Next up is for the promiscuous set, especially guys who are still doing lots of oral and sucking cum:

STIs will be missed unless gay men have rectal and throat swabs

Michael Carter, AIDS Map, Tuesday, May 31, 2005

Sexual health screens which include only urethral tests would miss the majority of cases of Chlamydia and gonorrhoea in gay men, according to a study conducted in San Francisco and published in the July 1st edition of Clinical Infectious Diseases. Clinics offering sexual health services should provide gay men with "straightforward, non-judgmental risk assessments" and appropriate screens for sexually transmitted infections, argue the investigators.

To prevent HIV-infection and transmission, the United States Centers for Disease Control and Prevention (CDC) currently recommend that sexually active gay men should have an annual urethral and urine screen for gonorrhoea and Chlamydia. In addition, men who have had oral sex are recommended to have throat swab to test for gonorrhoea, and men who have had receptive anal sex are recommended to have rectal swabs taken for Chlamydia and gonorrhoea. These tests are recommended regardless of condoms being used or not. Men with multiple partners are recommended to undergo more frequent screening, every three to six months.

[So as we saw in the post titled Important New HIV Risk Study, which discussed Buchbinder et al, multiple partners, receptive anal whether "protected" or not, and "unprotected" oral put you at greatest risk.

Frot of course is lowest risk.]

However, there is some evidence that few sexual health clinics and gay men’s health centres are offering rectal Chlamydia screening or rectal or throat swabs for gonorrhoea without symptoms of the infection.

Investigators from San Francisco wished to obtain "more data on the prevalence of Chlamydia and gonorrhoea among [gay] men by anatomic site" to encourage "appropriate screening strategies."

Therefore demographic and clinic data from gay men attending two sexual health clinics in San Francisco were examined from 2003. The investigators had four specific aims:

To identify the prevalence of oral, throat and rectal infection with Chlamydia and gonorrhoea.

To determine the proportion of asymptomatic infections.

To see if men had infections in single or multiple sites.

To see how many Chlamydia infections would be missed if men were not routinely tested for the infection.

A total of 5539 men attending the municipal sexual health clinic and 895 who used the gay men’s health centre were included in the investigators’ analysis. Approximately 60% of men had rectal swabs taken to check for infection with Chlamydia and gonorrhoea, 85% had throat swabs, and 96% of men attending the municipal clinic were tested for urethral infections, against 88% of men who were patients at the gay men’s health centre.

The anatomical site with the highest prevalence of Chlamydia was the rectum (9% municipal clinic, 6% gay men’s clinic) followed by the urethra (6% municipal clinic, 3% gay men’s clinic) and throat (1% municipal clinic, 2% gay men’s clinic). Gonorrhoea followed a different clinic with the anatomical site with the highest prevalence being the throat (9% municipal clinic, 8% gay men’s clinic), followed by the rectum (8% municipal clinic, 3% gay men’s clinic) and urethra (7% municipal clinic, 2% gay men’s clinic).

Of the 290 men with rectal Chlamydia attending the municipal clinic (there were not enough data to allow for analysis of results from the gay men’s clinic), 57% were HIV-negative or did not know their HIV status. Similarly, of the 139 men with rectal gonorrhoea 57% were HIV-negative or did not know their HIV status.

The majority of cases (85%) of rectal Chlamydia and gonorrhoea at both clinics were asymptomatic. By contrast, only 42% of urethral Chlamydia infections and 10% of urethral gonorrhoea infections were without symptoms.

Just over half (54%) of the men with Chlamydia had the infection in the rectum alone, with 10% of men having the infection in more than more anatomical site. The investigators note "if only urethral screening for Chlamydia was conducted in this population of men who had receptive anal sex during the previous six months, 90% of rectal Chlamydia infections would be missed."

With regards to gonorrhoea, 36% of men with the infection had it in their throat only, with 28% having the infection in more than one site. Once again, the investigators caution, "if only urethral screening for gonorrhoea was performed, 77% of rectal gonorrhoea infections would be missed."

