Thrombocytopenia in homosexual men

The office records of two private practices with a preponderance of homosexual patients were reviewed for cases of males with unexplained thrombocytopenia. Twenty-five patients meeting the selection criteria were found. The clinical and laboratory features of these patients were reviewed and compared to those characteristically seen in classic autoimmune thrombocytopenic purpura. The mean age of the group was 36.5 years. There was a high incidence of a history of sexually transmitted diseases. Sixty percent had another hematologic abnormality in addition to thrombocytopenia. The clinical outcomes for these 25 patients were as follows: eight (32%) had a spontaneous increase in platelets; four (16%) had a stable count not requiring therapy; 12 (48%) received high-dose prednisone; seven (28%) failed prednisone therapy and went on to splenectomy; two (8%) subsequently developed CDC-defined AIDS.     

Increased prevalence of cytomegalovirus antibodies in homosexual men with syphilis: relation to sexual behaviour

Serum samples from 146 homosexual males, 40 heterosexual males and 51 females with at least one episode of syphilis were tested for the presence of IgG and IgM antibodies against cytomegalovirus (CMV IgG and CMV IgM). 100 blood donors served as a control group. CMV IgG was present in 95% of homosexual men compared with 68% of heterosexual men (p less than 0.001) and 73% of females (p less than 0.001) with past or present syphilis. CMV IgM was found in 43-68% of the venereal patients and with the highest percentage in homosexual men. Only 7% of blood donors had CMV IgM. It is concluded that CMV infection may be regarded as a venereal disease.     

Cryptosporidiosis in homosexual men

Between April 1982 and June 1983, cryptosporidiosis was diagnosed in six homosexual men. Four patients with the acquired immunodeficiency syndrome had lymphopenia, cutaneous anergy, and profoundly impaired cellular immunity; their cryptosporidiosis was severe, unremitting, and refractory to all therapy. Two patients without other opportunistic infections or Kaposi's sarcoma had moderately impaired cellular immunity but not lymphopenia or anergy; their enteric illness was self-limited. Cryptosporidium recently had been recognized as a human pathogen that is transmitted through fecal-oral contamination. The severity of human cryptosporidiosis appears to be determined primarily by immunocompetence of the patient. These six homosexual men, with different degrees of immunologic impairment, had two clinically divergent forms of cryptosporidiosis. Their cases raise questions about human transmission of Cryptosporidium and the prognostic significance of this disease in patients who are at high risk for developing the acquired immunodeficiency syndrome.     

Recent sexual behaviors among homosexual men seeking primary medical care

We studied the sociodemographic characteristics, knowledge, and beliefs about acquired immunodeficiency syndrome transmission and sexual practices of 823 gay or bisexual men seeking primary care. During the previous 2 months, 64% had engaged in at least one sexual behavior considered unsafe. These patients compared with those having safer sex, were younger, of lower socioeconomic status, and from a racial minority, especially Latino. The unsafe group also had more sexual partners, engaged in sexual acts more often, felt less in control over their sexual behavior, used recreational drugs more frequently, and were less likely to talk about safe sex with partners. The unsafe group had less adequate knowledge about human immunodeficiency virus transmission but felt safer from the risk of acquired immunodeficiency syndrome even when engaging in unsafe sex. Educational programs dealing more directly with belief systems and the potential addiction to recreational drugs and sexual behaviors need to be developed for primary care settings.     

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.     

Rectal lymphoma in homosexual men

Lymphoma of the rectum is a rare tumor and in most studies is not separated from other lymphomas of the large intestine. We have recently examined four homosexual men with lymphoma presenting in the rectum. Symptoms included rectal bleeding in three, pain on defecation in two, and mucoid rectal discharge in two. Systemic "B" symptoms (ie, fever, night sweats, and/or weight loss), as well as a rectal mass, were present in all four. All were high-grade tumors, with B-cell immunoblastic sarcoma in two and small noncleaved Burkitt-like lymphoma in two. Intracytoplasmic immunoperoxidase staining revealed monoclonal kappa light chains in three tumors, whereas the fourth was nonstaining. Immunologic abnormalities were similar to those reported in patients with acquired immunodeficiency syndrome. Antibodies to human T-cell lymphotropic virus type III were found in the three cases tested, and retrovirus was cultured from lymphomatous tissue in one. Despite multiagent chemotherapy, two patients died within six months of diagnosis and a third has recently suffered relapse within the central nervous system.     

Clinical manifestations of primary hepatic angiosarcoma

Malignant tumors of the liver stemming from mesenchymal origins are rare neoplasms, <1% of primary malignant hepatic lesions. Primary hepatic angiosarcoma (PHA) is the most common (36%). This study describes the incidence and clinical characteristics of this rare tumor in two medical centers, over the past 18 years. We reviewed tumor registry files at Jackson Memorial Hospital and oncology data records at Cedar's Medical Center, 1979–1997. A total of 865 primary hepatic tumors were identified, of which five cases (0.58%) were PHA; four were men, and the median age was 53 years. Symptoms and signs included: pain, anemia, fever of unknown origin, weight loss, abdominal mass, and hemoperitoneum. Median survival was only 6 months. In conclusion, primary hepatic angiosarcomas frequently are symptomatic. The presentation and preexisting factors are valuable in establishing a clinical suspicion to diagnose this rare tumor. Although imaging studies are helpful, they are not conclusive, and liver biopsy is usually required.     

