The gay report on sexually transmitted diseases

The City Clinic Cohort Study: Hepatitis B, HTLV-III/LAV, and CDC AIDS Project 24

Anticipating the availability of a safe vaccine, scientists at the Center for Disease Control (CDC) planned for a multicenter study of the prevalence, incidence, and efficacy of an experimental vaccine for hepatitis B in 1977, conducted the study among homosexual male volunteers in five collaborating sexually transmitted infection (STI) clinics in the United States from April 1978 through 1980, and concluded that the candidate vaccine was highly efficacious in preventing infections with the hepatitis B virus. Then something completely unexpected and portentous happened. Some successfully vaccinated as well as other homosexual and bisexual men began to show signs and symptoms of a rare cancer, Kaposi's sarcoma, and opportunistic infections typically associated with severe immunodeficiency. As early as October 1983, members of the Hepatitis B study cohort in San Francisco were invited to return to the city STI clinic for further examinations, testing, and confidential interviews about their sexual and other practices. CDC AIDS Project 24 was designed to help describe the natural history of AIDS, define risk factors, and predict future trends. It produced some of the earliest and most convincing scientific evidence about the seriousness and extent of the AIDS epidemic among homosexual and bisexual men in the United States. How the City Clinic Cohort Study came about and evolved is the focus of this commentary.

And the Band Played on: Before and After

In fall 1987, Randy Shilts published his second book, "And the Band Played on: Politics, People, and the AIDS Epidemic." The jacket proclaimed that "the epidemic spread widely because the federal government put budget ahead of the nation's welfare; health authorities placed political expediency before the public health; and scientists were more often more concerned with international prestige than saving lives." In the Prologue Shilts wrote, "The bitter truth was that AIDS did not just happen to America-it was allowed to happen by an array of institutions, all of which failed to perform their appropriate tasks to safeguard the public health." This essay reviews the controversial book published by Randy Shilts 30 years ago in light of some of the events that have followed. First, the context and content of the book-and reactions to its publication-are summarized. Secondly, several major developments after publication of the book are noted. Thirdly, a critical assessment of the author and his work is offered in an era when some politicians and physicians in the United States are imagining "an AIDS-free generation."

Evolution of the syphilis epidemic among men who have sex with men

Syphilis has existed for millenni, but its epidemiology was only recently linked to men who have sex with men (MSM) after the introduction of penicillin in the 1940s; the syphilis epidemic became concentrated within the MSM community in subsequent decades. The HIV/AIDS epidemic in the 1980s led to a surge of new syphilis cases and revealed the potentiation between HIV and syphilis, as evidenced by a shift in the natural history of neurosyphilis. In response, MSM revolutionised their sexual behaviour by implementing community-driven seroadaptive strategies to stem HIV transmission. The Centers for Disease Control in the US called for the elimination of syphilis in the late 1990s since the rates had fallen sharply but this effort was overtaken by a resurgence of global outbreaks among MSM in the 2000s, many of which were linked to methamphetamine use and sexual networking websites. Syphilis remains highly prevalent today, especially among MSM and individuals infected with HIV, and it continues to present a significant public health conundrum. Innovative syphilis prevention strategies are warranted. MSM engaging in high-risk behaviour such as condomless anal receptive intercourse, sex with multiple partners or recreational drug use should be routinely screened for syphilis infection; they should also be counselled about the limits of seroadaptive behaviours and HIV pre-exposure prophylaxis as they relate to syphilis transmission.

Syphilis in the United States: on the rise?

Syphilis rates and trends vary by population subgroup. Among men who have sex with men (MSM), rates of primary and secondary (P&S) syphilis are high throughout the USA (228.8 per 100,000 in 2013). P&S syphilis among women is much less common (0.9 per 100,000 in 2013) and occurs in isolated outbreaks plus in a few counties with persistent low levels of infection. Congenital syphilis trends closely follow P&S trends among women. These trends have implications for prevention. Routine screening among MSM can prevent tertiary syphilis, but despite interventions, rates of infection continue to rise among MSM and will soon approach those last seen in 1982 (estimate: 340.7 per 100,000). Control of syphilis among women is possible and important because it often leads to congenital syphilis. Outbreaks among heterosexuals can be halted by intensive screening, treatment and partner notification.

