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PubMed1989

Changes in sexual behaviour and the fall in incidence of HIV infection among homosexual men.

To investigate the epidemiology and normal course of infection with HIV the prevalence and incidence of the infection were studied among two cohorts of homosexual men in Amsterdam in 1980-7. The cumulative incidence of infection increased from a weighted 2.2% in 1980 to 39.0% in 1987. The estimated yearly incidence of HIV was 3.0% in 1981, rose to 8.8% in 1984, and fell gradually to 0% in 1987. During the study the sexual behaviour of the cohorts was examined. The number of men with whom anopenetrative intercourse was practised fell from a mean of 10.6 to 1.4 for those positive for HIV antibody, whereas the number with whom anoreceptive intercourse was practised fell from a mean of 3.7 to 0.5 for those negative for the antibody. In addition, there was a reduction in the number of cases of hepatitis B and syphilis among men in general. The decline in infection with HIV was assumed to be linked to changes in sexual behaviour. Such changes practised early in the course of the epidemic probably had a strong effect on the number of cases of AIDS among homosexual men in Amsterdam.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Course of HIV-I infection in a cohort of homosexual and bisexual men: an 11 year follow up study.

OBJECTIVE--To characterise the natural history of sexually transmitted HIV-I infection in homosexual and bisexual men. DESIGN--Cohort study. SETTING--San Francisco municipal sexually transmitted disease clinic. PATIENTS--Cohort included 6705 homosexual and bisexual men originally recruited from 1978 to 1980 for studies of sexually transmitted hepatitis B. This analysis is of 489 cohort members who were either HIV-I seropositive on entry into the cohort (n = 312) or seroconverted during the study period and had less than or equal to 24 months between the dates of their last seronegative and first seropositive specimens (n = 177). A subset of 442 of these men was examined in 1988 or 1989 or had been reported to have developed AIDS. MAIN OUTCOME MEASURES--Development of clinical signs and symptoms of HIV-I infection, including AIDS, AIDS related complex, asymptomatic generalised lymphadenopathy, and no signs or symptoms of infection. MEASUREMENTS AND MAIN RESULTS--Of the 422 men examined in 1988 or 1989 or reported as having AIDS, 341 had been infected from 1977 to 1980; 49% (167) of these men had died of AIDS, 10% (34) were alive with AIDS, 19% (65) had AIDS related complex, 3% (10) had asymptomatic generalised lymphadenopathy, and 19% (34) had no clinical signs or symptoms of HIV-I infection. Cumulative risk of AIDS by duration of HIV-I infection was analysed for all 489 men by the Kaplan-Meier method. Of these 489 men, 226 (46%) had been diagnosed as having AIDS. We estimated that 13% of cohort members will have developed AIDS within five years of seroconversion, 51% within 10 years, and 54% within 11.1 years. CONCLUSION--Our analysis confirming the importance of duration of infection to clinical state and the high risk of AIDS after infection underscores the importance of continuing efforts both to prevent transmission of HIV-I and to develop further treatments to slow or stall the progression of HIV-I infection to AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Amoebiasis in homosexual men.

The clinical, histopathological, and serological features of 35 homosexual men with infection with Entamoeba histolytica were studied and compared with a group of 35 non-infected homosexual men. Each isolate was of Zymodeme type I. Although there was no significant difference in the numbers of infected and non-infected men with gastrointestinal symptoms (48.6% and 28.6% respectively), the mean duration of symptoms was greater in with amoebiasis (p less than 0.05). The histology of the rectal mucosa was abnormal in 17 (63.0%) of the 27 men with amoebic infection only and in two (7.4%) of the 27 control subjects (p less than 0.001). Serum antibodies reactive with E. histolytica were not shown in any patient.

Adolescent↗
PubMed1979

Chronic hepatitis B infection in male homosexuals.

Ten cases of hepatitis B virus infection were identified among asymptomatic male homosexuals. These patients shared a number of characteristics: A subclinical origin and course of infection; Persistence of HGsAg for periods exceeding six to 25 months; Persistent GPT elevation of two to five times upper normal limit; Morphological changes in the liver with portal and parenchymal inflammation (chronic persistent hepatitis, six cases; non-specific reactive hepatitis, 2 cases; cirrhosis and acute hepatitis with signs of chronicity, one case each). HBeAg was found in six cases, anti-HBe in none. These results indicate that screening for hepatitis B should be performed whenever these individuals come under medical attention in order to detect asymptomatic chronic liver diseases and to detect these silent vectors of an infection that presently shows an increased frequency among homosexuals.

