Some characteristics of homosexual men.

Although recognition of homosexuals is often important, many doctors lack the necessary skill or experience, so to assist them a group of 5,302 men was surveyed using a computer-based data system and 9-1 per cent. were recorded as homosexual. Analysis showed a relatively high proportion of homosexuals among men with syphilis and gonorrhoea, and a low proportion among men with nonspecific genital infection (non-specific urethritis and proctitis) and other infections. All men with secondary syphilis were homosexual. A relatively high proportion of men born in Eire, Spain, and North America were homosexual and a relatively high proportion of men living in the West End of London were homosexual. While these findings will be of most value to those working in STD clinics in London they may also be helpful to those working elsewhere and in other disciplines.     

Infection with cytomegalovirus in homosexual men.

The prevalence and incidence of cytomegalovirus (CMV) infections were studied in a group of homosexual men. Of the 710 participants, 501 (70.6%) had complement fixing antibodies to CMV on entry to the study. During the follow up (maximum 23 months) 69 CMV infections were found: 50 primary infections among the 209 seronegative men (attack rate 27.3%), and 19 recurrent infections among the 501 seropositive men (attack rate 6.2%). The prevalence of antibody to CMV was correlated with four characteristics of the participants' lifestyles: duration of homosexual activity, number of different sexual partners, history of syphilis, and anal sexual contact. Among the seronegative men, the incidence of primary infection with CMV correlated with a history of syphilis and anal sexual contact. We conclude that infections with CMV are highly prevalent among homosexual men, and that anal sexual contact plays an important part in the transmission of this virus.     

Giardia lamblia infection in homosexual men.

Epidemic Giardia lamblia infection has usually been associated with contaminated water. In this paper, five proved and one presumed case of G. lamblia infection among homosexual men are reported. The sequential onset of their clinical illnesses and their sexual interrelationships suggest that this outbreak could have been caused by the direct faecal-oral transmission of G. lamblia. Other parasitic diseases with possible venereal transmission have been described, and parasitic diseases should be considered in homosexual men with diarrhoea or other gastrointestinal symptomatology.     

Proctitis in homosexual men. A diagnostic problem.

One hundred and seventy six men with histories of anal intercourse were studied to determine if there was a correlation between the clinical features, cytological findings in the mucosal secretions, and the histological appearance of the rectal mucosa. The presence or absence of gastrointestinal symptoms did not differentiate between patients with and without proctitis. Sigmoidoscopy was normal in each of the 117 men with normal rectal histology. Macroscopic abnormalities were evident in the mucosa of nine of 11 men with infective proctitis, and sigmoidoscopy was normal in 40 of the 48 men with chronic proctitis. Cytological examination was often useful in detecting infective proctitis but not chronic proctitis.     

Hepatitis B in symptomless Danish homosexual men.

Forty eight symptomless homosexual men attending a sexually transmitted disease (STD) clinic and found by screening to have hepatitis B surface antigen (HBsAg) were followed up for a median of 10 (range six to 26) months to characterise their liver disease. Initially 33/50 (66%) of the men had increased serum liver enzyme activity and 19/47 (40%) had increased serum immunoglobulin G concentrations. Liver biopsy specimens showed acute hepatitis B in 12 (39%) and chronic hepatitis B in 19 (61%) of the 31 patients who underwent liver biopsy. The course of the infection was: acute hepatitis B in 14/48 (29%), chronic persistent hepatitis B in 23/48 (48%), chronic aggressive hepatitis B in 8/48 (17%), and cirrhosis in 3/48 (6%) of the patients. Antibodies against human immunodeficiency virus (HIV) were present in 16/45 (36%) of the patients, but the presence of antibodies to HIV did not influence the course of hepatitis B in the observation period.     

Prevalence of Chlamydia trachomatis infection in homosexual men.

Chlamydial cell culture isolation rates from 51 unselected homosexual men were 9.3% from the urethra, 4.3% (pharynx), and 6.5% (rectum). All the positive cultures showed extremely few inclusions. Direct immunofluorescence with the Microtrak reagent (Syva) was an acceptable alternative technique for non-genital sites, whereas the infectious disease enzyme immunoassay (IDEIA) (Boots-Celltech) was unsuitable.     

Hepatitis A seroprevalence in homosexual and heterosexual men.

OBJECTIVE--To determine the seroprevalence of hepatitis A antibodies in homosexual and heterosexual males attending a genitourinary medicine (GUM) clinic. DESIGN--Prospective study of male patients recruited from a GUM clinic during a 10 week period in 1993. SETTING--Central London outpatient GUM department at Chelsea and Westminster Hospital. SUBJECTS--255 patients were recruited, comprising 185 homosexual and 70 heterosexual males. Ninety two men were known to be HIV-positive, of whom 89 were homosexual. MAIN OUTCOME MEASURES--Serum samples were screened for both IgM and IgG antibodies to hepatitis A by enzyme linked immunoassay. Results were matched to an anonymously completed questionnaire. RESULTS--81 of the 255 subjects (31.8%) had been exposed to hepatitis A, two of whom were IgM positive. There were similar hepatitis A seroprevalence rates in homosexual (32.4%) and heterosexual men (30.0%). Although 48.1% of the homosexual men were known to be HIV-positive, compared with 4.3% of the heterosexuals. Hepatitis A seroprevalence remained comparable in both groups after patients with known HIV infection were excluded from the analysis. 11.4% of the heterosexual men admitted to oral-anal sexual contact compared with 62.2% of the homosexual men. This sexual practice was not associated with antibodies or a past history of hepatitis A exposure. CONCLUSIONS--There was no detectable difference in hepatitis A seroprevalence between male homosexual and heterosexual GUM clinic attenders, despite a much higher level of oral-anal sexual activity among the homosexual population.     