The syndemic of AIDS and STDS among MSM

The spread of HIV and other STDs among men who have sex with men (MSM) has been labeled a syndemic because in this population a number of different and interrelated health problems have come together and interact with one another. The various elements of the syndemic have an additive effect, each one intensifying the others. These factors include the number of infectious diseases endemic in this population, the high rate of substance abuse problems and psychological disorders, and the significant percentage of MSM who have experienced childhood sexual abuse and other adverse events. While MSM are disproportionately affected by HIV, syphilis, and other STDs, health activists from the gay community have systematically resisted the application of the full range of public health strategies traditionally used to prevent their spread. In the more than three decades since the beginning of the HIV/AIDS epidemic, there have been substantial advances in testing and treatment, yet the infection rate among MSM, and particularly young MSM, remains high, even as it has been dropping among other risk groups. This paper deals with the history of the syndemic, the failure of various risk reduction strategies, and treatment as prevention.

Presence of an HIV Testing Program Lowers the Prevalence of Unprotected Insertive Anal Intercourse inside a Gay Bathhouse among HIV-negative and HIV-unknown Patrons

This study sought to determine whether the presence of HIV testing inside a gay bathhouse reduced sexual risk behavior among patrons. A two-stage, time probability, cluster sample design recruited men exiting a northern California bathhouse in the last 5 weeks of 2001 (N=440), when no HIV testing was offered inside the bathhouse, and again in the last 5 weeks of 2002 (N=412) when HIV testing was offered 5 days a week. Separate logistic regression analyses compared a 2002 HIV testing exposure subgroup to both a 2001 non-exposure subgroup and a 2002 non-exposure subgroup for differences in sexual risk behavior during the bathhouse visit. Prevalence of unprotected insertive anal intercourse was significantly lower in the 2002 exposure subgroup than in the 2002 non-exposure subgroup. Similar results obtained when HIV-positive respondents were excluded. These results indicate on-site HIV testing has a preventive effect on some sexual risk behavior inside the bathhouse.

Gay bathhouse HIV prevention: the use of staff monitoring of patron sexual behavior

Many HIV prevention interventions have been launched in gay bathhouses and sex clubs since the onset of the AIDS epidemic, such as condom distribution and HIV testing. Perhaps none of these are as intrusive to the venue's environment as what is called "monitoring," which involves staff, during every shift, repeatedly walking throughout the public areas of a bathhouse to check on patrons' sexual behavior. Yet, monitoring has received little evaluation. Between 2002 and 2004, we conducted qualitative interviews with venue managers, staff and patrons in New York City, Los Angeles, and the San Francisco Bay Area. An analysis found that monitoring was influenced by the kinds of space available for sex, suggesting three approaches to monitoring: 1) monitoring all sex in clubs that only had public areas where men had sex ; 2) monitoring some sex in clubs with private rooms for sex; and 3) no monitoring of sex, regardless of the kinds of space for sex. This paper explores each approach as described by club managers, staff, and patrons to understand the potential effectiveness of monitoring as an HIV prevention intervention.

Building stakeholder partnerships for an on-site HIV testing programme

Because of the large number of individuals at risk for HIV infection who visit gay saunas and sex clubs, these venues are useful settings in which to offer HIV outreach programmes for voluntary counselling and testing (VCT). Nevertheless, establishing a successful VCT programme in such a setting can be a daunting challenge, in large part because there are many barriers to managing the various components likely to be involved. Using qualitative data from a process evaluation of a new VCT programme at a gay sauna in California, USA, we describe how the various stakeholders overcame barriers of disparate interests and responsibilities to work together to successfully facilitate a regular and frequent on-site VCT programme that was fully utilized by patrons.

Of pride and prejudice: the role of sociology and social networks in integrating the health sciences

Calls have been issued for understanding the "contexts" or "environment" shaping the causes and consequences of health and health care. Existing efforts raise concerns about how a panorama of influences can be considered simultaneously. Sociology's view of contexts as social network structures that shape and are shaped in social interaction offers one key to resolving this dilemma. Because social networks have become central in the social, natural, and physical sciences, this perspective provides a common platform for bringing in sociology's rich theoretical and methodological insights. Yet, to do this well, three conditions must shape our response. First, all levels relevant to health and health care must be considered, separated out, and linked by network mechanisms. The genetic-biological level, perhaps the most foreign level to sociologists, represents the greatest need and best prospect for advancing a sociologically based solution. Second, room must be made to tailor models to populations, whether defined socially or medically. Third, sociologists must find a voice within "big science " to address problems from social construction to social causation that contribute to basic social processes as well as health. I trace developments in the Network-Episode Model as one theoretical starting point.

