Sexual transmission of enteric pathogens among men who have sex with men (MSM) is well documented, although whether providers are cognizant of this risk when MSM patients present with gastrointestinal symptoms has not been studied. Over 34 months at a major tertiary metropolitan medical system, this study retrospectively analyzed 436 BioFire FilmArray Gastrointestinal results from 361 patients documented as MSM. An extensive chart review was performed, including specific sexual behaviors, socioeconomic risk factors, and whether providers charted a sexual history when a patient presented for care. Overall BioFire positivity rate was 62% with no significant difference in positivity between persons living with HIV and those without. Patients charted as sexually active had a significantly increased odds ratio (OR) of a positive result compared to those who were not. Anilingus had the highest OR. Providers charted any type of sexual history in 40.6% of cases, and HIV/infectious disease providers were significantly more likely to do this compared to other subspecialties. Sexual transmission of enteric pathogens within MSM is ongoing, and patients are at risk regardless of living with HIV. Not all sexual behaviors have the same associated risk, highlighting opportunities to decrease transmission. Increased provider vigilance and better patient education on sexual transmission of enteric pathogens are needed to reduce the disease burden.

The scientific community has systematically ignored the needs of women who have sex with women (WSW). The invisibilization of romantic and sexual relationships between women has caused a profound lack of knowledge about the impact of HIV and other STIs on this population subgroup. This study aims to analyze the frequency of dental dam and condom use in WSW and identify the variables that explain the use of these two preventive methods. The sample is composed of 327 women aged between 18 and 60 years (M = 27.82; SD = 8.10). The results indicate that only 4.7% of those who practice cunnilingus and 5.2% of those who practice anilingus report "always" using dental dam (systematic use). Condoms are used systematically by 37.1% of those who practice vaginal penetration and 37.8% of those who practice anal penetration. Age, high perceived self-efficacy, and adequate assertive communication skills are variables significantly related to preventive behavior. The severity attributed to HIV and the perceived risk of infection are protective factors regarding dental dam use. For condom use, high levels of internalized homophobia and drug use are risk factors. Future preventive strategies should provide information on preventive strategies to WSW who, for different reasons, are not involved in LGBT contexts or associations and, therefore, do not have access to training activities and mistakenly believe that they are invulnerable as they do not have sexual relations with men.

Streptococcus dysgalactiae subspecies equisimilis (SDSE) is a gram-positive, beta-hemolytic, large-colony-forming bacteria belonging to group C and G streptococci. It can be isolated in the normal flora of human skin, nasopharyngeal cavity, genitourinary, and gastrointestinal tracts. However, SDSE has been the cause of perianal bacterial infections associated with sexual practices. A 67-year-old man developed a penile bacterial infection secondary to SDSE. The infection presented as a painful erythematous patch on his penile distal shaft. He was successfully treated with oral cephalexin 500mg and topical mupirocin 2% ointment twice daily, for ten days. The infection resolved within ten days of treatment. Penile and perianal SDSE bacterial disease has been reported in five men, including the patient in this report. The perianal area was involved in 80 percent (4/5) of men; concurrent infection in the gluteal area was present in two men. The probable route of transmission was oral-anal (two men) or oral-genital (one man). All of the mens SDSE infections completely resolved after treatment with antibiotics. In conclusion, SDSE can cause penile and perianal bacterial disease, perhaps more frequently in individuals that receive unprotected fellatio and anilingus from asymptomatic or symptomatic carriers of the organism in their oropharynx.

We present four cases in which probable sexual transmission of Giardia lamblia was suspected. Diagnosing this mode of transmission in endemic areas is often difficult and should be considered only as possible, because exposure to poor sanitation and a potentially contaminated environment are always latent. However, as patients reported, there was no history of drinking tap water, exposure to recreational water, eating contaminated food, or other potential sources of infection but anilingus with an infected partner. We consider that in endemic countries, even when other more frequent modes of transmission could be playing the main role, the possibility of (re)infection due to sexual transmission should not be forgotten. Talking openly with patients, strengthening patient-specific preventive measures and counselling appear to be needed to reduce risks of Giardia infection transmission due to this often neglected route.

