Anorectal lymphogranuloma venereum in a Melbourne man

We report the first case of anorectal lymphogranuloma venereum (LGV) in a man who has sex with men (MSM) in Australia in the setting of the recent emergence of LGV among MSM in Europe and the USA. A 33-year-old man presented with a 2 month history of mild external anal discomfort. He gave a history of unprotected receptive and insertive anal intercourse with one partner in Europe during the preceding 6 months. No symptoms suggested proctitis and examination revealed two small anal fissures. An anal swab was positive for Chlamydia trachomatis; investigation for other STIs including HIV were negative. On review 6 days later, he was investigated and treated presumptively for LGV. The LGV diagnosis was confirmed by identifying the L2 serovar of C. trachomatis using a genotype test on the original anal specimen. This case is in keeping with the more recent reports of LGV from Europe, and has demonstrated the need for a high index of suspicion for asymptomatic or minimally symptomatic anorectal LGV.     

Enhanced surveillance of a lymphogranuloma venereum outbreak in Sydney 2010–2012

Objectives : To investigate an increase in lymphogranuloma venereum (LGV) notifications in New South Wales (NSW). Methods : Enhanced surveillance of notified LGV cases in NSW between May 2010 and April 2012 using doctor and patient questionnaires. Results : Thirty‐seven doctors who had diagnosed 67 (76%) of 88 notified anorectal LGV infections were interviewed. The majority (n=33, 89%) of treating doctors were formally trained and accredited in HIV management and prescribing, and most (n=32, 86%) worked in a public sexual health clinic or a general practice with a high caseload of men who have sex with men (MSM). All 67 cases were MSM who resided in inner‐city Sydney and all were serovar L2b. Anal symptoms had been present in 64 cases (96%, 95%CI 87–99%) for a median of 8 days (range 2–1,825) prior to presentation. Almost one‐third (n=20) had another concurrent STI diagnosed. Most (82%) of the 22 interviewed patients reported being HIV positive and having other STIs diagnosed over the past year. In the preceding month, all 22 men reported condomless anal sex and the median number of casual sexual partners was 5 (range 0–100). Conclusions : Characteristics of LGV cases in NSW are similar to those described worldwide, suggesting that a sexually adventurous subgroup of MSM are at particular risk of infection. Implications : Education of non‐sexual‐health clinicians on LGV risk factors, presentation, testing and management may allow more timely diagnosis and notification of contacts to reduce LGV transmission in the community.     

Two HIV-positive men with anorectal lymphogranuloma venereum and hepatitis C: emerging sexually transmitted diseases

Two men, aged 41 and 28 years, both known to be HIV-positive, contracted multiple sexually-transmitted diseases (STDs) through unprotected anal sexual contact. These included lymphogranuloma venereum (LGV) proctitis and hepatitis C. Recently in The Netherlands and Belgium there has been an outbreak of LGV proctitis in HIV-positive men who have sex with men, caused by Chlamydia trachomatis serovar L2, an STD which up to now has been rare in Europe. Due to information about the epidemic received a few days previously, the LGV proctitis in the second patient could be diagnosed and treated rapidly. The incidence of STDs in men having sex with men is increasing, also in HIV-positive men. STDs with ulcerative lesions, such as LGV, facilitate transmission of other pathogenic micro-organisms, including HIV. This, in combination with high-risk sexual behaviour such as unprotected anal sexual intercourse, will increase the chance of blood-blood contact and hence the chance of contracting multiple STDs concurrently. Hepatitis C is not normally considered as an STD, but ulcerative lesions in one of the partners combined with high-risk sexual behaviour enables the hepatitis C virus to be sexually transmitted.     

Asymptomatic Lymphogranuloma Venereum in Men who Have Sex with Men,United Kingdom

We investigated prevalence of lymphogranuloma venereum (LGV) among men who have sex with men who were tested for chlamydia at 12 clinics in the United Kingdom during 10 weeks in 2012. Of 713 men positive for Chlamydia trachomatis, 66 (9%) had LGV serovars; 15 (27%) of 55 for whom data were available were asymptomatic.     