Public health policy and gay bathhouses

Public health policy on bathhouses has been limited and poorly documented. This volume is intended to expand policy-makers' and prevention-professionals' knowledge and awareness about gay bathhouses. The present paper provides a context and an overview for the volume by describing the bathhouse environment and how it differs from other public sex environments, and by describing public policies that have been implemented.

Number and distribution of gay bathhouses in the United States and Canada

Although gay bathhouses have been the subject of debate and some public health policy for decades, the relative number and geographic distribution of these establishments has not been described. As a result, it is easy to miss or ignore them in making public policy in response to discase prevention. No straightforward methodology for such a description is available, so we used a series of gay travel books, first published in 1965 by the Damron Company, to estimate this distribution in the United States and Canada. Each of the annual guides published from 1968 to 1999 were reviewed for listings of bathhouses and sex clubs. The results suggest that bathhouses and other similar establishments exist in most states and provinces and in most large and many moderate-sized cities. Furthermore, the largest numbers of listings for bathhouses were in the same six cities across the decades, three in the U.S. and three in Canada. The greatest change in the number of listings was seen in the three U.S. cities where a public policy of closure was attempted. Nevertheless, the numbers of venues in these three cities have been increasing again since the early 1990s, although nothing near the numbers of listings in the late 1970s and early 1980s.

Dogma disputed: potential endemic heterosexual transmission of human immunodeficiency virus in Australia

The concept of tertiary sexual transmission of human immunodeficiency virus (HIV) has been central to government efforts to communicate notions of risk to heterosexuals in Australia. Data on heterosexually transmitted acquired immune deficiency syndrome (AIDS) and HIV for Australia are reviewed with emphasis given to the probability of misclassification bias in the heterosexually acquired and 'other/undetermined' categories. Tertiary cases are almost certainly rare in Australia, with little evidence of any increase in their incidence since the first cases were recorded. Three factors (low probability of exposure, the infectivity of HIV and a comparatively low rate of sexual partner change) make it improbable that Australian heterosexuals with no risk factors will experience endemic HIV infection, with a caveat to this conclusion lying in the potential of Australian sex tourism to Southeast Asia for introducing HIV into the Australian heterosexual population. Four hegemonic factors which have acted to suppress any serious debate of the notion that HIV in Australia is unlikely to become endemic among heterosexuals are discussed: the political 'democratization' of risk inspired by concerns that gay men should not be further vilified as a victim group; the preventive imperative; a reluctance among health educators to question the very foundations of the message they are employed to deliver; and a reluctance to curtail 'Trojan horse' benefits to sexually transmissible disease prevention engendered by HIV education promoting safe sex messages.

The HIV test and sexual behaviour in a sample of homosexually active men

This paper aims to assess the effects of voluntary anti-HIV testing on homosexual sexual behaviour. A sample of 502 men were recruited from four different areas of England. The criterion for inclusion was 'any man who had had sex with another man in the previous 5 years'. Men were interviewed about their recent sexual behaviour, histories of sexually transmitted diseases, experience of HIV tests and attitudes to the test. Men with a history of sexually transmitted diseases were more likely to have had the test. Thirty-one percent of men reported passive anal sex in the last month and 19% had had unprotected passive anal sex. These behaviours were most often reported by those testing HIV antibody positive and least by those never tested. The findings suggest that homosexually active men who volunteer for an anti-HIV test are broadly similar to those who do not. The absence of any clear effects of the test alone on sexual behaviour suggests that the quality of counselling in this area needs urgent attention.

Sexually transmitted diseases of the colon, rectum, and anus. The challenge of the nineties

