Male Homosexual Patients Research Articles

Blurry Diagnosis of Ocular Syphilis

The incidence of syphilis is on the rise worldwide which may be due to increased diagnosis.Given the wide variety of presenting symptoms, syphilis can pose many diagnostic and therapeutic difficulties for doctors. In turn, these difficulties frequently leadto a noticeable delay in patient care. Here we present a case of ocular syphilis in ahomosexual male patientpresenting with uveitis with no prior symptoms except for an itchy rash in the pelvic area. The patient was treated with IV penicillin after which full vision was restored. By presenting this case, we hope to stress the importance of adding syphilis in the differential diagnosis of men who have sex with men (MSM)who present with otherwise unexplained rash and/or uveitis.

Epidemiological data on HIV-infected patients and the importance of education regarding the infection rate. An analytical cross-sectional study.

Sexually transmitted diseases (STIs) are an important public health problem in all countries. Knowledge of their relationship with the various socioeconomic levels is necessary for an understanding of their epidemiology and behavior in society. To investigate the epidemiology of human immunodeficiency virus (HIV)-positive patients and to correlate education with history of sexually transmitted diseases, especially for syphilis. Analytical cross-sectional study carried out in the city of Juiz de Fora, Minas Gerais, Brazil. The medical records of HIV/acquired immunodeficiency syndrome (AIDS) patients who started antiretroviral therapy (ART) between January 2010 and July 2018 were assessed. These patients were attended at the specialized assistance service for HIV/AIDS) of the Department of Sexually Transmitted Diseases (STD/AIDS) of the city of Juiz de Fora. In total, 335 patients were selected. In our sample, 73.13% were male; 57.36% were aged between 25 and 45 years and 24.23% were over 45 years of age. Regarding sexual orientation, 61.78% were homosexual. Regarding education, 52.88% had "unskilled education", while 47.12% had "qualified education". Analysis on the relationship between schooling and syphilis, a positive relationship between qualified schooling and syphilis was observed: odds ratio = 3.588; 95% confidence interval: 1.090-11.808. Homosexual male patients are most affected by HIV. Furthermore, this disease is not limited only to individuals with low education. Syphilis should be suspected in all individuals.

Erosive acute colitis associated with intestinal spirochetosis

BackgroundAlthough usually believed to be harmless, intestinal spirochetosis may active erosive colitis associated with intestinal spirochetosis that may mimic idiopathic chronic inflammatory bowel disease. Case presentation. A 49-year-old homosexual male patient sought medical assistance due to asthenia, rectal bleeding, tenesmus, and diarrhea for one month. He had been using corticosteroids for nine months to treat sciatic nerve pain. Colonoscopy showed rectum and distal sigmoid with diffuse erythema with many surface erosions. Rectal biopsy showed inflammatory changes including chronic changes such as architectural distortion and basal plasmacytosis, and active inflammation including crypt microabscesses. In all large bowel sample, dense colonization of intestinal spirochetosis was observed. Patient also had a positive PCR testing for Chlamydia trachomatis. The patient was treated with metronidazole for 14 days, ciprofloxacin for 14 days and azithromycin (single dose). Symptoms improved and the patient is asymptomatic after two months of follow-up.ConclusionIn some high-risk groups, intestinal spirochetosis may cause colonic manifestations with overlapping features with intestinal bowel diseases. Awareness of this association is importance since proper antibiotic therapy against Brachyspira (metronidazole) is highly effective. Coinfection with other sexually transmitted infections is common and proper treatment is required.

Pilot study about the relationship between body perception and sexuality using the DAS59