Sexually transmitted infections (STIs) are often discussed in the context of syphilis, gonorrhea, herpes, chlamydiasis and AIDS. However, since the past 30 years of the last century, epidemiology and natural history studies have led to improved understanding of giardiasis as a STI, as a result of oral-anal sexual contact. Studies suggest that Giardia is an increasingly recognized infection that may be underdiagnosed under the STI context. Health care providers should maintain a high index of suspicion for Giardia, obtain suitable diagnostic tests to identify and screen those at high risk for this infection, institute appropriate therapy, counsel patients regarding treatment compliance, follow-up, encourage partner notification and teach strategies for preventing the transmission of this disease, including the discussion of the risk of enteric infections after oral-anal sexual contact. We summarize some data concerning the research and clinical literature on Giardia infection as a STI and identify the specific recommendations for control of giardiasis as STI that available evidence indicates can reduce its transmission.

Various sexual practices like fellatio, cunnilingus, or anilingus (rimming) can cause both symptomatic and asymptomatic oral infections in both sexes. Clinically apparent lesions are found in primary, secondary, and tertiary syphilis, in acute HIV infection and the subsequent stage of immunodeficiency (opportunistic infections), as well as in herpes and human papilloma virus infections. Genital candidiasis also can be transmitted to the oral cavity. Depending on the infective agent transmitted, ulcerative, inflammatory or papillomatous lesions of the lips, tongue, mucous membranes and pharynx occur. Oropharyngeal infections with Neisseria gonorrhoeae or Chlamydia trachomatis (Serovar D-K) can cause pharyngitis and tonsillitis with sore throat, but are completely asymptomatic in most cases. Asymptomatic infections are an important, but frequently overlooked reservoir for new infections. Systemic treatment of oral STI's usually is the same as that for anogenital infections. It can be accompanied by symptomatic topical therapy. When the tonsils and other difficult to reach tissues are infected, higher doses and an antibiotic with good tissue penetration are recommended.

Some studies (mostly retrospective) have pointed to an increasing frequency (up to 60%) of herpes simplex virus type 1 (HSV-1) in genital herpes (GH), but they were biased towards severe or atypical cases. We wished to evaluate the frequency of HSV-1 in patients attending our clinic for both first and recurrent episodes of GH. All patients (men and women) with genital lesions compatible with GH were included in a prospective study between May 1999 and April 2002. For all patients a standardized questionnaire, clinical examination, MRC5 culture (Dade Behring), polymerase chain reaction (PCR)-herpes consensus (Argène Biosoft) in case of negative culture and type-specific herpes serology HSV-1 and HSV-2 (Elisa Eurobio) were obtained. Predictive factors associated with HSV-1 and HSV-2 GH were studied by uni- and multivariable analyses. In all, 255 patients had a positive culture (n = 216) or PCR (n = 39). A total of 248 patients had typable herpes (148 men and 100 women). Median age was 33 (27-43); 20% had anal herpes; 48% had clinically recurrent lesions; 21% were HIV +; 20% of men were homosexual; 77% practised oral sex. In all, 36 were HSV-1 (14.5%): more in women, 25/100 (25%), than in men, 11/148 (7.5%) (odds ratio [OR]: 4 [1.8-9.1], P = 0.008). HSV-1 accounted for 23% of cases of first clinical episodes (women: 31.5%; men: 14.7%) (P = 0.02) and 6% of clinically recurrent episodes (women: 15%; men: 1.2%) (OR: 3.8 [1.6-9.1], P = 0.0033). Serological study was done in 239: primary infection was disclosed in 33 (HSV-1: 61%), HSV-2 non-primary first episode in 22 and recurrence in 184 (HSV-1: 8%). In all, 37% of recurrent episodes presented as a first clinical episode. HSV-1 was linked in men with homosexuality (P<0.01) and anilingus (P<0.01), in women with younger age (P<0.01), more sexual intercourses (P<0.0001) and more oral sex (P<0.001). Although HSV-1 is frequent in first clinical (23%) and primary (61%) episodes of GH, recurrent GH remains mostly due to HSV-2 (94%).

Peer-led interventions are effective in reducing risk for HIV among adolescents. A pre-intervention study was conducted to determine how to successfully carry out a possible future intervention to reduce HIV risk among adolescents in urban Zambia. Ethnographic and sexual data were collected on 276 males and females both attending and not attending secondary school during a 14-month period in 1992-1993. Additionally, several focus groups were conducted. This paper reviews the cultural background of Zambian adolescents and presents an overview of the study results. Among the findings, it was learned that most of the male and female adolescents (average age of 17) are sexually active, very few routinely use condoms, less than half of sexually active adolescents have ever used a condom, AIDS is omnipresent in Zambia, the threat of HIV infection is a very real concern for most of the adolescents, there is a strong desire to protect themselves from HIV infection during sex (but condoms are often seen as ineffective and other forms of safer sex are not discussed), nearly all of the sexually active females and some of the males have received money or gifts for sex, and some of the out-of-school females are engaging in very risky sex (e.g., unprotected anal intercourse, and anilingus) with adult men. The ethnographic data, including a brief trial risk reduction workshop, suggests that the core values and social norms of the adolescents may shape behavioral change. A value utilization/norm change (VUNC) model is developed, which is intended to provide a conceptual framework for understanding how to utilize selected core values of the adolescents to strengthen or alter norms within the social networks in order to elicit desired HIV risk reduction.

