Gonorrhea in homosexual men.

Extragenital gonorrhea was seen in 65% of 54 cases of gonorrhea in 43 homosexual men attending a venereal diseases clinic between 1974 and 1977; in 21 cases the infection was extragenital only. This type of gonorrhea was often asymptomatic and was associated with a high rate of failure of initial treatment in 6 of the 50 cases in which the patient returned for follow-up assessment, and in 5 of the 6 the persistent infection was extragenital. Syphillis was seen concomitantly or had previously occurred in 6 of the 54 cases. Fifteen of 28 cases of primary, secondary or early latent syphilis seen in men during the same study period had occurred in homosexuals. Appropriate testing for extragenital gonorrhea and for syphilis is important in homosexual men who present for examination, and homosexuality with the possibility of extragenital gonorrhea should be considered in a man with syphilis of recent onset.     

Cytomegalovirus isolation from healthy homosexual men

The acquired immune deficiency syndrome (AIDS) has focused renewed interest on cytomegalovirus (CMV) both as an infectious complication of the syndrome and as a potential etiologic agent in the pathogenesis of the immunosuppression. We studied 30 healthy homosexual men in New York City to determine the prevalence of virus excretion and its relationship to CMV-IgM antibodies and to T-lymphocyte subsets. Cytomegalovirus was detected in the urine and/or semen of 11 subjects. Eight of 11 CMV shedders were CMV-IgM positive, but CMV IgM was found in only one of 19 not shedding the virus. While homosexuals as a group had lower OKT4/OKT8 ratios (0.8 +/- 0.4, mean +/- SD) than heterosexual controls (1.8 +/- 0.4, mean +/- SD), there was no significant difference in ratios between homosexuals excreting virus and those not excreting virus. Cytomegalovirus excretion by homosexual men seems to be more prevalent than previously appreciated and may pose a significant risk for sexual transmission.     

Seroepidemiologic aspects of Neisseria meningitidis in homosexual men

Neisseria meningitidis has been isolated with increasing frequency from specimens obtained from patients attending venereal disease clinics and is an occasional cause of genital infection. Among 383 homosexual men attending either a venereal disease clinic or a community screening clinic meningococci were cultured from specimens obtained from 35.0% of all the subjects, and with similar frequency in the two groups. Of the positive specimens 93.5% were from the throat, 5.8% from the rectum and 0.72% from the urethra. The serogroups and serotypes of the isolates were characteristic of those commonly found in nasopharyngeal specimens from other asymptomatic carriers. Gonococci were isolated from 8.6% of all the subjects and were 1.4 times more common in those who also harboured meningococci. Of the cultures positive for gonococci, 14.7% were from the throat and 85.3% from the rectum. The two bacteria were rarely isolated from the same site in the same individual. Gonococci, but not meningococci, were significantly more common (P less than 0.05) in the group attending the venereal disease, clinic than in the group attending the screening clinic, the rates being 17.1% and 7.0%.     

Papillomavirus antigens in anorectal condyloma and carcinoma in homosexual men

Squamous cell carcinoma of the cervix and vulva has been associated with infection by human papillomavirus. Recent epidemiologic studies have observed more anal carcinoma among single than married men. To investigate this association between human papillomavirus and squamous proliferative lesions of the anus, we studied eight homosexual or bisexual men with recent diagnoses of anorectal carcinoma and six older patients of unknown sexual orientation with similar diagnoses 20 to 30 years ago. Using an immunohistochemical stain for papillomavirus, we found evidence of its presence in the carcinomas of five (63%) of the eight homosexual men and in two (33%) of the six older patients. Only one homosexual patient had the acquired immunodeficiency syndrome. In the possibly immunocompromised patient, human papillomavirus antigen is present in anorectal dysplasia and carcinoma.     

Characteristics of homosexual men who donate blood

A number of demographic, psychological, medical, immunological and haematological indices, as well as sexual practices and partner numbers, were investigated in 97 homosexual men in Adelaide. A comparison of blood donors with non-donors among these men showed that the donors were younger, spent more time in the homosexual subculture, maintained a stable blood-donation pattern, and were significantly less likely to have had a sexually transmitted disease. Donors contacted their sexual partners in non-anonymous settings more frequently than did non-donors.     