The idea of this study stemmed to understand if sexuality can be a factor that affects the perception of one’s body and can be a feature that makes the subject more inclined to undergo esthetic surgery. A total of 51 male subjects participated in this study by filling out the Italian version of the DAS59 consisting of 59 items, which took approximately 35 min, under the supervision of a research assistant who did not interfere with the privacy of the patient. The data was entered in SAS version 8.4 (SAS Institute, Cary, NC, USA). The reliability of the scale was tested by Cronbach’s alpha coefficient and the correlation coefficient. Retest reliability was also tested using Spearman’s correlation coefficient between items and the total scale score. Analysis of variance was performed between the two groups. Differences between the homosexual and heterosexual subjects were assessed using the Mann–Whitney test of discriminant validity. Adult homosexual male patients without a personal history of esthetic procedures were recruited. We enrolled 26 adult homosexual male patients aged 18–42 years old and 25 male heterosexual adults aged 18–43 years. Any subject had personal history of esthetic procedures. We analyzed direct and indirect indicators of “esthetic concern,” the number of answers given by each subject accuracy, the attention to the questionnaire, and the effect on age on accuracy between the two groups. We confirmed that there are many differences between the two groups. Nevertheless, the greater attention to esthetics and concern for appearance is much more present in the homosexual group than in the heterosexual group, and its relationship with age in the homosexual group is a strong indication of an important and essential phenomenon in development. The absence of such a relationship in the heterosexual group leads instead to think that the esthetic concern is in this group a phenomenon of local type and much less fundamental than the personality. The DAS59, used in a homogeneous study group, has shown that esthetic sensibility may depend on emotional and psychological factors within a homogeneous social dimension that does not create a difference. This pilot study is the first to introduce the importance of the role of sexuality in the perception of the esthetics of one’s body. Level of evidence: Not ratable.

Bilateral Peripheral Facial Paralysis Combined with HIV Meningitis During Acute HIV-1 Infection: A Case Report

Here we reported a Chinese case of bilateral peripheral facial paralysis (PFP) in human immunodeficiency virusc (HIV) infected population. A 38-year-old homosexual male patient was referred to our hospital for bilateral facial paralysis. 21 days prior to admission he had developed high fever, chills, headache, fatigue, general malaise, nausea and vomiting. Neurological examination revealed bilateral ptosis of lower lip and cheeks, as well as failure of bilateral eyes closure. Analysis of cerebrospinal fluid (CSF) revealed pleocytosis, a marked rise of micro total protein and a marked rise of intrathecal lgG synthesis. The result of HIV-1 serology was positive by ELISA and that was confirmed by western blot. His CD4 + cell count was 180 cells/mm 3. HIV-1 viral load in CSF was almost 10 times higher than that in plasma. The patient's condition improved steadily and experienced complete resolution of bilateral PFP after 2 months.

Humanes Papillomavirus und Analkarzinom

The incidence of anal cancer is increasing worldwide, especially in male homosexual patients. The main risk factor for development of anal cancer is anal infection with the human papillomavirus (HPV). The prevalence of anal HPV infection in HIV-negative homosexual men is 50–60%, while in HIV-positive homosexual men the prevalence is nearly 100%. HPV-related anal intraepithelial neoplasia (AIN) is the putative precursor of anal cancer. AIN can be found in approximately 20% of HIV-negative homosexual men and 5–10% of these patients have high-grade dysplasia (AIN II–III). The prevalence of high-grade dysplasia in HIV-positive homosexual men is, however, significantly higher being up to 50%. Despite the prevalence of HPV-related anal dysplasia and the increasing number of patients with anal cancer, there is still a lack of consensus regarding screening, surveillance and therapy of patients with AIN. The standard treatment for anal cancer is still radiochemotherapy with 5-FU and mitomycin C independent of the HPV or HIV status.

Kaposi's sarcoma in HIV-negative men having sex with men

Four epidemiologic forms of Kaposi's sarcoma have been described, all of which are associated with the human herpesvirus-8. In western countries, human herpesvirus-8 is more prevalent in homosexual men than in the general population, and anecdotal cases of Kaposi's sarcoma in HIV-negative homosexual men have been reported. We included HIV-negative homosexual and bisexual male patients with histologically proven Kaposi's sarcoma in a retrospective study. Clinical data were collected using a standardized form. Risk factors for human herpesvirus-8 infection and for the development of Kaposi's sarcoma were systematically recorded. Between 1995 and 2007, 28 men met the defined inclusion criteria. Mean age at first symptoms of Kaposi's sarcoma was 53 years. Clinical presentation resembled classical Kaposi's sarcoma, with limited disease in most patients. No cellular or humoral immunodeficiency was observed. Serologic tests for human herpesvirus-8 (latent immunofluorescence assay) were positive in 88% of patients, and only two patients displayed human herpesvirus-8 viremia at the time of Kaposi's sarcoma diagnosis. Three patients developed lymphoproliferative disorders (Castleman disease, follicular lymphoma and Burkitt lymphoma). In this population, alpha-interferon was well tolerated and gave a complete response, but most patients require only local treatment, if any. Kaposi's sarcoma may develop in homosexual or bisexual men without HIV infection. This type of Kaposi's sarcoma has clinical features in common with classical Kaposi's sarcoma but occurs in younger patients. Its prognosis is good, as Kaposi's sarcoma is generally limited, but clinicians should be aware of the association with lymphoproliferative diseases, which may affect prognosis.