Lifetime sexual behaviors were examined among two samples of predominantly minority, male adolescents in New York City aged 12 to 18 (M = 16.3), believed to be at high risk for HIV infection: 59 runaway males in two residential shelters and 60 males attending a community agency (HMI) for gay and bisexual youths. Interviews regarding psychosexual milestones indicated that 93% of these youths had engaged in oral, anal or vaginal intercourse and/or anilingus, with a median of 11.0 female partners among runaway males and a median of 7.0 male partners among HMI males. Both groups initiated sexual activity at a relatively early mean age of 12.6 years. Each group reported a unique developmental sequence of psychosexual milestones. Consistent condom use was reported by 13% of the youths. One quarter of the youths reported involvement in prostitution. These findings detail the need for AIDS prevention programs for these youths.

Information was collected from 148 homosexual men to examine their current sexual practices, knowledge of acquired immunodeficiency syndrome (AIDS), perception of risk for this disease and change in sexual behaviour. The data were analyzed to investigate the relationship of these variables to the degree of worry and concern about AIDS expressed by most respondents. Overall, a decline in high-risk sexual behaviour was reported. Measures of worry and concern were significantly related to the subjects' perception of risk for AIDS and reduction in risk behaviours. However, the measures of Health Locus of Control, knowledge about AIDS and sociodemographic characteristics did not significantly predict the degree of worry and concern. The data are discussed in light of the current AIDS epidemic.

As part of a prospective study in Toronto, Canada of male sexual contacts of men with either acquired immunodeficiency syndrome (AIDS) or an AIDS-related condition (primary cases), separate interviews were conducted in 1984-1985 with primary cases and their corresponding sexual contacts. Seventy-five primary cases and their corresponding sexual contacts were asked details concerning the sexual activities involved in their sexual encounters. Spearman correlation coefficients were calculated for the responses regarding frequency of various sexual activities between the primary case and his corresponding contact. Comparison of responses revealed good to excellent correlations for the majority of the sexual activities. Regression analysis of responses (dependent variable = contact's response; independent variable = primary's response) revealed the tendency for primary cases to report greater numbers of various activities than sexual contacts, as illustrated by regression coefficients that were consistently less than unity. Agreement between primary responses and sexual contact responses appeared to be affected by the time lapsed from the last sexual encounter with the contact and the date of the primary case's interview. No effect on agreement was observed when primary case diagnosis and the total number of other sexual partners of primary cases were considered. The authors conclude that such data can be captured with sufficient reliability and validity for use in epidemiologic investigations to assess the risk of acquisition of human immunodeficiency virus for the more common forms of sexual activity. However, some caution may be necessary in interpreting the results for some activities (anal digit insertion, anilingus) since agreement is less satisfactory for these activities.

This study is a mapping of intestinal protozoal and pathogenic bacterial infections, and sexually transmitted urethral and anorectal infections among 365 consecutive male patients attending a veneric disease (VD) clinic in Copenhagen. The profile of diseases was strongly correlated to sexual life-style. Amoebiasis and giardiasis were found respectively in 31.9% and 13.8% of homosexuals. None of the heterosexuals had pathogenic protozoa. Protozoal infections were correlated to anilingus. Forty-five percent of the patients were infected in Denmark. Travelling to endemic areas was of no obvious importance. Among males with homosexual partners, 14% had rectal infections. Gonococcal and chlamydial infections were equally frequent. Three percent had symptomatic anorectal herpes simplex infection and 11% anal warts. Gastrointestinal symptoms were not reliable indicators of gastrointestinal infection; symptoms were claimed frequently among homosexuals without infections compared to heterosexuals. Urethral gonorrhoea and/or chlamydia infections were diagnosed in 39% of the heterosexuals compared to only 10% of the homo-bisexuals. Twelve percent of the homosexuals had untreated early syphilis, whereas syphilis was exceptional among heterosexuals. The total burden of infections expressed as the actual number of infections was largest among homosexuals, 40.4%, 22.4%, and 5.3% having one, two, and three infections respectively.