more sensitive to the inhibitory activities than the corresponding T4 type. Since the meningococci co-isolated from the throat with gonococci were at least as inhibitory in vitro as those isolated without gonococci, the natural resistance to gonococcal pharyngitis cannot be explained on the basis of the inhibitory activities produced by the meningococci in vitro. The inhibitory strains of N. meningitidis were identified in decreasing importance as: nonserogroupable, W135, C, B, 29E, and X. The addition of trypsin to the solid medium removed the inhibition produced by the meningococci, an observation suggesting the involvement of protein inhibitors.

Animals↗
PubMedDate not supplied

Single-site infection with Neisseria gonorrhoeae in homosexual men.

To determine need to culture multiple anatomic sites of homosexual men, we examined 1803 cultures from 791 men who had positive cultures for Neisseria gonorrhoeae from one or more sites. The men were examined during fiscal year 1982 at a health center that serves the gay community. Not included are 184 patients who had positive cultures from the only site tested. Of the 607 patients cultured from two or more anatomic sites, 34 (5.6%) had cultures positive for N. gonorrhoeae from each site, and 492 (81.1%) had N. gonorrhoeae isolated from one site only. Of these 492 patients, 36 (7.3%) had positive cultures from the oropharynx only, 232 (47.2%) from the urethra only, and 224 (45.5%) from the anal canal only. Of 405 patients cultured from the urethra, anal canal, and oropharynx, 92 (22.7%) had N. gonorrhoeae at two or more sites; 313 (77.3%) had the organism at one site only. Of 84 patients cultured from the anal canal and oropharynx only, 11 (13.1%) had positive cultures from the oropharynx and negative cultures from the anal canal. Since it is highly improbable that the infected site will be selected if only one site is cultured, routine culturing of the urethra, anal canal, and oropharynx of homosexual men is necessary for accurate diagnosis.

Anal Canal↗
PubMedDate not supplied

Treatment of asymptomatic amebiasis in homosexual men. Clinical trials with metronidazole, tinidazole, and diloxanide furoate.

In a randomized trial, the authors treated 42 asymptomatic homosexual men who had Entamoeba histolytica in fecal specimens with either metronidazole or tinidazole (study 1). They treated both groups initially with 2,000 mg in a single dose, and in case of failure with 2,000 mg daily for 5 days. In cases of repeated failure, the authors prescribed a dosage of 500 mg of diloxanide furoate three times per day (TID) for 10 days. In a subsequent study (study 2) the authors treated 49 asymptomatic homosexual men who had E. histolytica in fecal specimens with 500 mg of diloxanide furoate TID for 10 days. In study 1, the parasitological cure rates (PCR) for metronidazole and tinidazole were 29%-56%. Among the men treated with diloxanide furoate, the PCR was 93%. In study 2 the PCR with diloxanide furoate was 88%, which was significantly better (P less than .05) than metronidazole/tinidazole treatment in study 1. The present studies show that diloxanide furoate is an effective treatment of amebiasis in asymptomatic patients.

Adult↗
PubMed1984

Opportunistic infections in homosexual men.

In summary, we have described a homosexual patient who died of Kaposi's sarcoma and overwhelming disseminated opportunistic infections. Review of the literature attests to the severe alterations of immune surveillance inherent in the homosexual population as a whole and the need for vigorous clinical investigation when warranted.

Candidiasis↗
PubMed1987

Borderline immunodeficiency in male homosexuals: is life-style contributory?

Results of our study suggest that white Southern male homosexuals without clinical evidence of AIDS who patronize "gay bars" may have significant zinc deficiency and moderately depressed T-helper/T-suppressor cell ratios. No single causative factor could be identified to explain the significantly low zinc and elevated copper levels measured in whole blood, as well as the depressed OKT4/OKT8 cell ratios. Seventy-four percent of the homosexual male subjects were "recreational" drug abusers, 81% used inhalant nitrites routinely, and 41% routinely treated themselves with antibiotics. Eighty-one percent practiced active and/or passive penile-oral insertion, and 55.5% practiced both active and passive anal intercourse. Of the latter, 19% reported anal bleeding. Clinically inapparent, though statistically significant, borderline immunodeficiency and aberrant zinc and copper levels may be a consequence of multiple factors comprising the gay bar life-style.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Virologic, immunologic, and clinical parameters in the incidence and progression of anal squamous intraepithelial lesions in HIV-positive and HIV-negative homosexual men.