Transmission of HTLV-I and HIV among homosexual men in Trinidad

Risk for human T-cell lymphotropic virus type (HTLV-I) and human immunodeficiency virus (HIV) infection was evaluated in 100 homosexual or bisexual men from Trinidad. High seropositivity for HTLV-I (15% vs 2.4% in the general population) was linked to duration of homosexuality and numbers of partners, suggesting that HTLV-I, like HIV, can be transmitted by homosexual sex. Forty percent of homosexuals compared with 0.19% of the general population were seropositive for HIV, and sexual contact with US homosexual men and prior history of gonorrhea were major risk factors. The seroprevalence of HIV was three times higher than that for HTLV-I, suggesting that HIV is more efficiently transmitted, especially since HIV appears to have been recently introduced into Trinidad. Altered immune status was prominent in individuals infected with HIV and coinfected with HIV and HTLV-I. Whether HIV/HTLV-I coinfection amplifies clinical effects is a hypothesis that will require further evaluation.     

Unexplained lymphadenopathy in homosexual men. A longitudinal study

In January 1982, the Centers for Disease Control began a prospective study of unexplained generalized lymphadenopathy syndrome in 78 homosexual or bisexual men. As of Aug 1, 1984, the median durations of lymphadenopathy and enrollment were 29.5 months and 20 months, respectively. Antibodies to human T-cell lymphotropic virus type III/lymphadenopathy-associated virus were present in 75 (96%) of the study patients. Five (6%) of the patients were diagnosed as having the acquired immunodeficiency syndrome five to 25 months after the onset of lymphadenopathy. At the time of their initial visit, these five patients had lower T-helper cell counts, hematocrits, lymphocyte counts, and pokeweed mitogen stimulation ratios and were more likely to report severe symptoms than patients who did not develop the acquired immunodeficiency syndrome. During 318 follow-up visits, except for the development of the acquired immunodeficiency syndrome in five patients, there has been little change in the initial laboratory and clinical measures of this cohort. Within the follow-up period of this study, the features of lymphadenopathy syndrome have been unremitting for the majority of patients.     

Atypical lesions of the anal mucosa in homosexual men

Recent studies suggest that there is an increased incidence of squamous cell carcinoma of the anus in male homosexuals, but a precursor lesion has not been identified. We retrospectively analyzed in a blind fashion all anal tissue removed surgically during 1984. Twelve (6.7%) of the 180 specimens from men contained lesions with foci of epithelial atypia. Only one (0.85%) of 118 specimens from women harbored similar atypia. Of seven additional file cases exhibiting atypical anal mucosa, six were from men. Of 14 men with atypical anal lesions whose sexual orientation was known, 11 (79%) were homosexuals. In the 20 cases found to have atypical mucosal lesions, three patterns of atypia were identified, with more than one often occurring in the same specimen. Anal intraepithelial neoplasia (dysplasia) was identified in seven cases (35%) and occurred primarily at the anorectal junction and in anal ducts. Atypical condyloma was found in three cases (15%). A third lesion histologically indistinguishable from Bowen's disease or bowenoid papulosis was found in 12 cases (60%). In ten of these the lesion was adjacent to a condyloma. Although the natural history of these lesions of the anal mucosa is presently unknown, it may resemble that of similar lesions in other anatomic locations.     

Antibody responses after influenza and pneumococcal immunization in HIV-infected homosexual men

We conducted a study to assess the effect of human immunodeficiency virus (HIV) infection on humoral immunity. Fifty-five homosexual men and 19 heterosexual men had four- to six-week postimmunization antibody responses measured to trivalent influenza vaccine and 23-valent pneumococcal vaccine. The homosexual men were divided into three groups: 20 asymptomatic HIV-seronegative men, 10 asymptomatic HIV-seropositive men, and 25 HIV-seropositive men with persistent generalized lymphadenopathy. Antibody responses to influenza antigens in the subgroups of homosexual men did not significantly differ from those of heterosexual controls. The IgG antibody responses to pneumococcal capsular types 9N and 18C in men with lymphadenopathy, and type 18C in HIV-seronegative homosexual men, were lower than those of heterosexual controls. Otherwise, responses to other ten capsular types showed no significant differences. There was no evidence of an immunosuppressive effect of vaccination on T-cell numbers, or deterioration of clinical status associated with vaccination. This study demonstrates that HIV-infected homosexual men, asymptomatic or with persistent generalized lymphadenopathy, are able to mount appropriate antibody responses to two commonly used vaccines.     