New lymphogranuloma venereum Chlamydia trachomatis variant, Amsterdam

We retrospectively conducted a study of men who have sex with men who visited the Amsterdam, the Netherlands, sexually transmitted diseases clinic from January 2002 to December 2003 and had rectal Chlamydia trachomatis infections. We found that symptomatic (73%) as well as asymptomatic (43%) patients were infected with a new C. trachomatis LGV variant.     

Lymphogranuloma venereum among men who have sex with men--Netherlands, 2003-2004

Lymphogranuloma venereum (LGV) is a systemic, sexually transmitted disease (STD) caused by a variety of the bacterium Chlamydia trachomatis that rarely occurs in the United States and other industrialized countries; the prevalence of LGV is greatest in Africa, Southeast Asia, Central and South America, and Caribbean countries. However, in the Netherlands, which typically has fewer than five cases a year, as of September 2004, a total of 92 cases of LGV had been confirmed during the preceding 17 months among men who have sex with men (MSM). The first 13 cases, diagnosed during April-November 2003, were reported by local health authorities in Rotterdam in December 2003. An alert was sent to the Early Warning and Reporting System of the European Union and to the European Surveillance of Sexually Transmitted Infections Network (ESSTI). In April 2004, a report was made to CDC, and state and local health departments were alerted. Of the 92 cases confirmed in the Netherlands, 30 occurred during 2003 and 62 during 2004. This report describes the ongoing investigation of the LGV outbreak. Health-care providers should be vigilant for LGV, especially among MSM exposed to persons from Europe, and prepared to diagnose the disease and provide appropriate treatment to patients and their exposed sex partners.     

Lymphogranuloma venereum in Australia

Lymphogranuloma venereum (LGV), caused by C. trachomatis serovars L1, L2 and L3, is an invasive disease capable of causing tissue destruction with many patients experiencing complex, severe symptoms. LGV, endemic to areas of Africa, Asia, South America and the Caribbean, has emerged as a cause of significant morbidity among men who have sex with men (MSM) in more affluent nations. The high prevalence of HIV in LGV cases could suggest either that LGV is confined to a dense sexual network, or that clinicians are selectively testing HIV-positive MSM for LGV The increase in reported LGV cases highlights the need to improve sexual health overall among MSM; experience from the recent syphilis outbreaks suggests that control could prove difficult.     

Anorectal malignancies and dysplasia in HIV-positive men who have sex with men

Since the HIV epidemic, the incidence ofanorectal (pre)malignancies in men who have sex with men (MSM) is increasing. The incidence is likely to increase further in the coming years, given that HIV-positive MSM are living longer thanks to powerful antiretroviral treatment. Persistent human papillomavirus (HPV) infection is a major risk factor for the development of anal (pre)malignancies. Less is known about the natural history of anal intraepithelial neoplasia (AIN). Screening in HIV-positive and HIV-negative MSM for anorectal malignancies or dysplasia is cost-effective if the incidence is sufficiently high. Treatment options range from watchful waiting for asymptomatic grade-1 AIN to excision or radio(chemo)therapy for anorectal carcinoma. HPV vaccines are in development. Especially in HIV-positive MSM with anorectal complaints or genital warts in their medical history, one should consider these malignancies.     

Systematic Review and Meta-Analysis of Doxycycline Efficacy for Rectal Lymphogranuloma Venereum in Men Who Have Sex with Men

Rectal lymphogranuloma venereum (LGV) has reemerged as a sexually transmitted infection among men who have sex with men (MSM), particularly those who are HIV-positive. We undertook a systematic review and meta-analysis to determine the efficacy of doxycycline (100 mg 2×/d for 21 days) for rectal LGV in MSM. Nine studies were included: 4 prospective, 4 retrospective, and 1 combined retrospective and prospective. In total, 282 MSM with rectal LGV were included in the studies. All studies reported using nucleic acid amplification tests to assess microbial cure. Most patients (>80%) had symptomatic rectal infection. The fixed-effects pooled efficacy for doxycycline was 98.5% (95% CI 96.3%–100%, I² = 0%; p = 0.993). Doxycycline at 100 mg twice daily for 21 days demonstrated a high microbial cure rate. These data support doxycycline at this dosage and duration as first-line therapy for rectal LGV in MSM.     