Failed Reparative Therapy of Orthodox Jewish Homosexuals

ABSTRACT The author is an Orthodox Jewish psychiatrist who, at the time of this presentation, had spent thirty-six years in the general practice of psychiatry, primarily among the broad spectrum of Orthodox Jewish patients. As a part of this general practice, the author encountered a number of Orthodox patients with homosexual attractions who desired to change their orientation. Since the author's initial results seemed encouraging as he found that all of his patients moved at least one point towards heterosexuality on the Kinsey scale, he began accepting more referrals to achieve significant change in homosexual orientation. The author's therapeutic goals, at the time, were to counteract the homosexual patient's self-loathing; provide a warm, hopeful and accepting therapeutic environment; explain that human approaches to sexuality were variable and not monolithic and provide alternatives to a gay community lifestyle. The author believed a nurturing relationship with a straight male therapist, who understood the person's religious sensibilities and feelings, might help detoxify corrosive masculine influences of the past and provide some role-modeling for future identification. The author describes several long-term cases in which he treated Orthodox Jewish patients who wished to be rid of their homosexual feelings and attractions. All of the author's male homosexual patients in intensive therapy moved at least one point on the Kinsey scale towards heterosexuality. However, that movement was not unidirectional. Reversions occurred in response to stressful events of various sorts—at times compromising an intact and extensive nuclear family and leading to catastrophic results. In contrast to the men, the author found it virtually impossible to achieve significant movement toward heterosexuality with homosexual women. The author believes more was accomplished when there was no direct expectation that change in sexual orientation be the specific goal. In those cases, sexual reorientation happened as a result of organic change as a part of a successful therapy for mutually agreed emotional problems.

PATHOLOGICAL ORGANIZATIONS OF THE PERSONALITY: A CLINICAL CASE STUDY

abstract In this paper the author describes the features and clinical manifestations of specific states of mind, which functioned as psychic retreats in a male homosexual patient. Two main types of retreats emerged in the course of the analysis. The first took the shape of an inanimate object (a spaceship), within which little human contact was allowed to exist. In the second retreat some degree of relating was present, but that mental space was populated with threatening homosexual figures which kept a strong hold on the patient’s ego and attacked any meaningful contact established between patient and analyst. The presence of these structures enabled the patient to evade awareness of the injured, paralysed and damaged state in which his internal objects were kept, and to bypass depressive anxieties connected to painful early oedipal conflicts, which included a terrifying maternal introject. The attempt to recruit the analysis into the patient’s psychic retreat constituted a central transference manifestation.

Is Stapled Hemorrhoidopexy Safe for the Male Homosexual Patient? Report of a Case

Stapled hemorrhoidopexy is becoming a widely accepted surgical treatment for third- and fourth-degree hemorrhoids because it is associated with much less postoperative pain than open hemorrhoidectomy. After the procedure, a circular line of staples is left in the anal canal; therefore, there is a risk of penile injury or condom damage during anal intercourse, which increases the risk of exposure to sexually transmitted diseases. We report the case of a male homosexual patient who engaged in anal intercourse after recovering from a stapled hemorrhoidopexy, resulting in condom damage. We did not consider this possibility and neglected to discuss the issue with the patient. With an estimated 2.5% of the general population being exclusive, male homosexuals, it is necessary to inform such patients to refrain from anal intercourse after hemorrhoidopexy, although there are no reports stating how long this restraint should last.