Sleep disturbances in HIV-infected homosexual men

To provide a better understanding of the etiology of subjective sleep complaints in HIV-infected individuals, a study to evaluate sleep/wake disturbances in 10 healthy HIV-infected male volunteers was performed. All subjects were HIV-infected but had no history of AIDS-related infections, and considered clinically asymptomatic. Interviews and sleep questionnaires revealed sleep complaints in nine subjects. Five healthy HIV-seronegative male subjects, with no history of sleep complaints, were also evaluated. Sleep architecture analyses detected that, in comparison to published normative data and to negative controls, there was a significant increase in the total percentage of slow wave sleep (SWS) and an increase in the percentage of SWS in the later sleep cycles. When compared with normative data, an increase in stage 1 shifts, rapid eye movement (REM) periods, and arousals were also observed in the HIV-infected group. Significant decreases in sleep latency, total percentage stage 2 sleep, and average REM durations were also observed in the HIV-infected group compared with normative data. These sleep architecture abnormalities could not be attributed to known sole primary sleep disorders, first night effect, medications, anxiety or depression. This study indicates that sleep disturbances occur early in the course of HIV infection and suggests that the observed alterations of sleep physiology may be a consequence of central nervous system involvement and/or immune defense mobilization in the early phases of HIV infection.     

Parasitic infections in asymptomatic homosexual men

The purpose of this study was to develop a cost-effective strategy for screening for enteric protozoan infections in homosexual men without gastrointestinal symptoms suggesting infection. One hundred and one homosexual men in Portland, Oregon, each submitted at least one unpurged stool sample: 91% submitted three samples each. Of these, 27% had Entamoeba histolytica, 61% had nonpathogenic protozoa with or without E. histolytica, 36% had a nonpathogen alone, and 3% had Giardia lamblia. Protozoan infection was highly associated with the practice of anilingus (p<0.05). Infection with E. histolytica correlated significantly with the presence of nonpathogenic protozoa (p<0.005). The following screening strategy was judged to be the most cost-effective: examine one sample first; if E. histolytica is found or if the sample is negative, no further investigation is required; if a nonpathogen is found, one additional sample should be obtained. This strategy had a sensitivity for E. histolytica of 85% and a cost of $136 per case detected. Supported by the Oregon AIDS Task Force and NIH BRSG grant no. S07RR05593-17.     

Prevalence of cytomegalovirus infection in homosexual men

Cytomegalovirus (CMV) was cultured from the urine of 14 of 190 homosexual but none of 101 heterosexual men attending a venereal disease clinic (P less than 0.005). Viruria was confined to men less than 30 years of age and was present in 14% of this group. Antibody to CMV was measured in the sera of 139 homosexual and 70 heterosexual men attending the same clinic and in 103 male volunteer blood donors. Titers were found in 94% of homosexual patients but in only 54% of heterosexual patients (P less than 0.005) and 43% of male volunteer blood donors (P less than 0.005). The data suggest that sexual transmission is an important mode of spread of CMV among adults and the homosexual men are at greater risk for CMV infections than are heterosexual men. Homosexual men might considered candidates for the evaluation of the efficacy of CMV vaccines in preventing horizontal transmission of infection.     

Condom use among homosexual men

A postal questionnaire survey of 262 homosexual men was carried out to investigate patterns of sexual behaviour and the use of condoms. Two hundred and twenty-nine of these subjects had been sexually active during the past year, with the mean number of male sexual partners being 8.09. One hundred and eighty men engaged in oral sex, and 117 ejaculated during this activity, of whom 103 (88%) did not use a condom. One hundred and sixteen men had engaged in insertive anal intercourse in the past year, and 102 had ejaculated during this activity. Of these, 32 did not use a condom. Some, however, only engaged in this activity within a monogamous relationship. The overall proportion of men who continued to engage in very high-risk sexual activity was small, however a different picture emerged if the sample was analysed in terms of the number of encounters with different men during the past year. Of the total estimated number of such encounters, almost half involved anal intercourse, and about half of these were unprotected. The reason for the apparent discrepancy is that those who continue to engage in high risk behaviour tend to be particularly sexually active.     