Anal cancer may be preceded by anal squamous intraepithelial lesions (ASIL), but the natural history of ASIL is poorly understood. In this report, we characterize the 2-year incidence and progression of low-grade SIL (LSIL) and high-grade SIL (HSIL) in a cohort study in 346 HIV-positive and 262 HIV-negative homosexual or bisexual men. Subjects were studied at defined intervals using anal cytology, anoscopy with biopsy of visible lesions, human papillomavirus (HPV) testing, HIV serostatus, CD4 level, and data on medical history and lifestyle. The incidence of HSIL within 2 years was 20% in HIV-positive men and 8% in HIV-negative men who were normal at baseline. In total, 62% of HIV-positive and 36% of HIV-negative men with LSIL at baseline progressed to HSIL. The relative risk (RR) for anal disease progression in HIV-positive men was 2.4 (95% confidence interval [CI], 1.8-3.2) when compared with HIV-negative men. The RR increased to 3.1 (95% CI, 2.3-4.1) in HIV-positive men with CD4 counts <200/mm3. Infection with multiple HPV types was a risk factor for anal disease progression in both HIV-positive (RR = 2.0; 95% CI, 1.0-4.1) and HIV-negative (RR = 5.1; 95% CI, 2.3-11) men. The incidence of anal HSIL and progression of LSIL to HSIL within 2 years of follow-up is high in HIV-positive homosexual or bisexual men and to a lesser extent, in HIV-negative men. Men with the above risk factors may be at increased risk of developing anal cancer.

Anal Canal↗
PubMed1998

Anal squamous intraepithelial lesions in HIV-positive and HIV-negative homosexual and bisexual men: prevalence and risk factors.

Anal cancer is more commonly found in homosexual and bisexual men than cervical cancer is in women. Invasive anal cancer may be preceded by anal squamous intraepithelial lesions (ASIL), and treatment of ASIL may prevent the development of anal cancer. We characterized the prevalence and risk factors for ASIL in 346 HIV-positive and 262 HIV-negative homosexual men. Anal cytology, biopsy of visible anal lesions, and human papillomavirus (HPV) tests were performed, and data on HIV serostatus, CD4 count, and medical and lifestyle history were collected. ASIL was diagnosed in 36% of HIV-positive men and 7% of HIV-negative men (relative risk [RR] = 5.7; 95% confidence interval [CI], 3.6-8.9). Among HIV-positive men, the RR for ASIL increased with lower CD4 levels but was elevated even in men with CD4 levels >500/mm3 (RR = 3.8; 95% CI, 2.1-6.7) when compared with HIV-negative men. High-level HPV infection, as measured by detection of both hybrid capture (HC) group A and group B types, was another significant risk factor for ASIL in both HIV-positive men (RR = 8.8; 95% CI, 2.3-35) and HIV-negative men (RR = 20; 95% CI, 5.5-71) when compared with HC-negative men. HIV-negative men with anal HPV infection and HIV-positive men, regardless of CD4 level, are at high risk for ASIL.

Adult↗
PubMed2000

Molecular epidemiology of HIV-1 in Switzerland: evidence for a silent mutation in the C2V3 region distinguishing intravenous drug users from homosexual men. Swiss HIV Cohort Study.