Addressing HIV knowledge, risk reduction, social support, and patient involvement using SMS: results of a proof-of-concept study

Men who have sex with men continue to be severely and disproportionately affected by the HIV/AIDS epidemic in the United States. Effective antiretroviral therapy has altered the HIV epidemic from being an acute disease to a chronic, manageable condition for many people living with HIV. The pervasiveness, low cost, and convenience of short message service suggests its potential suitability for supporting the treatment of conditions that must be managed over an extended period. The purpose of this proof-of-concept study was to develop, implement, and test a tailored short message service-based intervention for HIV-positive men who have sex with men. The messages focused on reducing risk-taking behaviors and enhancing HIV knowledge, social support, and patient involvement. Participants reported strong receptivity to the messages and the intervention. The authors detected a statistically significant increase in HIV knowledge and social support from baseline to follow-up. Among participants who received sexual risk reduction messages, the authors also detected a statistically significant reduction in reported risk behaviors from baseline to follow-up. Results confirm the feasibility of a tailored, short message service-based intervention designed to provide ongoing behavioral reinforcement for HIV-positive men who have sex with men. Future research should include a larger sample, a control group, multiple sites, younger participants, and longer term follow-up.     

INDUCTION OF SPERMATOGENESIS BY INGUINAL VARICOCELE REPAIR IN AZOOSPERMIC MEN

13 infertile patients who had complete azoospermia and clinical varicocele underwent inguinal varicocele repair. Semen analyses were obtained starting 3 months after varicocele repair. Bilateral varicocele repair in 2 men and unilateral in 11 men were performed. Induction of spermatogenesis was achieved in 3 (23%) patients. Two of them had hypospermatogenesis and one had maturation arrest at spermatid stage. No pregnancies by natural intercourse resulted. Although one couple used fresh ejaculate for intracytoplasmic sperm injection, the result was unsuccessful. All men with Sertoli cell-only and early maturation arrest remained azoospermic after surgery. No association between successful outcome and patient age, sex hormone analysis, varicocele grade, testicular volume, unilateral or bilateral varicocele repair were apparent. Varicocele repair can result in the induction of spermatogenesis for men with hypospermatogenesis and late maturation arrest. No other related factor could be detected.     

Institutionalization of the NACP and Way Ahead

In India, HIV prevention and control activities started way before the reporting of the first case of HIV infection. On reporting of evidences of HIV infection from different parts of the country and varied groups, Government launched the National AIDS Control Program (NACP). The program was launched on the foundation of early interventions and Mid-Term Plan, which evolved in three phases over the period of eighteen years. With progression of time, epidemiological situation changed and knowledge/capacity to tackle HIV improved. In the course of the evolution, NACP has moved from the centrally controlled program to district driven. Also different strategies were inducted/refined and many important institutes like Task Force, a high-powered National AIDS Committee, National AIDS Control Board, National AIDS Control Organization, State AIDS Control Societies, Project Support Units/Project Management Units, National Council on AIDS, Department of AIDS Control, Technical Support Unit, District AIDS Prevention and Control Unit (DAPCU) were created. Currently program is implemented vertically with good impetus and is able to contain the spread of HIV in India. For enhancing the effectiveness and sustainability, future of the NACP is strongly linked with the well-performing DAPCU and good synergy/integration with General Health System. HIV/AIDS epidemic in India has entered into the third decade. Evidences show that this epidemic in India is of concentrated type and characterized by the heterogeneity, following the type 4 pattern, where the epidemic shifts from the most vulnerable populations [such as female sex workers, men who have sex with men, injecting drug users to bridge populations (clients of sex workers, sexually transmitted infection patients, partners of drug users, long route truck drivers, short stay cyclical single male migrants], then to the general population and from urban centers to rural areas (ruralization of epidemic) with increasing involvement of youth and women (feminization of epidemic).     

