Oro-anal Sex Research Articles

Asymptomatic enteric pathogen carriage and its association with proton pump inhibitors use in men who have sex with men in Taiwan, 2019-2022

ObjectivesCurrently recognized risk factors for sexually transmitted enteric infections (STEIs) among men who have sex with men (MSM) include oroanal sex, multiple sexual partners, and chemsex. This study aimed to investigate the prevalence of the asymptomatic carriage of enteric pathogens in men who have sex with men (MSM) and to identify the associated risk factors. MethodsQuestionnaires were completed by 375 MSM in Taiwan from December 2019 to November 2022. Fecal samples were analyzed by multiplex PCR to determine whether seven enteric pathogens, including Entamoeba histolytica, Giardia duodenalis, Shiga toxin-producing Escherichia coli, Cryptosporidium, Campylobacter, Salmonella, and Shigella species, were present. ResultsAmong 375 fecal samples from asymptomatic MSM, 27 (7.2%) fecal samples tested positive for at least one enteric pathogen. The recent use of proton pump inhibitors (PPIs) was significantly associated with asymptomatic fecal carriage (22.2% vs. 2.0%, P < 0.001). G. duodenalis (2.1%, 8 cases), E. histolytica (1.6%, 6 cases), and Shigella species (1.3%, 5 cases) were commonly detected. Oroanal sex and PPI use were associated with the asymptomatic carriage of enteric pathogens. Specifically, Shigella, Salmonella, or Campylobacter carriage was significantly correlated with PPI use. In contrast, rectal gonorrhea was associated with multiple sexual partners and prior syphilis. ConclusionsRecent use of PPIs was associated with the asymptomatic carriage of enteric pathogens. Therefore, targeted education about the appropriate use of PPIs is necessary to mitigate the risk of STEIs among MSM.

Chlamydia trachomatis anorectal infections by LGV (L1, L2 and L2b) and non-LGV serotypes in symptomatic patients in Buenos Aires, Argentina

Chlamydia trachomatis (CT) can infect the anorectum producing various signs and symptoms. There is scarce literature regarding the differences between LGV and non-LGV CT anorectal manifestations. We compare the clinical spectrum of LGV and non-LGV infections. Patients over 18 years with presumptive infectious anorectal symptoms were examined in two healthcare centres in Buenos Aires. The patients were studied and treated according to current sexually transmitted infection guidelines. Anorectal swabs were collected to detect and genotype CT. A three-year-long study on 317 patients with anorectal symptoms showed 45.11% CT infection (85% LGV strains). Of 140 samples, 92 were sequenced: 80/119 LGV (L2b 45%, L1 32.5% and L2 22.5%) and 12/21 non-LGV. Older age and HIV+ status were significantly higher in the LGV group. Anal discharge, bleeding, severe proctitis and anal ulcers were more common in the LGV group. Multivariate logistic regression analysis revealed that HIV infection, anorectal bleeding and oro-anal sex are independent predictors of LGV infection. In patients with anorectal symptoms, LGV serovars predominate over non-LGV ones. Clinical manifestations are not pathognomonic of a specific biovar. If genotyping is not available, having clinical predictors may help to presume an LGV infection and define length of treatment.

Human intestinal spirochetosis, a sexually transmissible infection? Review of six cases from two sexually transmitted infection centres in Barcelona.

Human intestinal spirochetosis (HIS) is a possible cause of chronic diarrhoea and affects mainly men who have sex with men (MSM) and people living with HIV. Diagnosis is based on colon biopsy, where spirochetes can be observed on the luminal surface, especially with the Warthin-Starry stain or similar silver stains. We conducted a retrospective descriptive study of all HIS cases diagnosed in two sexually transmitted infections (STI) centres in Barcelona from 2009 until 2018. The medical histories were reviewed to gather epidemiological, clinical, and diagnostic variables. Six patients were diagnosed with HIS. All the individuals were MSM, with a median age of 31.5 years (interquartile range [IQR] 29.5;49.25) and half of them were living with HIV. Five patients reported condomless anal intercourse and 4 patients had practised oro-anal sex previously. Concomitantly, two of them had rectal gonorrhoea, one had rectal Chlamydia trachomatis and none of them had syphilis. The predominant clinical symptom was diarrhoea (5 patients). All cases were diagnosed by a Warthin-Starry stain on a colon biopsy specimen, and mild inflammatory changes were found in 5 cases. Five patients were treated with metronidazole and one with benzathine penicillin G. Treatment was successful in all the patients. HIS should be considered in patients with chronic diarrhoea who report risky sexual practices and/or concomitant STI. HIS may also be sexually transmitted according to the context.