During the past two decades, an explosive growth in both the prevalence and types of sexually transmitted diseases has occurred. Up to 55 percent of homosexual men with anorectal complaints have gonorrhea; 80 percent of the patients with syphilis are homosexuals. Chlamydia is found in 15 percent of asymptomatic homosexual men, and up to one third of homosexuals have active anorectal herpes simplex virus. In addition, a host of parasites, bacterial, viral, and protozoan are all rampant in the homosexual population. Furthermore, the global epidemic of AIDS has produced a plethora of colorectal manifestations. Acute cytomegalovirus ileocolitis is the most common indication for emergency abdominal surgery in the homosexual AIDS population. Along with cryptosporidia and isospora, the patient may present to the colorectal surgeon with bloody diarrhea and weight loss before the diagnosis of human immunodeficiency virus (HIV) disease. Other patients may present with colorectal Kaposi's sarcoma or anorectal lymphoma, and consequently will be found to have seropositivity for HIV. However, in addition to these protean manifestations, one third of patients with AIDS consult the colorectal surgeon with either condylomata acuminata, anorectal sepsis, or proctitis before the diagnosis of HIV disease. Although aggressive anorectal surgery is associated with reasonable surgical results in some asymptomatic HIV positive patients, the same procedures in AIDS (symptomatic HIV positive) patients will often be met with disastrous results. It is incumbent upon the surgeon, therefore, to recognize the manifestations of HIV disease and diagnose these conditions accordingly.

Possible correlation between exposure to AIDS risk factors, clinical presentation in AIDS, and subsequent prognosis

AIDS-related Kaposi's sarcoma (KS) has a better prognosis than other presentations of AIDS. It is more frequent among homo-bisexual men than in other risk groups. This has raised the possibility of specific etiological agent(s) or co-factor(s) which induce its development. However, this suggestion is confusing since it implies that exposure to such agent(s) or co-factor(s) would result in an improved prognosis. Recent virological studies indicate that the HIV itself could be responsible for the induction or growth of KS. Since HIV antigenemia and the immunosuppression are lower among KS cases than among those with opportunistic infections (OI), we could expect a lower level of exposure to AIDS-related factors in KS cases as compared to OI cases. To investigate this possibility, we compared 25 cases with Kaposi's sarcoma alone (KS) with 25 cases having OI without KS, among homo-bisexual men. The KS cases were more likely than OI cases to have a higher educational level. They were less likely to have inhaled nitrites, to have had repeated syphilis and repeated gonorrhoea, and to be promiscuous. In the multivariate analysis, the factors which best discriminated the groups were nitrite inhalations, history of repeated syphilis, and anonymous promiscuity ("one-night stands"). Our study does not support the hypothesized association between nitrite inhalations and Kaposi's sarcoma. We found that cases with opportunistic infections - that is, with a poor prognosis - had been exposed to AIDS-related risk factors (e.g. history of venereal diseases, nitrite inhalations, promiscuity) at higher levels than cases with Kaposi's sarcoma alone.(ABSTRACT TRUNCATED AT 250 WORDS)

[Seroprevalence and risk factors for syphilis in prisoners in Goiás, Brazil]

A cross-sectional survey was carried-out among 299 prisoners in the Penitentiary Center of Industrial Activity of Goiás (CEPAIGO), to determine the seroprevalence to T. pallidum and to identify risk factors associated to seropositivity. The seropositivity criterion was a positive VDRL test at any titer. A questionnaire was applied to evaluate the following risk factors: time of imprisonment, clinical evidence of sexually transmitted diseases (STD), history of syphilis or others STD, homo/bisexuality and number of sexual partners. The positive (PPV) and negative (NPV) predictive values of the history of syphilis were calculated. Seroprevalence of 18.4% was found and no difference was detected in the different age groups. The PPV of history of syphilis was 26% indicating that 74% of the individuals who have reported syphilis in the past presented a negative VDRL test. Among all the risk factors studied, homo/bisexuality was the only one with statistically significant association with seropositivity (relative risks 5.7-95% CL1.2-26, p = 0.03). The paper discusses the methodological problems related with the investigation.

Factors distinguishing homosexual males practicing risky and safer sex

A longitudinal study of patterns of sexual behavior among asymptomatic, homosexual males in New York City was conducted. Participants were interviewed at two time points, 6 months apart. Based on their reports of sexual behavior during a recent 'typical' month, respondents were classified at each time point as engaging in safer (or low-risk) sexual practices versus high-risk sexual behaviors. Discriminant analysis was employed to distinguish the 53 males classified as risky at both time 1 and time 2 from the 47 males classified as safer in both periods. Statistically significant discrimination was achieved with 10 psychosocial predictor variables, four of which were significant while controlling for all other variables in the model. Of these predictors, drug use within sexual contexts was particularly noteworthy, since it provided the greatest relative contribution to the discriminant function and appears to be an important candidate for educational intervention. Other significant variables included perceived adequacy of emotional support, number of years engaged in regular sexual intercourse with other males, and perceived difficulty in modifying sexual behavior. Self-esteem and alcohol consumption approached significance.