男性同性恋与男性异性恋对厌恶情绪调节模式的差异

目的:探索男性同性恋和男性异性恋与负性情绪调节相关的大脑功能变化,比较两组之间调节模式的差异.方法:健康男性同性 恋和健康男性异性恋各10名参与本研究.采用Block设计的3种类型性爱活动录像对两组被试者进行视 觉刺激,诱发其厌恶情绪;利用功能核磁共振成像技术进行脑功能成像,使用SPM2软件对图 像进行分析和统计.结果:男性同性恋组和男性异性恋组分别在女-女和男 -男性刺激下,诱发达到了相同程度的厌恶情绪.两组被试的前额回、颞回、枕回及小脑均 被激活,海马和楔前叶的激活存在左右侧的差异性.男性同性恋组还观察到右扣带回的激活 ,而男性异性恋组则无类似现象.结论:男性同性恋和男性异性恋对负性情 绪的调节模式中,部分相关的神经结构存在敏感性的差异和侧化现象.     

Common psychiatric problems in homosexual men and women consulting family physicians.

This paper describes the commoner psychiatric difficulties of homosexual patients seen in a family practice. It is written primarily to aid general practitioners in deciding who should be referred to a psychiatrist. Recent developments in the study of homosexuality indicate that homosexual persons are no more likely than heterosexuals to suffer psychiatric problems. Practical suggestions are made for management and counseling, and some of the misconceptions about the gay community are dispelled.     

Risk of developing AIDS in HIV-infected cohorts of hemophilic and homosexual men

The latency period and/or incidence of the acquired immunodeficiency syndrome (AIDS) may differ in persons infected with the human immunodeficiency virus by different routes or having different "cofactors." We compared 79 hemophilic men in Pennsylvania and 117 homosexual and bisexual men in California, all having known dates of infection and long postinfection observation periods, to examine these hypotheses. By 1987, twenty-one percent of the hemophilic and 27% of the homosexual men had developed AIDS. However, seroconversion patterns differed for the two groups, and when this was taken into account, the conditional odds ratio for AIDS was 1.20. Kaplan-Meier survival analysis showed no significant difference in the cumulative proportion with AIDS, from time of infection. These results are limited by the small size and geographically localized nature of our study populations, but they suggest that currently the relative length of human immunodeficiency virus infection is of primary importance in comparing disease outcome for different populations.     

Prevalence and site-pathogen studies of Neisseria meningitidis and N gonorrhoeae in homosexual men

Prevalence and site-pathogen studies of pathogenic Neisseria were conducted in 815 homosexual men over a 12-month period. Neisseria meningitidis was isolated from more patients than N gonorrhoeae (43.1% vs 33.1%). A high oropharyngeal carriage of n meningitidis (42.5%) was present, with much lower urethral (0.7%) and rectal (2.0%) colonization. Although N meningitidis urethral isolates were associated with urethral discharge in five of six patients, N meningitidis in the oropharynx or rectum was not usually associated with clinical illness. Neisseria meningitidis was usually isolated from only one site in individual patients. Neisseria gonorrhoeae was isolated from the urethra (18.5%), rectum (16.3%), and oropharynx (5.6%). Of the 270 patients with gonococcal infection, 49.1% had urethral gonorrhea only, and 20.7% were infected at two or more body sites. Virtually all patients with urethral infection had symptoms of urethritis, whereas 89.1% of patients with oropharyngeal infection and 61.9% of patients with anorectal infection had no local symptoms.     

Empirical therapy for the management of acute proctitis in homosexual men

An effective empirical treatment regimen would provide a more rapid and less expensive approach to the management of homosexual men with acute proctitis. We conducted a randomized trial in 129 homosexual men who presented with acute proctitis, comparing treatment with an empirical regimen (4.8 million U of aqueous penicillin G procaine intramuscularly and 1.0 g of probenecid orally, followed by 100 mg of oral doxycycline twice daily for seven days) with specific therapy for each infection as it was recognized. Therapy with the empirical regimen resulted in more rapid resolution of the symptoms of proctitis, the objective signs of proctitis, and the infecting microorganisms. However, nearly one fourth of the patients, primarily those with unrecognized herpes simplex virus proctitis, did not respond to empirical therapy. We recommend empirical therapy coupled with appropriate pretreatment diagnostic testing for the initial management of acute proctitis in homosexual men with no clinical evidence of acquired immunodeficiency syndrome or AIDS-related complex.