An outbreak no longer: factors contributing to the return of syphilis in Greater Manchester

The use of the Internet by gay and bisexual male escorts: sex workers as sex educators

While prior studies have targeted street-based male sex workers as potential vectors of disease transmission, the number of men who work independently through Internet chat-rooms and other online endeavors has steadily increased. It is likely that these men differ substantially from their street-based counterparts in terms of sexual risk behaviors with their clients. The purpose of this study was to explore the ways in which the Internet has impacted the work of male escorts and their sexual practices with clients. Semi-structured qualitative interviews and quantitative surveys were administered to 46 such men. Less than half the men reported unprotected anal sex with clients. The qualitative data lend support to this finding, in that the majority talked about refusing any unsafe sex with clients, and many reported taking the extra step of educating their clients about the dangers of risky sex. Some of the escorts described the methods used to incorporate safer sex practices into sessions with their clients. Internet-based male escorts can play an important role as potential sex educators on the front lines of the fight against HIV and other sexually transmitted infections.

Zunahme der Syphilis und STD-Koinfektionen bei HIV-Infizierten in Dresden

BACKGROUND

In the past few years, increased diagnoses of syphilis and other sexually transmitted diseases (STD) have been reported in the cities of the United States and Europe, including Germany. The majority of cases identified were men who have sex with men (MSM).

PATIENTS AND METHODS

A retrospective chart review of 144 HIV-infected patients from Dresden enrolled between 2000 and October 2003 was analyzed for the prevalence of syphilis and other STDs and compared with previous data of 104 patients collected between 1993 and 1999.

RESULTS

The seroprevalence of syphilis increased from 13.5% to 17.5%, mainly due to a marked increase of active early syphilis from 0% to 7% of patients, all of whom were MSM. 63% of the patients had clinical or serological signs of other STDs.

CONCLUSION

These data confirm previous reports on the increase of syphilis among MSM. The frequent occurrence of other STDs in HIV-infected patients outlines the need for special STD screening offers and adequate counseling.

Neurosyphilis

Treponema pallidum, the bacterium that causes syphilis, invades the central nervous system early in the course of disease but causes persistent infection in only a subset of infected persons. Individuals with persistent infection or asymptomatic meningitis are at risk for developing symptomatic neurosyphilis if they are not treated with a drug regimen that achieves sufficient drug levels in cerebrospinal fluid to kill the organism. In this article, recent studies that address the risk, diagnosis, and management of neurosyphilis are discussed within the context of a brief review. Particular attention is given to current controversies. In the developed world, these issues are particularly relevant to persons who are infected with HIV.

Perceived viral load, but not actual HIV-1-RNA load, is associated with sexual risk behaviour among HIV-infected homosexual men

BACKGROUND

Increases in sexual risk behaviour and sexually transmitted infections among HIV-infected homosexual men after the introduction of highly active antiretroviral therapy (HAART) confirm the need for innovative prevention activities. The present study focused on time trends in sexual risk behaviour and predictors for unprotected anal intercourse in the HAART era among HIV-infected homosexual men.

METHODS

In 2000-2003, 57 HIV-infected homosexual men (mean age 45 years) were interviewed in three serial data waves. Logistic regression, correcting for repeated measurements, was used to assess time trends in risky sex, and the association between HAART-related beliefs, and both the perceived and actual viral load level and CD4 cell counts and subsequent risky sex.

RESULTS

Risky sex with casual partners increased from 10.5% in 2000 to 27.8% in 2003 (P < 0.01), and with steady partners of negative or unknown HIV status from 5.3% to 10.7% (P = 0.6). Homosexual men with a favourable perception of their viral load were more likely to engage in subsequent risky sex with steady partners of negative or unknown HIV status than men with a less favourable perception of their viral load; this association was independent of the actual HIV-1-RNA load and CD4 cell counts.

CONCLUSION

Risky sex increased in this group of HIV-infected homosexual men. The perceived viral load, but not the actual load, is associated with subsequent risky sex with steady partners of negative or unknown HIV status. Care givers should discuss with patients not only their actual viral load and CD4 cell count but also their perceived viral load.

Syphilis and HIV: a dangerous combination

HIV and syphilis affect similar patient groups and co-infection is common. All patients presenting with syphilis should be offered HIV testing and all HIV-positive patients should be regularly screened for syphilis. Syphilis agent may enhance the transmission of the other, probably through increased incidence of genital ulcers. Detection and treatment of syphilis can, therefore, help to reduce HIV transmission. Syphilis may present with non-typical features in the HIV-positive patient: there is a higher rate of symptomless primary syphilis and proportionately more HIV-positive patients present with secondary disease. Secondary infection may be more aggressive and there is an increased rate of early neurological and ophthalmic involvement. Diagnosis is generally made with serology but the clinician should be aware of the potential for false-negative serology in both primary and, less commonly, in secondary syphilis. All HIV-positive patients should be treated with a penicillin-based regimen that is adequate for the treatment of neurosyphilis. Relapse of infection is more likely in the HIV-positive patient and careful follow-up is required.

Epidemiología de la infección por el VIH/sida y su relación con otras infecciones de transmisión sexual. Perspectivas de futuro

Over the last decade, different cross-sectional and case-control studies have shown the relationship between HIV and Sexually Transmitted infections (STI). In this sense, different reasons are found: a modification of the clinical manifestations of some STI as well as an increase of HIV infectiousness and susceptibility to HIV. The main objective of HIV/AIDS and STI surveillance includes: to assess its temporal trends, to define high risk groups and high-risk behaviours and to plan and to evaluate public health programmes. Nevertheless, classical surveillance systems are not enough to describe the real situation of HIV/AIDS and STI. Thus, an enhanced surveillance system which includes complementary resources should be implemented.