Sexually transmitted diseases in homosexual adolescents

In 1986, an estimated 13 million cases of sexually transmitted diseases (STDs) were diagnosed in the United States, with the highest incidence rates occurring within the adolescent age group. Homosexual adolescent men are at particularly high risk for STDs. Because of the myriad clinical presentations of STD in gay men, these diseases are often not recognized as being sexually transmitted. In this paper, the epidemiology and clinical features of STDs in gay adolescents are discussed. The sexual history is emphasized as an integral tool in developing a differential diagnosis. A priori, the sexual history also can give a risk-assessment profile for STD. Clinical aspects of STD are reviewed using a syndrome approach, and the diagnostic workup is outlined for the etiologic agents most likely implicated in each syndrome. Clinical signs and symptoms of urethritis, genital ulcers and papular lesions, pharyngitis, and hepatitis are reviewed. Sexually acquired gastrointestinal disorders are described. As the AIDS epidemic continues, disease prevention, risk reduction, and patient education are becoming more important. Current recommendations for "safer sex" practices are reviewed.

Risk factors for A.I.D.S. among homosexual men in France

To identify risk factors for A.I.D.S. among homosexual men in France, a high-risk group in a moderate-incidence area, we undertook a case-control study in Paris and its suburbs. Fifty-three cases were compared to 99 controls from a venereal disease clinic and 79 controls from the staff of an amateur gay broadcasting station. In our univariate analysis, cases were more likely than controls to belong to upper socio-economical classes, to have used local corticosteroids, to have regularly inhaled nitrites, to report history of syphilis and of herpes infections, to have higher level of promiscuity with occasional partners ("one night stands"), and to have had sexual encounters in the U.S.A. In the multivariate analysis, history of syphilis and promiscuity with occasional partners appeared to be the main risk factors, as well as the use of local corticosteroids, especially during the prodrome period. The correlation between promiscuity and disease risk was weak in our study when we did not discriminate between occasional and regular sex partners, contrary to that found in epidemiological studies of A.I.D.S. and H.I.V.-seropositivity in high-incidence areas. In association with the history of syphilis, the development of the syndrome in our moderate-incidence country is more correlated to the contact with "one-night-stand" partners rather than to the total number of the sex partners. The public health policies in our area should be adapted to these findings. Otherwise they may be less efficient than hoped.

Sexually transmitted diseases and the use of condoms in a cohort of homosexual men followed since 1983 in Finland

High rates of sexually transmitted diseases (STDs) were recorded among 235 homosexually active men at the start of a prospective follow-up study in June 1983 in Finland. The vast majority (88.5%) reported at least one STD, the most common of them being pubic lice (64.7%) followed by gonorrhoea (42.9%) and non-gonococcal urethritis (26.4%). Those 31 (13.2%) who were seropositive for HIV at the end of the study, had experienced more episodes of STDs than the seronegative individuals (p = 0.0027). Nine HIV seroconversions were noted during the follow-up of 5-40 months, all in individuals who had practised "unsafe" sex. The study participants were repeatedly given detailed advice for avoiding HIV infection, and a tendency towards "safer" sexual practises resulting in a decrease in incidence of most STDs, was noted during the course of the study. However, further spread of HIV is to be expected because 57% of the men still reported practising and sex at the end of the follow-up, and 42% of them without condoms.

Risk factors for human immunodeficiency virus (HIV) infections in homosexual men

To clarify risk factors for infection with the human immunodeficiency virus (HIV) we selected at random 785 homosexual men who had participated in studies of hepatitis B in San Francisco in 1978-80 for a follow-up study of the acquired immunodeficiency syndrome. Although most had not been contacted in over five years, 492 (63 per cent) were located and enrolled. The 240 (67 per cent) who had developed antibodies to HIV, as measured by an enzyme-linked immunosorbent assay (ELISA), were compared with 119 who had remained seronegative. In multivariate analyses, receptive anal intercourse with ejaculation by nonsteady sexual partners, many sexual partners per month, and other indicators of high levels of sexual activity were highly associated with seroconversions. None of the sexual practices that we studied appeared to offer protection against HIV infection.