The investigators add, "on the basis of our data, the majority of Chlamydial (53%) and gonococcal (64%) infections would be missed if only urine/urethral screening was performed for men who have sex with men."

In addition, the investigators established that 70% of Chlamydia infections would have been missed if men were only tested for gonorrhoea. A total of 23% of men with rectal gonorrhoea had rectal infection with Chlamydia, 11% of men with gonorrhoea in their urethra also had Chlamydia present in this site, and 4% of men with gonorrhoea in the throat also had Chlamydia in their throat.

The investigators comment, "given that 55% of men with rectal Chlamydial and gonococcal infection reported that they were HIV-negative in our study, it is critical that rectal infections be identified and treated to reduce the risk for acquisition of HIV-infection."

Providing appropriate sexual health screens for gay men requires that clinicians perform a risk assessment. The investigators recommend guidelines available here for performing non-judgmental risk assessments.

Reference

Kent CK et al. Prevalence of rectal, urethral, and pharyngeal Chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003. Clin Infect Dis 41 (on-line edition), 2005.

Next up: From the journal Sexually Transmitted Infections, a cautionary word from Dr. John Richens, who wrote:

Richens, J., Imrie, J., & Weiss, H. (2003). Sex and death: why does HIV continue to spread when so many people know about the risks? J. of R. Statist Soc A 2003;166, 207-215.

HIV treatment after risky sex debated

By Will Boggs, MD

Wed Jun 1, 2005

NEW YORK (Reuters Health) - It seems like a good idea to offer so-called postexposure prophylaxis (PEP) when someone thinks they may have been exposed to HIV through sex -- but there could be a down side.

"I believe in a certain model of risk behavior that predicts that the benefits of PEP will be offset by unintended effects on sexual risk taking," Dr. John Richens, from the Center for Sexual Health and HIV Research in London, told Reuters Health.

"Promoting PEP may bring unintended and undesirable consequences that have not been sufficiently seriously considered by those who have worked on PEP guidelines," he explained

In an editorial in the journal Sexually Transmitted Infections, Richens and colleagues contend that "there is a distinct danger that the promotion of PEP after sexual exposure to HIV could reinforce rising trends in risky sexual behavior and might add to, rather than lessen, HIV transmission."

They say that "until the evidence is clearer, we would question the wisdom of a national campaign publicizing access to free provision of PEP after sexual exposure to HIV."

"My ideas create discomfort and may be interpreted as anti-gay," Richens commented, "but I have no hostility to gay men and enjoy looking after a large cohort of gay men in my HIV clinic."

In an editorial reply, Dr. Martin Fisher, from Brighton and Sussex University Hospitals, notes that Richens and colleagues are concerned that "individuals will engage in high-risk activity in the knowledge that PEP after sexual exposure to HIV is available. However, contrary to these concerns, all available data suggest that this is not the case."

The available data suggest that the opposite behavior occurs -- high-risk sexual acts actually declined over time in the two studies that have examined behavior after PEP.

A large multicenter observational study in the UK is currently collecting data on individuals who receive PEP and "will provide some information on efficacy and tolerability," Fisher adds. "Clearly more work needs to be done on the possible effects on risk behavior, though what work has been performed to date suggests there is not a deleterious effect."

Fisher stresses that PEP "should be considered only one strand of HIV prevention -- essentially a last strand if conventional, cheaper, and better proven methods have failed."

SOURCE: Sexually Transmitted Infections, June 2005

Who's right here?

Richens, who believes that the availability of post exposure prophylaxis (PEP) will increase the incidence of unsafe sex -- that is, anal penetration -- and with it the rate of new HIV infections and other STIs;

or Fisher, who thinks that won't happen?

In my view, Richens.

First of all, we know that the incidence of barebacking has radically increased with the perception that antivirals will protect guys who are infected with HIV from developing frank AIDS.