Carrier State↗
PubMed1981

Isolation of intestinal spirochaetes from homosexuals.

Spirochaetes were isolated from rectal swabs of two homosexuals and the faeces of a third, using simple isolation techniques not previously applied to specimens of this type. The ease of culture of these organisms will enable their distribution and pathogenicity to be studied, particularly in relation to their significance in homosexuals.

Adult↗
PubMed1994

HIV infection: social network, social support, and CD4 lymphocyte values in infected homosexual men in Malmö, Sweden.

STUDY OBJECTIVE: The aim was to determine if there is an association between social network and social support and the CD4 cell count in HIV infected homosexual men. DESIGN: The study was cross sectional. A structured questionnaire assessing psychosocial factors such as social network and social support was administered at interview. Information on CD4 cell counts and HIV symptoms were obtained from participants' medical records. SETTING: The study population consisted of all HIV seropositive homosexual and bisexual men who had not been diagnosed as having AIDS seen at the Department of Infectious Diseases, the only hospital clinic in the city of Malmö (230,000 inhabitants), Sweden that provides care for HIV infected patients. PARTICIPANTS: Altogether 47 (68%) of 69 men in the population agreed to be interviewed. MAIN RESULTS: A low CD4 cell count was found more frequently in men with low social participation scores (OR 3.3; 95% CI 1.0, 11), in those with a low adequacy of social participation (OR 3.8; 95% CI 1.1, 13), and in men with low material support scores (OR 3.9; 95% CI 1.1, 13). After adjustment for age and time of awareness of the HIV infection, the two former associations remained statistically significant. CONCLUSIONS: These results, if reproduced in a longitudinal study, might suggest that psychosocial factors can affect an individual's immune system.

Adult↗
PubMed2004

Increasing risk behaviour and high levels of undiagnosed HIV infection in a community sample of homosexual men.

OBJECTIVES: To estimate changes in sexual behaviour over time. To examine the proportion of undiagnosed HIV infection in a community sample of homosexual men. To explore the relation between HIV status, diagnosis, and sexual behaviour. METHODS: Five cross sectional surveys of men attending selected gay community venues in London between 1996 and 2000 (n = 8052). Men were recruited in 45 to 58 social venues (including bars, clubs, and saunas) across London. Participants self completed an anonymous behavioural questionnaire. In 2000, participants in community venues provided anonymous saliva samples for testing for anti-HIV antibody. RESULTS: The proportion of men having unprotected anal intercourse (UAI) increased significantly each year from 30% in 1996 to 42% in 2000 (p<<0.001). In 2000, 132 of 1206 (10.9%) saliva samples were HIV antibody positive. Of the HIV saliva antibody positive samples, 43/132 (32.5%) were undiagnosed. Around half of both diagnosed and undiagnosed HIV saliva positive men reported UAI in the past year. Of the 83% of men who reported their current perceived HIV status, 4.1% reported an incorrect status. HIV antibody positivity was associated with increasing numbers of UAI partners, and having a sexually transmitted infection (STI) in the past year (OR 2.15). CONCLUSIONS: Homosexual men continue to report increasing levels of UAI. HIV prevalence is high in this group, with many infections remaining undiagnosed. The high level of risky behaviour in HIV positive men, regardless of whether they are diagnosed, is of public health concern, in an era when HIV prevalence, antiretroviral resistance, and STI incidence are increasing.

Adult↗
PubMed2005

The effects of urethritis on seminal plasma HIV-1 RNA loads in homosexual men not receiving antiretroviral therapy.

OBJECTIVES: To examine the effects of urethritis and its treatment on semen plasma HIV-1 RNA load in HIV-1 infected men not receiving antiretroviral therapy (ART), in a developed world setting. METHODS: Prospective case-control study. HIV-1 infected homosexual men, not receiving ART for at least 3 months, with (cases) and without (controls) symptomatic urethritis, were recruited. Blood and semen were collected for HIV-1 RNA quantification at presentation, before antibiotic therapy, and at 1 and 2 weeks. RESULTS: 20 cases (13 gonococcal urethritis and/or chlamydial urethritis (GU/CU) and seven non-specific urethritis (NSU)) and 35 controls were recruited. Baseline characteristics and blood plasma viral load were similar in cases and controls. Mean log semen plasma viral loads were higher among those with GU/CU compared with controls (4.27 log versus 3.55 log respectively; p = 0.01) but not in those with NSU (3.48 log; p = 0.82). Following antibiotics, semen plasma viral loads fell by a mean of 0.25 log (95% CI: 0.03 to 0.47) in those with GU/CU. Semen plasma viral loads did not fall in those with NSU. CONCLUSIONS: In this study of 55 homosexual men not on ART, semen plasma viral loads were approximately fivefold higher in those with GU/CU, but not NSU, compared with controls. Treatment of GU/CU resulted in reduction in semen plasma viral loads. Although absolute effects were considerably lower when compared to patients from a similar study from sub-Saharan Africa, our data demonstrate the potential for sexually transmitted infections to enhance HIV infectivity of men not receiving ART in the developed world.