Sexual practices and the risk of Hepatitis A in men who have sex with men in Spain.

To determine the frequency of and identify risk factors associated with sexual practices leading to hepatitis A infection in the population of men who have sex with men in Spain. The increased incidence of hepatitis A as a result of sexual contact among this population is a public health concern and a challenge in controlling sexually transmitted infections. This cross-sectional, online survey-based study included 881 men who have sex with men. Unprotected oro-anal and insertive-anal sex are considered to be unsafe sexual practices associated with hepatitis A infection. Of all respondents, 83.4% engaged in insertive-anal sex and 71.3% in unprotected oro-anal sex during the previous 12months. An association was found with sociodemographic factors [living alone (OR=2; 95%CI=1.13-3.35)] and contextual factors of sexual behaviour [previous diagnosis of sexually transmitted infection(s) (OR=1.74; 95%CI=1.15-2.61) and participating in 'chemsex' (OR=5.15; 95%CI=1.05-25.15)]. The frequency of unsafe sexual practices associated with hepatitis A among men who have sex with men in Spain is high. Interventions based on sociodemographic and contextual factors of sexual behaviour should be implemented. Nurse managers should update and incorporate the support needs of men who have sex with men and take advantage of the opportunity to implement harm reduction strategies.

Anale Herpes-simplex-Virus-Infektionen

Herpes simplex virus (HSV) type1 and type2 may infect the anal region and induce aphthous ulcers. HSV-induced proctitis may be severe with fever, anal pain, anal bleeding, and diarrhea. The pathogenic agents and treatment are reviewed. A review of the current literature was performed. The shift to later primary infections with HSV1 and changes towards more frequent oro-genital and oro-anal sex has increased the incidence of HSV1-induced primary anal infections. Due to frequent recurrences, HSV2 remains the most common cause of anal HSV infection. Anal and genital HSV infections are arisk factor for subsequent HIV infection. In case of suspicion, pathogen detection by polymerase chain reaction (PCR) should be performed and other sexually transmitted diseases should be excluded. HSV proctitis may mimic inflammatory bowel disease. Treatment should include antiviral medication as in genital herpes simplex. HSV may induce perianal infections, anal infections and HSV proctitis. Diagnosis of HSV1 and HSV2 using PCR is recommended. Anal and genital HSV infections are arisk factor for subsequent HIV infection. The risk is higher for HSV2 infection due to more frequent recurrences.

Oro-anal sexual practice among female sex workers in Melbourne: implication for extragenital gonorrhoea and chlamydia transmission.

A cross-sectional survey among FSWs attending the Melbourne Sexual Health Centre in Australia in March 2018 was conducted. All females aged ≥18 years and self-reported as a sex worker were eligible. The survey included questions related to the number of insertive and receptive rimming partners with their male clients in an average working week. Forty-five FSWs completed the survey; five (11.1%; 95% CI: 3.7-24.1%) FSWs had had insertive rimming and 19 (42.2%; 95% CI: 27.7-57.8%) had had receptive rimming with their male clients in an average working week. The median number of insertive rimming partners was two (interquartile range (IQR) 1-5) and the median number of receptive rimming partners was one (IQR 1-3). Insertive rimming is more commonly practiced than receptive rimming among FSWs with their male clients in an average working week.

Evidence for a new paradigm of gonorrhoea transmission: cross-sectional analysis of Neisseria gonorrhoeae infections by anatomical site in both partners in 60 male couples

ObjectiveGonorrhoea transmission between men is currently thought to occur primarily to and from the urethra. Transmission without urethral involvement, from throat-to-throat and throat-to-anus, is considered to be uncommon. Using gonorrhoea...