梅毒的眼部表现

梅毒螺旋体可侵犯眼的各层组织,其临床表现可因梅毒螺旋体累及眼的不同组分而异,其中以葡萄膜炎最为常见。该文就各期梅毒中主要的眼部表现做一综述。     

Intestinal protozoa in homosexual men in Edinburgh

Our objective was to determine the prevalence of intestinal protozoa in homosexual men attending a sexually transmitted diseases (STD) clinic, to compare it with the prevalence in a previous study from the same clinic, and to examine the relationship, if any, between the presence of protozoa and sexual practices. Men who consecutively attended the clinic and who gave a history of having had recent sexual contact with another male were invited to provide a stool sample for protozoological examination. Diarrhoeal samples were examined by direct microscopy for trophozoites and cysts and, after staining, for Cryptosporidium spp. In all cases, a modified formol-ether method was used to concentrate protozoal cysts before microscopy. One hundred and seventy-five of the 257 men invited to participate in the study provided a stool sample. At least one species of protozoan was found in 99 (57%) men. Giardia intestinalis was identified in only 5 (3%) men. Blastocystis hominis was found in 46 (26%) men, but the presence of this protozoan was not associated with diarrhoea. Other than the prevalence of Entamoeba dispar/histolytica and G. intestinalis, which remained unchanged, the proportion of men who harboured the non-pathogenic protozoa was significantly increased from 1981/82. A correlation between oral-anal sex or peno-insertive or peno-receptive anal intercourse and the prevalence of protozoa was not found. There was also no correlation between the number of species of protozoa carried and these sexual practices. The presence of protozoa was not associated with a history of foreign travel or sexual contact with a man who had recently travelled outside the UK. The study showed that, although the prevalence of infection is low, giardiasis is still transmissible amongst homosexual men. A correlation between individual sexual practices and the prevalence of intestinal protozoa was not found.     

B-cell lymphoma in two monogamous homosexual men

Opportunistic infections and malignant neoplasms have been described in homosexual men in association with immunologic abnormalities. We observed the development of malignant B-cell lymphomas in two homosexual men who had had a monogamous relationship for two years. Patient 1 had an aggressive, monoclonal, small, noncleaved, non-Burkitt's lymphoma ("undifferentiated lymphoma"), associated with severe immunocompromise. Patient 2 manifested a monoclonal, small, cleaved, follicular center cell lymphoma, with a follicular pattern, two months later. No common acute infection was detected. Staining for Epstein-Barr nuclear antigen in malignant tissue was negative in the second patient. However, the possibility of a transmissible agent as a causative factor cannot be excluded, and further study of similar patients is warranted.     

Central nervous system toxoplasmosis in homosexual men

Many opportunistic infections have been associated with an acquired immunodeficiency state in which cellular immune status has been altered. Two homosexual patients are described who presented with fever, peripheral eosinophilia, and a travel history to Haiti and were found to have central nervous system toxoplasmosis. Despite definitive diagnosis and appropriate therapy, both died. Techniques for diagnosis of central nervous system toxoplasmosis are discussed, and the importance of brain biopsy in this clinical situation is stressed. Eosinophilia may serve as an early diagnostic marker for disseminated toxoplasmosis in homosexual patients.     

Tuberculosis in homosexual men with HIV disease

In a 1-year period 4 cases of disseminated tuberculosis were seen among homosexual men with HIV infection. In 3 of the cases tuberculosis was the initial manifestation of defective cell mediated immunity. It is concluded that tuberculosis must be considered in any anti-HIV positive patient presenting with fever of unknown origin.     

The etiology of anorectal infections in homosexual men

The infectious etiology of symptomatic anorectal disease was studied in 52 homosexual men who did not have gonococci on initial Gram stain of anorectal exudate. Herpes simplex virus (HSV) was isolated from the anal canal or rectum in 15 of the 52 (29 percent) men and characteristically caused severe anorectal pain and focal ulcerations visible on sigmoidoscopy. Despite negative initial Gram stains, seven men (14 percent) had anorectal gonococcal infection. Six (12 percent) had syphilis, including two with dark-field positive anal lesions. Four were infected with enteric pathogens, including Giardia lamblia, Entamoeba histolytica or Campylobacter fetus ssp. jejuni. Chlamydia trachomatis (LGV 2 strain) was isolated from one patient with severe granulomatous proctitis. One or more etiologic pathogens were identified in 28 (67 percent) of 42 men who had anorectal leukocytic exudate and in two of 10 who did not (p = 0.01). A review of the prominent features of different etiologic forms of anorectal infection in homosexuals is presented.     

Intraepithelial carcinoma of the anus in homosexual men

Anal warts (condylomata acuminata) from seven homosexual men revealed intraepithelial carcinoma (carcinomain situ) within the condylomatous tissue or in adjacent anal mucosa. All lesions displayed morphologic evidence of papillomavirus infection and two of the seven revealed histologic changes characteristic of herpes simplex infection. This association of viral infection with malignant transformation indicates that persistent or recurrent anal warts should be excised and thoroughly examined by histologic techniques. Since four of the seven patients had histories suspicious for or diagnostic of the acquired immunodeficiency syndrome (AIDS), we further suggest that homosexual men with persistent or recurrent perianal lesons be evaluated for the presence of the syndrome.