Adult↗
PubMed2005

Increase in HIV sexual risk behaviour in homosexual men in Scotland, 1996-2002: prevention failure?

OBJECTIVE: To investigate trends in homosexual men's sexual risk behaviour for HIV infection in Scotland. METHODS: Cross sectional surveys in 1996, 1999, and 2002 were carried out in "gay" bars in Glasgow and Edinburgh, Scotland. 6508 men-2276 (79% response rate) in 1996, 2498 (78%) in 1999, and 1734 (62%) in 2002. RESULTS: In 1996, 10.7% of men surveyed and in 1999, 11.2% reported unprotected anal intercourse (UAI) with casual partners, compared with 18.6% in 2002 (p < 0.001). There was also a significant increase in men reporting that they "knew" their casual partners' HIV status, despite no increase in HIV testing among men who reported UAI with casual partners. In 2002, increases in UAI with more than one partner, in UAI with casual partners and in reporting seroconcordance remained significant after adjusting for confounding factors including HIV testing status and demographic characteristics. CONCLUSIONS: High risk sexual behaviour among homosexual men in Scotland increased between 1999 and 2002. Men showed increased confidence of shared antibody status, despite no increase in HIV testing, or evidence of discussion of HIV status. Explanations for this must include consideration of a cultural shift in the perception of HIV and "prevention failure" on the part of governments and health agencies.

Adolescent↗
PubMed2006

Incidence and risk factors for urethral and anal gonorrhoea and chlamydia in a cohort of HIV-negative homosexual men: the Health in Men Study.

BACKGROUND: Early detection and treatment of bacterial sexually transmitted infections has been advocated as an HIV prevention strategy. AIM: To inform screening guidelines, the incidence and risk factors for urethral and anal gonorrhoea and chlamydia were studied in a prospective cohort of community-based HIV negative homosexual men in Sydney, New South Wales, Australia. METHODS: All participants were offered annual screening for gonorrhoea and chlamydia (study-visit diagnoses) on urine and anal swabs using nucleic acid amplification. Participants also reported diagnoses of gonorrhoea and chlamydia made elsewhere between interviews (interval diagnoses). All diagnoses were summed to create a combined incidence rate, and detailed data on specific sexual practices with casual and regular partners were collected. RESULTS: Among 1427 men enrolled, the combined incidence rates were 3.49 and 2.96 per 100 person-years for urethral and anal gonorrhoea, respectively; and 7.43 and 4.98 per 100 person-years for urethral and anal chlamydia, respectively. Urethral infections were associated with unprotected anal intercourse (UAI) with HIV-positive partners (hazard ratio (HR) = 2.58, 95% CI 1.10 to 6.05 for urethral gonorrhoea) and with frequent insertive oral sex (p for trend 0.007 for urethral chlamydia). Anal infections were associated with receptive UAI (p for trend 0.001 for both anal gonorrhoea and chlamydia) and other receptive anal sexual practices. Stratified analyses showed the independence of the associations of insertive oral sex with urethral infections and of non-intercourse receptive anal practices with anal infections. CONCLUSION: Incident gonorrhoea and chlamydia were common. Risk behaviours for both urethral and anal infections were not restricted to UAI. Screening that includes tests for anal and urethral infections should be considered for all sexually active homosexual men, not just for those who report UAI.

Adult↗
PubMed1976

Changing pattern of male homosexual registrations in a venereal disease clinic, 1964-1974.

Registrations of heterosexual and homosexual men, with and without gonorrhoea, as recorded at Ward 34, Newcastle General Hospital, from 1964 to 1974, show substantial rises. During this time, the number of cases of gonorrhoea in men, both heterosexually and homosecually acquired, has approximately doubled. However, the incidence of individual gonococcal re-infection would not appear to have changed significantly. More men attend with non-venereal conditions and show an increasing willingness to return. A greater co-operation between homosexuals with gonorrhoea and the social unit has evolved and a greater number of sexual contacts are now traced and examined.