Secondly, we have a number of studies which indicate that condoms disinhibit -- that is, that men who use condoms have more partners, are less "picky" in their choice of partners, and of course do anal.

If condoms and antivirals disinhibit, so would PEP.

It's not mysterious.

Given the premises of analist culture, if guys think they can get away with lots of unprotected anal and lots of partners -- that's what they'll do.

The better way to go, of course, is to toss out the analism and with it the anal.

And eliminate both the disease and the dysphoria.

But until analism is given the boot, nothing will change.

Analism has built a culture based on raunch, kink, and sleaze, on sex which isn't sex and men who aren't men and relationships which aren't relationships.

That's where the disease and dysphoria -- unhappiness -- is coming from.

Men need to be men.

Not pseudo-women.

Men need to have sex with other men which is real and mutually genital.

Not a pale facsimile of heterosex, but TRUE HOMOSEX: PHALLUS ON PHALLUS.

And men need relationships with each other which are faithful and bonded.

Not promiscuous, and not "open."

But stand-by-your-man till death-do-you-part.

A community built on those prinicples will not be riddled with disease, nor crippled by substance abuse, nor beset with psychological distress and spiritual confusion.

Rather it will be physically healthy and psychologically and spiritually strong.

That's the choice we offer.

And it's a no-brainer.

Recently one of the debaters on gay dot com who's a so-called safer sex counselor told Greg Milliken that while he in no way endorses "the Frot movement," he's begun recommending frot to some of this clients.

Even though he's not only an ardent and promiscuous analist but a dedicated condom pusher as well.

Of course he's not -- heaven forfend! -- recommending Frot to all his clients.

But some.

Even though he insists he does NOT support the Frot movement.

Because that would mean agreeing with that evil Mr. Weintraub, and hell will freeze over before he'll do that.

Interestingly, the safer-sex establishment has done the same thing to Dr. Edward C. Green, who first reported on the success of the ABC approach in Uganda.

More and more AIDS prevention specialists abroad are embracing ABC, while at the same time insisting they don't agree with Dr. Green.

Which led Chuck Tarver to observe, "Classic case of paint someone as evil, then even if you come around to his way of thinking, it's not really his way of thinking after all."

But it is.

If an American MSM safer-sex counselor recommends Frot, he has, no matter what he may say, accepted at least two of our key premises:

that you cannot make anal penetration safe.

And that Frot is the better way to go.

Just as those prevention specialists working abroad have accepted Green's work when they endorse ABC.

They've accepted that abstinence and partner reduction need to be part of the mix in both HIV and other STI prevention.

That's what's happening, and it's not surprising.

Faced with intractably rising HIV infection rates; high levels of asymptomatic rectal gonnorhea and Chlamydia and other STIs; and gay male abuse of each and every new sexually-related drug, whether licit or illicit, to come down the pike -- public health officials and the safer-sex boyz will have to re-examine their committment to supporting anal and promiscuity.

Condoms are a band-aid placed over a big, gaping, pestiferous wound.

Only a significant shift in MSM culture, away from anal, promiscuity, and effeminacy, and towards Frot, Fidelity, and Masculinity, can begin to heal this community and the lives of men who love men.

Greg Milliken

Re: Buttboyz' bad behavior boosts Viagra ban; Rectal and throat swabs recommended for gay men

6-7-2005

I think there's more to this study than was told.

It fails to mention the newest STD to enter the arena, LGV.

From my understanding, LGV is similar to chlamydia, and therefore I would expect it will spread like chlamydia.

Which means there are a LOT of men who have sex with men at risk for catching a serious, debillitating illness.

Of course, LGV won't be the last disease inflicted on the gay community, as history shows.

Rather it is simply the newest, biggest, ugliest addition to the arena of bacterial infections, of which there will be bigger and uglier.

And, if it's as similar to chlamydia as doctors think, it has the potential to infect a very large portion of gay men.

Just something to think about.