Detection of hepatitis B virus DNA in spermatozoa, urine, saliva and leucocytes, of chronic HBsAg carriers. A lack of relationship with serum markers of replication

Urine, saliva and semen from 18 chronic HBsAg carriers, material that might be concerned in the transmission of hepatitis B virus infection, was examined for the presence of HBV-DNA using molecular hybridisation. HBV-DNA was detected in samples from 14 patients: semen was positive in all of these, saliva in 12 and urine in 10. Autoradiographic studies indicated that HBV-DNA was present in the free form in all cases and in 10, higher molecular weight bands were also observed. While the latter suggested integration of HBV-DNA into host chromosome, resolution to 3.2 Kb following digestion with Eco RI in every case was more consistent with the HBV-DNA being free. In a further group of patients peripheral blood leucocytes were also found to contain HBV-DNA and were the likely source of HBV-DNA in saliva and urine, while in semen both spermatozoa and mononuclear cells contained HBV-DNA. Moreover, free HBV-DNA was identified in the semen of patients without markers of viral replication in serum indicating that sexual transmission could still occur and this is of importance in relation to current vaccination policies.

[Deliberations and computer computations on the epidemiology of the acquired immunodeficiency syndrome in the Federal Republic of Germany]

A computer simulation of the morbidity and mortality rates of the "Acquired Immunodeficiency Syndrome" in the Federal Republic of Germany was performed. Since sexual intercourse is the main mode of transmission, the population was divided into six groups with different sexual behaviour. In several variations of the program it is demonstrated that during the next 15 years up to 41,000 AIDS patients can be expected. The importance of female prostitutes and male bisexuals as "vectors" who may transmit the infection into exclusively heterosexual groups is shown. Using this program, the effect of prophylaxis against infection as well as of changes of sexual behaviour within the population at large can also be examined.

Prevalence of antibody to LAV/HTLV-III among homosexual men in Seattle

The prevalence of antibody to LAV/HTLV-III among homosexual men attending a community clinic and a sexually transmitted disease clinic in Seattle, Washington in early 1985 was 42 per cent and 32 per cent, respectively. Seropositivity was apparently not related to age or number of sexual partners. The high prevalence of LAV/HTLV-III seropositivity in an area where overt AIDS (acquired immune deficiency syndrome) is still relatively uncommon suggests that public health measures to prevent acquisition and transmission of LAV/HTLV-III should be a high priority even in areas with low incidences of AIDS.

The clinical approach to the male homosexual patient

A history of sexual orientation, practices, and life styles, a complete review of organ systems, and a thorough physical examination are unique but essential elements of the examination of homosexual men. Laboratory screening should take into account the incubation period for infections, the risk for infection based on sexual practices, and cost. Physicians should counsel homosexual men about all aspects of a healthy life style; for this advice to be accepted, however, physicians must develop a relation with their homosexual patients that is based on awareness, expertise, and mutual understanding.

Social and behavioral aspects of male homosexuality

This article describes some of the social and behavioral aspects of homosexual life styles, with particular reference to their implications for diagnosis, treatment, and continuing medical management. The cultural, psychologic, and sexual variables that may necessitate varying the management of homosexual or bisexual men compared with heterosexual men are emphasized. Areas of psychosomatic involvement, and the influence of social support and stigmatization on presentation and response, are also discussed.

Adolescent homosexuality. Issues for pediatricians

Homosexuality is among the most complex and controversial issues of adolescent health care. Although homosexual activity is common during adolescence, the prevalence and origins of homosexuality per se are poorly understood. Homosexual identity formation is a potentially tumultuous process that begins in childhood and extends through adulthood. The adolescent's experiences may ultimately contribute to a variety of physical and mental health problems. The sociological, psychological, and medical issues are considered, and guidelines for the care of homosexual youths are proposed.

Syphilis, hepatitis A and hepatitis B seromarkers in homosexual men

Two hundred homosexual men were investigated for prevalence rates of syphilis, hepatitis A (HAV) and hepatitis B (HBV). A reactive Treponema pallidum haemagglutination test (TPHA) was found in 56.3% of the participants. In 81.7% HBV seromarkers were detected. Hepatitis B surface antigen (HBsAG) was present in 6.6%. Anti-HAV was found in 51.0%. Risk factors for acquisition of these infections are discussed.