England↗
PubMed1977

Giardia lamblia infection in homosexual men.

Epidemic Giardia lamblia infection has usually been associated with contaminated water. In this paper, five proved and one presumed case of G. lamblia infection among homosexual men are reported. The sequential onset of their clinical illnesses and their sexual interrelationships suggest that this outbreak could have been caused by the direct faecal-oral transmission of G. lamblia. Other parasitic diseases with possible venereal transmission have been described, and parasitic diseases should be considered in homosexual men with diarrhoea or other gastrointestinal symptomatology.

Giardiasis↗
PubMed1981

Gonorrhoea in men with homosexual contacts. Serogroups of isolated gonococcal strains related to antibiotic susceptibility, site of infection, and symptoms.

In 37 homosexual men the incidences of urethral, rectal, and pharyngeal gonorrhoea were 45.9%, 56.8%, and 27% respectively. Local symptoms were present in all men with urethral gonorrhoea but in only 25% of those with pharyngeal or rectal gonorrhoea or both. Infection at two sites was found in 29.7% of the patients. Forty-nine gonococcal isolates from the 37 patients were serogrouped by coagglutination into one of the serogroups WI, WII, and WIII, and their susceptibility to benzylpenicillin, ampicillin, cefuroxime, doxycycline, and spectinomycin tested. Only one gonococcal isolate from each patient was counted when two isolates belonged to the same serogroup and had the same antibiotic susceptibility. Thus, 15.4%, 76.9%, and 7.7% of the gonococcal strains belonged to serogroups WI, WII, and WIII respectively. There was a significantly lower incidence of WI strains and a significantly higher incidence of WII strains among men with homosexual contacts than among other patients with gonorrhoea from the same geographical region. Gonococcal strains of serogroup WI were significantly more resistant to all antibiotics tested, except to spectinomycin, than randomly chosen WI strains. Among WII and WIII strains the incidence of diminished susceptibility to all antibiotics tested was about the same.

Anti-Bacterial Agents↗
PubMed1982

Guillain-Barré syndrome associated with hepatitis A in a male homosexual.

A 48-year-old male homosexual developed the Guillain-Barré syndrome in association with acute hepatitis. The hepatitis A virus was almost certainly transmitted sexually. Since the incidence of viral hepatitis is high in active male homosexuals, they are particularly at risk of developing such complications.

Hepatitis A↗
PubMed1983

Lymphogranuloma venereum of the rectum in a homosexual man. Case report.

A male homosexual presented initially with bloody diarrhoea and a swelling in the left groin, which was unsuccessfully treated with erythromycin. Examination in hospital showed a rectal mass and an abscess in the left groin. Histological examination of the rectal mass and a positive lymphogranuloma complement fixation test result confirmed the diagnosis of lymphogranuloma venereum. This disease, although rare, should not be forgotten in the differential diagnosis of rectal problems in male homosexuals.

Adult↗
PubMed1984

Sexually transmitted diseases in homosexual men: A study of four societies.

The prevalence of venereal disease among homosexual men was investigated by looking at non-clinic patients from Sweden, Australia, Finland, and the Republic of Ireland. Results showed significant differences between nationalities in the incidence of syphilis, gonorrhoea, other sexually transmitted diseases (STD), number of variables of presentation to STD clinics, and number of infections. Data were interpreted as indicating that social and cultural factors may influence incidence of STD in male homosexuals.

Adult↗
PubMed1984

Epstein-Barr (EB) virus infection in homosexual men in London.

Twenty five homosexual men from London, 14 of whom had persistent lymphadenopathy and 11 of whom did not, were tested for immunity to Epstein-Barr (EB) virus. All yielded positive results to serological tests for the viral capsid antibody, and 11 had antibodies to the early antigen. Thirteen out of 17 were excreting virus into the saliva; culture of peripheral blood mononuclear cells from two of these patients showed no detectable regression induced by T cells that was specific to EB virus. No differences were found between the patients with and without lymphadenopathy. Peripheral blood B cells from six patients with hypergammaglobulinaemia were double stained for cytoplasmic immunoglobulin and EB viral nuclear antigen, and in all cases the activated B cells producing immunoglobulin did not contain EB nuclear antigen. Similarly, lymph node biopsy specimens from five patients showed no cells with EB nuclear antigen. These results indicate that although homosexual men have a high incidence of reactivated infection with EB virus, this viral infection is not the cause of the polyclonal activation of B cells seen in peripheral blood and is not implicated in the aetiology of the lymphadenopathy found in these men.

Adult↗