中国15个大城市艾滋病疫情状况分析

目的了解中国卫生部—比尔盖茨基金会艾滋病防治国际合作项目（简称中盖艾滋病项目）地区的等15个大城市艾滋病流行现状,为艾滋病防治决策提供依据。方法利用全国艾滋病综合防治数据信息管理系统资料,分析15个城市艾滋病疫情状况,采用专家咨询法（Delphi method）估计感染人数,同时对暗娼、吸毒人员及男男性接触人群（MSM）现场调查、检测HI V。结果截至2007年底,15个城市累计报告HI V/AIDS 29 134例,各地报告疫情呈逐年上升趋势;静脉注射吸毒为主要传播途径,占46.9%,异性和同性性接触呈上升趋势,分别从2005年的17.5%和4.0%上升到2007年的28.7%和10.9%。暗娼、吸毒及MSM人群的HI V感染率分别为0.02%、2.67%和6.3%。结论 15城市艾滋病报告疫情呈逐年上升趋势,需加强传染源发现;静脉注射吸毒传播呈下降趋势,异性和男男同性性接触途径大幅上升,MSM人群艾滋病感染率急剧升高,需加强MSM人群艾滋病防治。     

绵阳城区男男性行为者性伴特征及影响因素

目的了解绵阳市城区男男性行为者(MSM)性伴现况。方法采用应答者趋动招募抽样法(RDS),在MSM活动场所定时、定点进行性伴及相关因素招募和寻问式匿名现场调查。结果共调查MSM 400人,首次插入性性行为平均(18±3.59)岁。最近6个月与男性发生过性行为占88.4%(352/398),平均(2±3.29)人;买性占4.7%(17/359),平均(1±2.49)人;卖性占2.5%(9/355),平均(4±6.19)人;与女性发生过性关系占18.3%(73/400),平均(1±2.42)人。调查者中不同婚姻状况、性取向、首次插入性行为年龄、认识当地MSM朋友数、性伴居住城市数、近6月男男肛交安全套使用,艾滋病知识是否来自书籍、来自学校,是否知道性伴没有健康问题、是否知道性伴健康状况者,近6个月男男肛交用安全套等因素与男男肛交数有关。多因素Logistic回归分析,最终进入回归模型的有婚姻、认识当地MSM朋友数、首次插入性行为年龄、性伴居住城市数、不知道性伴健康状况共5个(P<0.05),在婚(OR=5.074)、认识当地MSM朋友数≥9人(OR=2.192)、不知道性伴健康状况(OR=1.235)、首次插入性行年龄≤24岁(OR=6.948～9.871)者近6月肛交人数较多,性伴居住城市数≤1个者肛交人数较少。结论绵阳城区MSM首次性行为较早,多种性伴共存,多性伴普遍。     

139例软下疳、性病性淋巴肉芽肿疑似病例调查分析

目的　了解软下疳、性病性淋巴肉芽肿两种少见性病的流行病学临床诊断及治疗情况 ,为制定性病防治措施提供依据。方法　采用流行病学个案调查方法 ,对安徽省近年报告的 139例两种疑似病例进行调查。结果　 139例两种性病疑似病例多为临床诊断 ,缺乏实验室诊断依据 ,且存在着盲目使用高档抗菌素。结论　规范软下疳、性病性淋巴肉芽肿的诊断、治疗、报病 ,加大两种少见性病的防治力度刻不容缓     

重庆市发现1例境外输入猴痘病例

分析上海市长宁区人感染猴痘确诊病例的临床与流行病学特征,探讨其临床特征和流行病学特征。

收集在2023年7月20日—9月30日由上海市长宁区医疗机构发现报告或居住在本区的猴痘病例10例的临床资料,进行流病学个案调查并由就诊医疗机构采集咽拭子、肛拭子和皮疹拭子标本,应用实时荧光定量PCR法进行猴痘病毒核酸检测。应用描述性流行病学分析方法分析病例的流行病学特征。