Hépatite à syphilis et transplantation hépatique

We report a case of secondary syphilis hepatitis in a liver-transplant patient. This homosexual male patient presented, 15 years after orthotopic liver transplantation, with non-squamous papulomacular rash, mild cytolysis, and anicteric cholestasis. Laboratory tests showed syphilis seroconversion with a venereal diseases research laboratory (VDRL) titer of 1/256, a Treponema pallidum hemaglutination assay (TPHA) of 1/5120, and a positive IgM fluorescent Treponemal antibody absorbance (FTA-abs). A liver biopsy performed 13 months after the diagnosis showed low-grade hepatitis with a Metavir score of A1F1; it also showed non-specific portal moderate inflammation consisting primarily of neutrophils, with no evidence of cholestasis. He was given benzathine-penicillin at 2,400,000 IU with a transient increase in prednisolone doses. Cytolysis rapidly, and cholestasis progressively disappeared. IgM FTA-abs became negative, whereas VDRL and TPHA titers decreased slightly over time.

Épidémie de syphilis dans le sud-est de la France

Since 2000, syphilis has reappeared in the form of an epidemic in France and more particularly, in the Paris region. However, there is little available data concerning other regions of France. The purpose of this study was to identify the chief characteristics of this epidemic in the Côte d'Azur region. Between January 2001 and July 2003, cases of syphilis were collated by the Department of Dermatology and Infectious Diseases of Nice University Teaching Hospital and by the Department of Dermatology and Infectious Diseases of Fréjus hospital and based on spontaneous reports submitted by general practitioners in private practice. We collected 54 reports of cases of syphilis: 37 in the Alpes-Maritimes region and 17 in the eastern Var region. The epidemic chiefly affected men since 44 of the 54 cases reported (81%) concerned males. 70% of these men were contaminated during homosexual contact (31 patients). In the majority of cases, contamination concerned local subjects. 50% of the patients in the study were infected with human immunodeficiency virus (HIV). The clinical forms observed were distributed as follows: 12 primary syphilis, 28 secondary syphilis, 13 latent syphilis, 1 case not specified. There was no difference in terms of clinical form between patients with and without HIV. Syphilis, which had become rare in France as a whole and in our region in particular, reappeared in the form of an epidemic in the Côte d'Azur region after first resurfacing in the Paris region. This outbreak principally affected homosexual and bisexual male patients, half of whom were HIV-positive. Screening for syphilis, potentially latent, should thus be carried out routinely during initial assessment and at subsequent monitoring of HIV patients.

The Role of Hydroxyurea in Enhancing the Virologic Control Achieved Through Structured Treatment Interruption in Primary HIV Infection

Structured treatment interruptions (STIs) have been postulated to improve virologic control in primary HIV infection (PHI) by stimulating HIV-specific T-lymphocyte immunity. The addition of hydroxyurea (HU) may reduce viral production from activated CD4 cells. Patients with PHI received a standardized antiretroviral (ARV) regimen consisting of indinavir 800 mg twice daily (BID), ritonavir 100 mg BID, didanosine 400 mg (QD), and either stavudine 40 mg BID or lamivudine 150 mg BID, for up to 12 months and were randomized to HU 500 mg BID or not. If viral suppression (<50 copies/mL) was achieved, up to 3 STIs were undertaken. Two ARV cycles were allowed after each interruption if virologic rebound to more than 5000 RNA copies/mL occurred. Treatment success was defined as maintaining viral loads below 5000 copies/mL for 6 months after ARV interruption. Sixty-eight male homosexual patients were randomized: 35 to ARV + HU and 33 to ARV-alone. Median baseline HIV RNA was 5.73 log10 copies/mL, and median CD4 T-lymphocyte count was 517 cells/microL. Treatment success was not significantly different between those receiving and not receiving HU, with 9 (26%) and 9 (27%), respectively, maintaining viral load at less than 5000 copies/mL in each group (P = 0.88). Virologic control was achieved by 11 (19%) of 59 after 1 STI, 1 (2%) of 41 after 2 STIs, and 6 (17%) of 36 after the third STI. Serious adverse events were recorded for 9 (26%) of 35 of patients using HU and 3 (9%) of 33 in the ARV-only group (P = 0.28). CD4 cell increases were significantly blunted for the HU group compared to the ARV-alone group after the initial treatment phase (+101 cells vs. +196 cells, respectively, P = 0.006). Hydroxyurea was not found to be beneficial when used in association with STIs in patients during PHI.