Bill Weintraub

Re: Buttboyz' bad behavior boosts Viagra ban; Rectal and throat swabs recommended for gay men

6-12-2005

Yes Greg.

You're absolutely right about LGV and what it portends.

That study didn't mention LGV because it was done in the US in 2003, before LGV had reached America.

And you're correct that LGV is related to chlamydia and comparatively difficult to treat.

Here's our discussion of LGV, based on a report by Randy Dotinga for PlanetOut and on other sources, from an anus is not a vagina.

Lymphogranuloma Venereum (LGV)

LGV, which is closely related to the STD chlamydia, causes painless genital lesions at first. If untreated, lymph nodes around the sex organs begin to swell, leading to symptoms like fever, decreased appetite and malaise. In men who are anally receptive, the disease can strike the rectal area, leading to a variety of unpleasant gastrointestinal symptoms.

LGV is rare in the West, but common in Africa, Southeast Asia and the Caribbean. While treatment with an antibiotic called doxycycline wipes out the disease, doctors worry that the symptoms of the illness make it easier for men to transmit and become infected with the AIDS virus.

Dutch officials first noticed an LGV outbreak in the city of Rotterdam in December 2003. Most of those infected reported having unprotected anal sex and taking part in fisting [the insertion of the fist into the anus and rectum]. Men at highest risk also tended to be HIV-positive, members of the leather community and active partiers [that is, men who participate in a combination of drug use and promiscuous sex, often in dance or sex clubs where multiple partners and group sex are the norm].

Since 2003, LGV has been found among gay men in a number of American cities, including SF, NYC, LA, and Atlanta.

LGV is signicantly more difficult to treat than chlamydia, requiring a three-week course of antibiotics, and is frequently misdiagnosed as chlamydia, meaning it's not treated properly.

At the top of this message thread I said, seemingly facetiously, that the following articles are brought to you by the letter A for Analism.

The reality behind that little joke, however, is that without analism, these diseases would be neither widespread nor a menace.

Nor would Viagra be "a problem."

Remember what Dr. Goldstone of gayhealth dot com says:

STDs: Anal sex is the highest risk sex [sic] act that men who have sex with men can perform. Virtually every STD can pass between partners during anal sex, and for most, penetration isn't necessary and a condom may not protect you. STDs are harder to diagnose when they are inside your anal canal and not on your penis.

And STDs inside the "anal canal" are often more difficult to treat.

The anus was never meant to be penetrated.

It's extremely vulnerable when penetrated.

And so long as anal is prevalent, the medical community will be continually playing catch-up with each new anally-vectored disease.

The sensible thing, as I said, is to get rid of analism and with it the anal, and replace it with Frot, which is true, mutually genital sex, and far safer.

Of course human beings don't always do what's sensible.

But anal penetration has NOTHING to recommend it.

It's dirty, dangerous, and degrading, and we'll continue to say so.

For our task is to continue putting forward our message, and in so doing help guide MSM culture through the changes it must make for men who love men to survive.

Because that's what's at stake.

As Greg says,

LGV won't be the last disease inflicted on the gay community, as history shows.

Rather it is simply the newest, biggest, ugliest addition to the arena of bacterial infections, of which there will be bigger and uglier.

Right.

Infections which, whether bacterial or viral, prionic or protozoan, are overwhelmingly anally-transmitted.

Over the last 30 years, not only has the number of anally-vectored STDs increased, but they've become increasingly lethal.

There's a fantasy among gay men that once HIV has been "cured," they'll be able to return to life as it was, or as they think it was, in the 1970s.

That's neither possible nor desirable.

No more possible nor desirable than the religious right's goal of returning America to their fantasy of family life circa 1880.

Times change, the material conditions of life change, and we have to change with them.

The movement of MSM away from anal and promiscuity and toward Fidelity and Frot can be seen in that regard as a cultural evolution designed to insure the survival of the MLM species.

Because survival of the fittest doesn't mean survival of the most buffed.

It means survival of those best able to adapt to changing conditions.