10例人感染猴痘确诊病例均为青年男性,平均年龄35.4岁,均为男男同性性行为（MSM）人群,无职业聚集性。病例主要临床症状以发热、皮疹、腹股沟淋巴结肿大、肌肉酸痛为主,9例病例出现皮疹,7例出现发热症状。10例病例中出现发热、皮疹、淋巴结肿大、肌肉酸痛者1例;出现发热、皮疹、淋巴结肿大者3例;出现发热、皮疹、全身酸痛者2例;仅出现皮疹者2例;出现发热、皮疹者1例;无症状1人。其中9例出现皮疹的病例出疹部位均为生殖器或肛周,四肢或躯干同时出现皮疹的情况较少。所有病例发病前21 d内均有非固定性伴侣MSM史,末次可疑高危暴露到出现可疑症状的间隔时间为4~10 d,平均间隔时间6.90 d。从出现发热到出疹的间隔时间为0~5 d,平均1.87 d。

人感染猴痘以发热、皮疹及腹股沟淋巴结肿大为主要临床表现;MSM是感染猴痘的高危人群,其感染来源可能与MSM暴露有关,发病早期症状较轻,容易漏诊,同时调查过程中患者存在隐瞒事实的情况,造成疫情防控难度增加。

     

Bridging Sexual Boundaries: Men Who Have Sex with Men and Women in a Street-Based Sample in Los Angeles

The purpose of the study was to determine the potential contribution of bisexual men to the spread of HIV in Los Angeles. We compare the characteristics and behaviors of men who have sex with men and women (MSMW) to men who have sex with only women (MSW) and men who have sex with only men (MSM) in Los Angeles. Men (N = 1,125) who participated in one of the two waves of data collection from 2005 to 2007 at the Los Angeles site for NIDA’s Sexual Acquisition and Transmission of HIV—Cooperative Agreement Program were recruited using Respondent Driven Sampling. Participants completed Audio Computer Assisted Self Interviews and received oral HIV rapid testing with confirmatory blood test by Western Blot and provided urine specimens for detection of recent powder cocaine, crack cocaine, methamphetamine, or heroin use. MSM, MSW, or MSMW were defined by the gender of whom they reported sex with in the past 6 months. Chi-square tests and ANOVAs were used to test independence between these groups and demographic characteristics, substance use, and sexual behaviors. We fit generalized linear random intercept models to predict sexual risk behaviors at the partner level. Men were mostly of low income, unemployed, and minority, with many being homeless; 66% had been to jail or prison, 29% had ever injected drugs, and 25% had used methamphetamine in the past 30 days. The sample had high HIV prevalence: 12% of MSMW, 65% of MSM, and 4% of MSW. MSMW were behaviorally between MSW and MSM, except that more MSMW practiced sex for trade (both receiving and giving), and more MSMW had partners who are drug users than MSW. Generalized linear random intercept models included a partner-level predictor with four partner groups: MSM, MSMW-male partners, MSMW-female partners, and MSW. The following were significantly associated with unprotected anal intercourse (UAI): MSW (AOR 0.15, 95% CI 0.08, 0.27), MSMW-female partners (AOR 0.4, 95% CI 0.27, 0.61), HIV-positive partners (AOR 2.03, 95% CI 1.31, 3.13), and being homeless (AOR 1.37, 95% CI 1.01, 1.86). The factors associated with giving money or drugs for sex were MSMW-female partners (AOR 1.70, 95% CI 1.09, 2.65), unknown HIV status partners (AOR 1.72, 95% CI 1.29, 2.30), being older (AOR 1.02, 95% CI 1.00, 1.04), history of incarceration (AOR 1.64, 95% CI 1.17, 2.29), and being homeless (AOR 1.73, 95% CI 1.27, 2.36). The following were associated with receiving money or drugs for sex: MSW (AOR 0.53, 95% CI 0.32, 0.89), African American (AOR 2.42, 95% CI 1.56, 3.76), Hispanic (AOR 1.85, 95% CI 1.12, 3.05), history of incarceration (AOR 1.44, 95% CI 1.04, 2.01), history of injecting drugs (AOR 1.57, 95% CI 1.13, 2.19), and had been recently homeless (AOR 2.14, 95% CI 1.57, 2.94). While overall HIV-positive MSM had more UAI with partners of any HIV status than MSMW with either partner gender, among HIV-positive MSMW, more had UAI with HIV-negative and HIV status unknown female partners than male partners. Findings highlight the interconnectedness of sexual and drug networks in this sample of men—as most have partners who use drugs and they use drugs themselves. We find a concentration of risk that occurs particularly among impoverished minorities—where many men use drugs, trade sex, and have sex with either gender. Findings also suggest an embedded core group of drug-using MSMW who may not so much contribute to spreading the HIV epidemic to the general population, but driven by their pressing need for drugs and money, concentrate the epidemic among men and women like themselves who have few resources.     