AIDS surveillance and health education: use of previously described risk factors to identify high-risk homosexuals

Previously defined "risk factors" in homosexuals with Kaposi's sarcoma may not be causative of AIDS (acquired immune deficiency syndrome) but are an important tool in identifying segments of the homosexual population who are at increased risk for the development of AIDS and who may benefit from health education and surveillance efforts. The epidemiologic characteristics of such a group of homosexuals from a low incidence area (Pittsburgh, PA) are examined and several factors which may account for differences in incidence are briefly discussed.

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.

Syphilis, hepatitis A, hepatitis B, and cytomegalovirus infection in homosexual men in Antwerp

In a homosexual communication centre in Antwerp 196 homosexual men were screened for seromarkers of syphilis, hepatitis A (HAV), hepatitis B (HBV) and cytomegalovirus (CMV). A comparison group consisted of 118 heterosexual men attending a venereal disease clinic in Antwerp. Treponemal antibodies were found in 7.1% of homosexual men, of whom half gave no history of past or present infection. Anti HAV was present in 43.3%, HBV seromarkers in 34.4%, and CMV antibodies in 71.2% of homosexual men. Hepatitis B surface antigen (HBsAg) was detected in eight homosexual men, but not in the heterosexual control group. Prevalence rates of infections other than HAV were significantly higher in homosexual men than in heterosexual men. Answers to a questionnaire were used to evaluate risk factors for different diseases, which were: duration of active homosexuality for all infections, promiscuity (greater than or equal to 10 partners in the past six months) for syphilis and hepatitis B, and anal intercourse for hepatitis B. Visiting saunas and travelling for sexual contacts also indicated a higher risk for STD, but were an indirect expression of promiscuity.

Risk factors for Kaposi's sarcoma in homosexual men

An investigation of 20 homosexual men with histologically confirmed Kaposi's sarcoma and 40 controls revealed significant associations between Kaposi's sarcoma and use of a number of drugs (amyl nitrite, ethyl chloride, cocaine, phencyclidine, methaqualone, and amphetamine), history of mononucleosis, and sexual activity in the year before onset of the disease. Patients with Kaposi's sarcoma also reported substantially higher rates of sexually transmitted infections than did controls. Multivariate analysis indicated independent significant associations for amyl nitrite and sexual activity and showed use of phencyclidine, methaqualone, and ethyl chloride to be non-significant. Evaluated at the median exposure for patients, the analysis yielded risk-ratio estimates of 12.3 for amyl nitrite (95% confidence limits 4.2, 35.8) and 2.0 for sexual activity (95% confidence limits 1.3, 3.1).

Enteric diseases of homosexual men

Certain enteric ailments are particularly common among homosexual men. They are primarily infectious diseases and include not only such common venereal diseases as gonorrhea and syphilis but also infections not usually regarded as being sexually transmitted. Among the latter are shigellosis, salmonellosis, giardiasis, and amebiasis. Patients' symptoms are non-specific and seldom helpful in diagnosing particular diseases. The practitioner must be prepared to identify a number of infections with similar presentations that may occur singly or together in gay men. Gonorrhea is probably the most common bacterial infection in gay men. Carriage rates as high as 50% have been reported, and extra-genital carriage is common; this necessitates culturing the urethra, rectum, and pharynx. Procaine penicillin G is the treatment of choice for most patients; spectinomycin is probably the drug of choice in penicillin-sensitive patients. In contrast to other venereal diseases, syphilis may have a characteristic protoscopic presentation. Benzathine penicillin G is the treatment of choice for most patients. Lymphogranuloma venereum causes penile lesions and inguinal lymphadenitis in heterosexual men, whereas homosexual men are more prone to proctitis. The disease may mimic Crohn's disease. Recommended treatment includes tetracycline or sulfamethoxazole-trimethoprim. Shigellosis usually presents as an acute diarrheal illness. Patients generally require only supportive treatment with fluids. Herpes simplex viral infection is difficult to diagnose and has several different presentations, including lumbosacral radiculomyelopathy. Symptomatic treatment with sitz baths, anesthetic ointment, and analgesics is recommended. Venereal warts are believed to be caused by the same virus that causes verrucous warts; they are usually found in the anal canal or around the anal orifice. They are commonly treated with 25% podophyllin solution. Parasitic infections include giardiasis, amebiasis, and pinworm infections. Metronidazole may be used in the treatment of symptomatic giardiasis and amebiasis, but it is not approved for the former indication; quinacrine is approved for giardiasis. Pinworm infestation may be treated with pyrantel pamoate or mebendazole. Cure of enteric diseases in homosexual men must be documented.