Hepatitis delta virus in homosexual men in Sydney.

In countries not generally endemic for hepatitis B, homosexual men who are carriers of hepatitis B surface antigen (HBsAg) have to date largely been spared additional delta virus infection. A focus of homosexually acquired delta has, however, recently been identified in California. To assess the prevalence and risk factors for delta virus infection in homosexual men in Sydney, we tested the sera of 204 homosexual men with acute or chronic hepatitis B infection for total antibody to delta and delta antigen. Total antibody to delta was detected in eight men and delta antigen in one other (4.4% of the total). All men with antibody or antigen had intravenous drug use as a risk factor. Overall nine of 22 (40.9%) male homosexual intravenous drug users had serological evidence of delta infection. Delta positive patients tended to be younger, to have engaged in prostitution, to have more severe chronic liver disease, to be more likely to have a symptomatic acute illness, and to be less likely to express hepatitis Be antigen (HBeAg) in their sera. Though the homosexual transmission of delta infection cannot be concluded from this study, the detection of delta markers in nine homosexual men (including four prostitutes) suggests considerable potential for dissemination of this virus homosexually.     

Proctitis and herpes simplex virus in homosexual men.

In a study of the prevalence of rectal infection with herpes simplex virus (HSV) in a group of homosexual men the magnified appearance of the rectal mucosa correlated with isolation of the virus. HSV was isolated from rectal material from five of 77 men with proctitis of unknown cause but from none of 44 control patients without proctitis; two of four men with HSV proctitis were asymptomatic. Thus, the magnified rectal mucosal image, showing severe congestion, haemorrhage, and pus, appears to be a sensitive indicator of the presence of HSV proctitis.     

Kaposi's sarcoma in young homosexual men

An outbreak of KS has been observed in young homosexual men. These patients are different from those with classical KS for the following reasons: 1. geographic distribution (clustering in New York and California); 2. age (younger, mean--39 years); 3. higher incidence; 4. sexual preference (homosexual); 5. distribution of skin lesions (face, upper extremities, trunk); 6. lymph node involvement; 7. visceral lesions; 8. associated opportunistic infections (Pneumocystis carinii, toxoplasmosis); 9. history of sexually-transmitted diseases (hepatitis, syphilis, gonorrhea); and 10. aggressive course of the disease. Awareness of these features of the new KS will enable the practitioner to better recognize this important, emerging disease.     

Infection with cytomegalovirus in homosexual men

The prevalence and incidence of cytomegalovirus (CMV) infections were studied in a group of homosexual men. Of the 710 participants, 501 (70.6%) had complement fixing antibodies to CMV on entry to the study. During the follow up (maximum 23 months) 69 CMV infections were found: 50 primary infections among the 209 seronegative men (attack rate 27.3%), and 19 recurrent infections among the 501 seropositive men (attack rate 6.2%). The prevalence of antibody to CMV was correlated with four characteristics of the participants' lifestyles: duration of homosexual activity, number of different sexual partners, history of syphilis, and anal sexual contact. Among the seronegative men, the incidence of primary infection with CMV correlated with a history of syphilis and anal sexual contact. We conclude that infections with CMV are highly prevalent among homosexual men, and that anal sexual contact plays an important part in the transmission of this virus.     

Dermatophytosis and HIV infection. A study in homosexual men

Mycological and clinical investigations were carried out in 193 homosexual men, 83 of whom had HIV antibodies, and 117 heterosexual men. Dermatophytes were recovered from the feet in 37.3% of HIV seropositive homosexual men, 31.8% of seronegative homosexual men and 8.6% of heterosexual men. Tinea pedis in homosexual men was significantly more common with increasing age. There was an increased number of sexual partners in the group of homosexual men with tinea pedis. Two dermatophytes were recovered from single samples in 14.5% of homosexual men with dermatophytosis. Dermatophytes were occasionally isolated from clinically normal toe clefts. Present results point to the importance of dermatophytes in nail dystrophy affecting patients with advanced HIV infection. Dermatophytosis in homosexual men was not associated with any changes in counts of blood T lymphocyte subsets or skin reactivity to tuberculin.     

Prevalence of urinary tract infection in homosexual and heterosexual men.

Homosexual practices might be expected to result in an increase in urinary tract infection in adult men. Midstream urine specimens were collected from 200 homosexual and 205 heterosexual men attending a clinic for sexually transmitted diseases. Three specimens from each group yielded more than 10(5) Escherichia coli per ml. The prevalence of urinary tract infection among homosexuals was therefore similar to that in the heterosexual population.     

Failure rate of condoms during anogenital intercourse in homosexual men.

Two hundred and seventy seven homosexual men participating in an AIDS study in Amsterdam, The Netherlands, were interviewed in July to December 1986 regarding their experiences with the use of condoms during anogenital intercourse. It appeared that in many cases the condoms used could not be described as reliable, or were not used safely. In 8% (117/1468) of cases the condom tore or slipped off. When different condoms were compared, it was seen that "qualified" anal condoms functioned best. Other anal condoms functioned worse, and in many cases even worse than classic vaginal condoms. Whether these differences exclusively depended on differences in quality cannot be assessed. Men who buy a qualified anal condom are possibly more motivated and thus also less likely to have failures. Regarding the apparent unreliability of the condoms used, homosexual men are advised to refrain from anogenital intercourse. When this is not feasible, a qualified anal condom should be used.