OBJECTIVES: To study the molecular epidemiology of HIV-1 strains found in Switzerland and to determine possible genetic linkages among strains sorted by risk group or geographic region. DESIGN: A cross-sectional, clinic-based survey of HIV-1 molecular sequences and linked patient history from Swiss people. METHODS: Specimens were collected from 215 HIV-1-infected people in HIV outpatient clinics of four tertiary referral centers (Lausanne, St. Gallen, Zurich, and Basel) between May and August 1996, mainly from homosexual men, injecting drug users (IDU), and heterosexually infected people. In addition, specimens collected between 1991 and 1995 in the HIV outpatient clinic at University of Geneva were included into this survey. These specimens were collected primarily for an ongoing, prospective cohort (Swiss HIV Cohort Study). Direct C2V3C3 sequences of the env gene were determined from 158 samples of peripheral blood mononuclear cells. Genetic data were analyzed with the available patient history on each specimen. RESULTS: As found in other previous studies in Europe, primarily subtype B viruses were identified, whereas seven (4%) of 158 were non-subtype B: one subtype D, four subtype A, and two subtype E. Five of seven non-B subtypes occurred in immigrants from African or Asian countries and all seven were found exclusively in individuals who had been infected by heterosexual contact. No significant clustering of strains within different study sites or risk groups was found. A silent mutation (LAI env 834) occurred significantly more often in IDU than in homosexual men (p<.001). CONCLUSIONS: Although the lack of significant clustering of strains by risk group or geographic region may result from early introduction of subtype B viruses in Switzerland, the strong association of a silent mutation with IDU suggests that, early in the epidemic, there was a unique founder virus among IDUs. The HIV epidemic in Switzerland is still predominantly caused by subtype B viruses.

Amino Acid Sequence↗
PubMed2004

Increasing prevalence of male homosexual partnerships and practices in Britain 1990-2000: evidence from national probability surveys.

OBJECTIVES: To estimate the prevalence and timing of homosexual experience among British men; to explore the patterns of sexual practices and partnerships in 2000, and behavioural and attitudinal changes between 1990 and 2000 among men who have sex with men (MSM). DESIGN: Two large, stratified probability sample surveys of the general population. METHODS: Trained interviewers administered a combination of face-to-face and self-completion questionnaires to men aged 16 to 44 years resident in Britain (n = 6000 in 1990 and n = 4762 in 2000). RESULTS: In 2000, 2.8% of British men reported sex with men in the past 5 years. 46.0% of MSM reported five or more partners in the past 5 years, and 59.8% reported unprotected anal intercourse in the past year. A total of 33.0% of MSM reported one or more female partner(s) in the past year. In comparison with 1990, there was a significant increase in the proportion of MSM in the population in 2000, and among these men, in the proportion reporting receptive anal intercourse in the past year [age-adjusted odds ratio (OR), 2.08; 95% confidence interval (CI), 1.08-4.00], but no significant change in self-perceived HIV-risk (age-adjusted OR, 1.11; 95% CI, 0.49-2.51) or HIV testing in past 5 years (age-adjusted OR, 1.14; 95% CI, 0.57-2.25). CONCLUSIONS: Evidence of increasing prevalence of homosexual intercourse among the British male population coupled with increases in some HIV-risk behaviours among MSM suggests overall increasing numbers at risk in the population. Although these changes may partly reflect an increased willingness to report these behaviours, our results are consistent with increasing incidence of sexually transmitted infections and behavioural surveillance data.

Adolescent↗
PubMed2005

The association between the fraternal birth order effect in male homosexuality and other markers of human sexual orientation.

Later fraternal birth order (FBO) is a well-established correlate of homosexuality in human males and may implicate a maternal immunization response in the feminization of male sexuality. This has led to the suggestion that FBO may relate to other markers of male sexual orientation which are robustly sexually dimorphic. If so, among homosexual males the number of older brothers should strongly correlate with traits such as spatial ability and psychological gender, indicative of greater behavioural feminization, compared to heterosexual males. The present study failed to find significant associations between number of older brothers and these traits.

Adolescent↗
PubMed1989

The transmission dynamics of the human immunodeficiency virus type 1 in the male homosexual community in the United Kingdom: the influence of changes in sexual behaviour.