Acute Epididymitis: Etiology and Therapy

Fifty patients with acute epididymitis were evaluated prospectively by history, examination, and microbiologic studies, including cultures for aerobes, anaerobes, N. gonorrhoeae, Chlamydia trachomatis, and Ureaplasma urealyticum. E. coli was the predominant pathogen isolated from the urine of men over 35 years old and C. trachomatis and N. gonnorrheae were the predominant pathogens isolated from the urethra of men under 35. The etiologic role of E. coli and C. trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine of urethral cultures for these agents. C. trachomatis epididymitis accounted for two thirds of “idiopathic epididymitis” in men, and was often associated with oligozoospermia. Of nine female sexual partners of men with C. trachomatis infection, six had antibody to C. trachomatis, of whom two had positive cervical cultures for this organism, and the others had nongonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with C. trachomatis epididymitis, and should be offered to their female sex partner.     

南京市2008－2013年男男性行为人群早期梅毒及HIV感染率变化趋势分析

目的 了解南京市男男性行为人群早期梅毒、HIV感染流行水平及变化趋势,为估计疫情进展,调整、制订控制策略和干预措施提供依据.方法 对2008－2013年自愿接受艾滋病、梅毒咨询检测的男男性行为者进行梅毒和HIV感染的血清学监测,对梅毒血清学试验阳性者进行性病诊疗转介,以明确其临床诊断和分期.分析被调查人群人口学特征及早期梅毒、HIV感染和合并HIV感染的早期梅毒流行状况及其变化趋势.结果 2008－2013年各年度分别监测1 004、1 218、1 236、748、1 019和1 420名男男性行为者.各年度早期梅毒的感染率分别为2.19%、2.71%、2.43%、1.74%、3.04%和2.32%,趋势检验P> 0.05;HIV感染率分别为1.29%、2.63%、5.42%、8.82%、11.97%和10.42%,趋势检验P< 0.01;合并HIV感染的早期梅毒感染率从2008年的0.20%上升至2013年的1.06%,趋势检验P< 0.01;合并HIV感染的早期梅毒占早期梅毒的比例从2008年的9.09%上升至2013年的45.45%,趋势检验P< 0.01.结论 南京市男男性行为人群早期梅毒的流行趋于平稳,HIV感染状况上升趋势明显,合并HIV感染的早期梅毒的流行呈上升趋势,其占早期梅毒的比例也呈逐年增长的态势.在男男性行为人群中需要采取持续有效的干预措施以应对梅毒及HIV感染的流行.     

Homosexuality, seropositivity, and family obligations: perspectives of HIV-infected men who have sex with men in China

The HIV epidemic has had major impact on men who have sex with men in China. Most current studies view male-to-male sex as a behavioural dimension or variable affecting HIV infection, paying little attention to the socio-cultural meanings of homosexuality and their impacts on men's experiences with HIV/AIDS. This oversight has impeded understanding of the health practices of this population. Based on a qualitative study of experiences of Chinese people living with HIV/AIDS, this paper explores the complex processes in which men who have sex with men struggle and negotiate with their sexuality, family obligations, and this disease. To facilitate Chinese men who have sex with men in responding effectively to HIV and AIDS, researchers and practitioners should take into account a wide range of contextual factors including desired gender roles, family obligations, homophobia, and HIV-related stigma that contribute to current constructions of 'homosexuality' in China.