Mycoplasma penetrans infections and seroconversion in patients with AIDS: identification of major mycoplasmal antigens targeted by host antibody response

We examined Mycoplasma penetrans-specific antibodies in sera of five male homosexual AIDS patients from whom M. penetrans was isolated during the disease process. No consistent immune reaction pattern could be recognized in Western blot using whole cell proteins. Serum samples obtained prior to M. penetrans isolation reacted with a number of M. penetrans proteins, most likely due to non-specific cross-reactions. Further analysis revealed that patients produced prominent antibody reaction to lipid-associated membrane proteins (LAMPs) of M. penetrans at the time of mycoplasma isolation, which could not be observed for serum samples obtained prior to M. penetrans isolation. The positive antibody reaction was mainly directed against two major LAMPs of M. penetrans with molecular mass of 35 and 38 kDa and produced a distinctive pattern of positive immunoreaction bands. Our observation suggested that, comparing with whole mycoplasmal proteins, LAMPs were more specific target antigens in serological assays for M. penetrans infection.

AN UNUSUAL CASE OF HUMAN INTESTINAL SPIROCHETOSIS INCIDENTALLY DIAGNOSED IN AN ASYMPTOMATIC IMMUNOCOMPETENT NORTH AMERICAN PATIENT

Intestinal spirochetosis describes the presence of spirochetes in the human gastrointestinal tract. Most of the recent reports have involved homosexual male patients with advanced human immunodeficiency virus (HIV) infection. In immunocompetent patients, a variety of symptoms have been attributed to spirochetal infections with different degrees of improvement after treatment of that infection. We present a case of human intestinal spirochetosis diagnosed in an asymptomatic 64 year-old female patient who was referred for screening colonoscopy. Diagnosis was made on biopsies obtained from a single superficial ulcer of the transverse colon. A prominent brush border was noted on routine light microscopy and confirmed with the Warthin-Starry stain. The patient was immunocompetent and had no risk factors or recent travel outside the United States. She was treated with a short course of oral antibiotics and remained asymptomatic afterward. This case supports the opinion that human intestinal spirochetosis is possibly more prevalent than traditionally taught. Clinical significance of this condition remains unclear as patients can be completely asymptomatic. Diagnosis can be easily missed as the histopathological changes are subtle. More research is needed to better define both the prevalence and the significance of this infection.

Oral ulcers in AIDS patients frequently associated with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections.

Oral ulcers are common in AIDS patients, with a wide spectrum of underlying causes, including different viruses. In the present study, the presence of cytomegalovirus (CMV), Epstein-Barr virus (EBV) and human herpesvirus-8 (HHV-8) DNA was analysed in 21 biopsies from oral ulcers of 17 male homosexual AIDS patients. The methods used were in situ hybridization (ISH) and the polymerase chain reaction (PCR) with subsequent non-radioactive Southern blot hybridization to confirm the specificity of PCR products. With ISH, 4 biopsies were CMV DNA-positive and 11 contained EBV-DNA. Using PCR, an additional 4 CMV- and 7 EBV-positive samples were detected, and HHV-8 DNA was present in three oral ulcers. Six of the patients (35%) had oral ulcers co-infected by two or three viruses. The overall figures for patients with the detectable EBV-, CMV-, and HHV-8 DNA were 82% (14/17), 35% (6/17) and 18% (3/17), respectively. This is the first study to show the frequent presence of EBV-DNA in oral ulcers of AIDS patients. Because ISH-positivity signifies active virus replication, these results implicate an etiological role of EBV in AIDS-associated oral ulcers. The causal role of HHV-8 has to be considered as well, because this virus was detected in three such ulcers, which were not associated with Kaposi's sarcoma. To conclude, three common members of the herpesvirus family (CMV, EBV, HHV-8) were detected in all but three ulcers in AIDS patients, warranting the inclusion of these viral analyses in the diagnosis of ulcerative lesions of the oral mucosa in all immunosuppressed individuals.