This paper examines the transmission dynamics of human immune deficiency virus type 1 (HIV-1) in the male homosexual population in the U.K. via numerical studies employing a mathematical model representing the principal epidemiological process. The model is based on an assumption of proportionate mixing between different sexual-activity classes (defined by the rate of sexual partner change per unit of time) and incorporates heterogeneity in sexual activity, distributed infection and incubation periods and the recruitment of susceptibles to the sexually active population. The sensitivity of model predictions to various assumptions and parameter assignments is examined. Numerical studies of model behaviour focus on the influence of changes in the magnitudes of the transmission parameters, associated with three periods of infectiousness during the incubation period of acquired immune deficiency syndrome (AIDS), on the magnitude and duration of the epidemic and on the level of the endemic equilibrium state. Predicted temporal trends in the incidence of AIDS are shown to be particularly sensitive to changes in the intensities and durations of the stages of infectiousness. Most of the paper addresses the influence of changes in sexual behaviour on the magnitude and duration of the epidemic. Numerical simulations show that the manner in which behavioural changes occur and who is influenced by such changes (i.e. infecteds or susceptibles, the sexually active population or new recruits to this population) have a major impact on the future timecourse of the epidemic. The greatest reduction in the incidence of AIDS over the coming decades is induced by changes in the rate of sexual-partner change among the sexually active population, particularly those currently infected. The time periods at which changes in behaviour occur, in relation to the starting point of the epidemic (assumed to be 1979), are also of particular significance to the future pattern of the incidence of disease and infection. Changes in behaviour early on in the timecourse of the epidemic have a much greater impact than equivalent changes at latter time points. On the basis of limited data on the pattern of change in sexual behaviour among the male homosexual community in the U.K., numerical studies of model behaviour tentatively suggest that the epidemic is at, or near to, a period of peak incidence of the disease AIDS. Analyses suggest that, following the peak in incidence, there will be a period of slow decline over many decades provided recent changes in behaviour are maintained in the coming years.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed2003

Prevalence of infection and genotypes of GBV-C/HGV among homosexual men.

Since the discovery of GB virus-C (GBV-C) and hepatitis G virus (HGV), many studies have been performed. These viruses are now known to be parenterally, as well as sexually transmitted. A phylogenetic analysis also revealed that GBV-C has five major genotypes: type 1 predominates in West Africa, type 2 in Europe and the United States, type 3 in parts of Asia, type 4 in Southeast Asia, and type 5 in South Africa. Despite the number of reports so far, there have been few large-scale surveys of homosexual men to determine the prevalence of the GBV-C/HGV infections. We examined the levels of GBV-C/HGV viremia in 297 homosexual men who attended the Nagoya Lesbian and Gay Revolution held in Nagoya, Japan. Reverse transcription-polymerase chain reaction (RT-PCR)/nested PCR of the GBV-C/HGV 5 ' -non-coding region (NCR), and base sequence analyses showed that the infection rate was 12.5%, and genotypes in this population were classified into type 2 (32%) and type 3 (68%). None were classified as types 1, 4, or 5 in this study. Our results indicate that the GBV-C/HGV type 2 seen mainly in Europe and the US is spreading widely in Japan, especially in the Nagoya district.

Flaviviridae Infections↗
PubMed1989

Kaposi's sarcoma in a homosexual--10 years on.

Kaposi's sarcoma is seen in one of several clinical settings. Before the recognition of the acquired immune deficiency syndrome (AIDS) in the early 1980s, the most frequent presentation of Kaposi's sarcoma in the UK was the so-called 'classical' form of the disease. The most common form of Kaposi's sarcoma in this country is now that associated with AIDS, which particularly affects young male homosexuals. Here we describe a homosexual man who has developed many Kaposi's sarcoma tumours during the past 10 years. The disease has run a benign course and there is no evidence of infection with human immunodeficiency virus (HIV).

Acquired Immunodeficiency Syndrome↗
PubMed1984

The prognosis of asymptomatic homosexual men with decreased T-helper to T-suppressor ratio.

Screening of 70 asymptomatic homosexual men in Copenhagen revealed that 13 (19%) had T-helper to T-suppressor (H/S) ratios less than or equal to 1.0. Clinical and immunological follow-up examinations for 2-7 months (mean, 5.2 months) disclosed that none of the 13 men developed the acquired immunodeficiency syndrome (AIDS) or AIDS-like symptoms. An increase in H/S ratios to greater than 1.0 was observed in 11 of the 13 men during the time of observation. The decreased H/S ratios were due to an increase in the T-suppressor population. The T-helper population did not at any time differ from that found in 31 male control subjects. The biological relevance of the observed decrease in H/S ratios was supported by the demonstration of a positive correlation to a decrease in the proliferative response of the lymphocytes. Serological studies did not reveal any specific infectious background for the low H/S ratio found in the 13 men, and the reason for the 'spontaneous' increase during the time of observation remains unknown. The present results indicate that most asymptomatic homosexual men with a decreased H/S ratio will experience normalization of the immunological variables.

Acquired Immunodeficiency Syndrome↗