Reactivation of hepatitis B in a long-term anti-HBs-positive patient with AIDS following lamivudine withdrawal

Background/Aims: In HIV-infected patients, who have recovered completely from an acute hepatitis B infection and become anti-HBs positive, hepatitis B infection may be reactivated after progression to AIDS. Case Report: We present the case of a homosexual male patient with AIDS who developed clinical and serological reactivation of hepatitis B with detectable HBV-DNA 18 years after complete recovery from acute hepatitis B infection. Prior to reactivation, anti-retroviral triple therapy including lamivudine was changed to therapy without lamivudine. After reintroduction of lamivudine in the triple therapy, HBV-DNA became undetectable and the patient lost HBsAg and again developed anti-HBs antibodies. Conclusion: The hepatitis B in this patient can be explained best by reactivation of persistent HBV infection, possibly because of transient decline in antibodies against HBs-antigen due to a reduction in CD4+ lymphocyte numbers and B cell dysfunction. This observation points to the clinical relevance of HBV persistence in serum and blood cells of anti-HBs-positive subjects for many years after recovery from acute hepatitis B infection. The possible role of lamivudine withdrawal which immediately preceded HBV breakthrough in our patient is noteworthy. Regular monitoring of markers of HBV infection, including HBV-DNA, in patients with AIDS appears justified after discontinuation of lamivudine.

Genital colonisation and infection with candida in heterosexual and homosexual males.

OBJECTIVES: To determine the penile, perianal, and oropharyngeal candidal colonisation rates among homosexual and heterosexual males attending an STD clinic. To determine the prevalence of balanitis and candidal balanitis in...

Systemic treatment modalities in the management of AIDS-related Kaposi's sarcoma

Abstract Background Kaposi's sarcoma (KS) is the most common neoplasm in patients with AIDS: in some cohorts of homosexual men with AIDS, the lifetime risk of KS approaches 50%. Prognosis is either ‘good risk’ or ‘poor risk’ according to recommended staging criteria. Objective In the present study we treated a good risk AIDS-KS group of patients with low dose of alpha-2 interferon (alpha-2IFN) plus AZT, and a poor risk AIDS-KS group of patients with chemotherapy. Study design Prospective, non-randomized trial. Subjects Forty-four homosexual or bisexual male patients between 21 and 45 years old with positive ELISA for HIV, and KS, were included in the study. Intervention Ten patients received alpha-2 IFN plus AZT, 12 bleomycin, 12 doxorubicin-bleomycin-vincristine (ABV), and ten patients did not receive treatment. Results One patient achieved complete remission, two partial remission (PR), six stable disease (SD) and one progression (P) during alpha-2 IFN plus AZT treatment. Seven patients showed SD and five P during bleomycin treatment; and four patients achieved PR and eight SD during ABV treatment. Outcome Despite the fact that the different systemic treatment modalities employed allowed us to achieve clinical responses, there was no significant improvement in survival.

An association between HIV-1 subtypes and mode of transmission in Cape Town, South Africa.

To determine HIV-1 env and gag subtypes in male homosexual and heterosexual populations in Cape Town, South Africa. DNA was isolated from blood originating from 61 patients attending local clinics. Samples were divided according to presumed mode of transmission: male homosexual (n = 26), heterosexual/vertical (n = 32), blood transfusion (n = 1) and unknown (n = 2). Proviral HIV-1 DNA was subtyped by heteroduplex mobility assay (HMA) based on the 799 base-pair V3-V5 region of the env gene (n = 47) or by sequence analysis of the p17 region of the gag gene (n = 33), or both. For HMA, reference plasmids were constructed containing the V1-V5 env region sequences (1.2-kb) representative of local subtypes. Subtype designation of reference subtypes was confirmed by sequence analysis of the V3-loop region. Analysis of the partial gag sequences and HMA of the V3-V5 env region identified three subtypes: B, C and D. A fourth env subtype, subtype E, was also identified by HMA. Subtypes were found to segregate according to mode of transmission, with subtype B viruses found in 96% (25 out of 26) of the male homosexual group and subtype C viruses found in 81% (26 out of 32) of the heterosexual/vertical transmission group. Subtype B viruses were also found in four heterosexual patients, one patient infected by blood transfusion and in two patients with unknown mode of transmission. Subtype D viruses were found in one male homosexual patient and one heterosexual patient. A subtype E virus was identified in a heterosexual patient. No discrepancy was found in subtype designation in samples analysed in both between the gag and env regions (n = 19). Subtype B viruses were associated with male homosexual transmission and subtype C viruses with heterosexual transmission, suggesting two independent epidemics. This data may have implications in the selection of appropriate vaccines for different risk groups in the country.