Risk Factors for Asymptomatic Enteric Pathogen Detection Among Men Who Have Sex With Men.

Improved knowledge of factors that promote outbreaks of enteric pathogens among men who have sex with men (MSM) could enable targeted public health interventions. We detected enteric pathogens in 57 of 519 (11%) asymptomatic MSM, and we found that enteric pathogen detection was associated with both oroanal sex (rimming) and group sex.

Human papillomavirus and oral and oropharyngeal carcinoma: the essentials.

There is a global increase in the prevalence of human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinoma (OPSCC) in Australia and New Zealand. Risk factors for HPV-positive OPSCC are male gender, white race, age older than 40 but younger than 59years old, having multiple lifetime sex partners, having oro-genital and oro-anal sex. High-risk HPV subtypes play a major role in the pathogenesis of OPSCC, however, they play a much lesser role in oral squamous cell carcinoma (OSCC). Among the laboratory tests used to detect oncogenic HPV infection, polymerase chain reaction is a sensitive method but does not reflect the role of HPV in oncogenesis. While widely used, p16 immunohistochemistry is both a sensitive and a specific surrogate marker for oncogenic HPV infection in OPSCC, but not in OSCC. However, it is a useful prognostic marker in OPSCC. The current gold standard to accurately detect oncogenic HPV infection is E6/E7 mRNAinsitu hybridization. Because both HPV-positive and p16-positive OPSCC have better short-term prognoses there is current debate and trials on treatment de-escalation in HPV-positive OPSCC. Dental practitioners can play an important role in early diagnosis of HPV-positive OPSCC.

Associations Between Anorectal Chlamydia and Oroanal Sex or Saliva Use as a Lubricant for Anal Sex: A Cross-sectional Survey.

Receptive condomless anal sex is a known risk factor for anorectal chlamydia, but it remains unclear whether oroanal sex practices also contribute. We aimed to determine whether oroanal sex ("rimming"), fingering, or the use of saliva as anal lubricant are risk factors for anorectal chlamydia among men who have sex with men (MSM). This cross-sectional study was conducted at Melbourne Sexual Health Centre from July 2014 to June 2015. Routinely collected computer-assisted self-interview data included demographics, number of sexual partners, and condom use. We added questions on receptive rimming, receptive fingering or penis "dipping," and the use of a partner's saliva as anal lubricant. A total of 1691 MSM completed the questionnaire and tested for anorectal chlamydia. In univariable analyses, anorectal chlamydia was associated with using a partner's saliva as lubricant (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.26-3.09), receptive rimming (OR 1.59; 95% CI 1.04-2.45), and receptive fingering or dipping (OR 1.90; 95% CI 1.06-3.43). In multivariable analysis, anorectal chlamydia was not associated with these sexual practices, after adjusting for number of sexual partners, HIV status, known contact with chlamydia, and condom use. However, collinearity between sexual practices likely obscured associations with anorectal chlamydia, and further analyses suggested weak associations between these sexual practices and anorectal chlamydia. The use of a partner's saliva during receptive anal sex practices such as rimming, fingering, or penis dipping were weak risk factor for anorectal chlamydia in MSM. This contrasts with our previously reported findings that the use of saliva as anal lubricant is more strongly associated with anorectal gonorrhea.

Risk factors for oropharyngeal gonorrhoea in men who have sex with men: an age-matched case–control study

ObjectivesOropharyngeal gonorrhoea is common among men who have sex with men (MSM). We aimed to clarify which oral sex practices were independent risk factors for oropharyngeal gonorrhoea: tongue kissing, receptive...

Saliva use in sex: Associations with use of smartphone dating applications in men who have sex with men.

Smartphone dating applications have become a primary source for men who have sex with men (MSM) to meet sexual partners. It has been found that MSM who used smartphone dating applications are at higher risk of gonorrhoea, but the reasons remain unknown. This study aimed to investigate whether MSM who met their partners via smartphone dating applications are more likely to engage in sexual practices such as rimming (oro-anal sex), and use of partner's saliva as a lubricant, that are associated with the risk of gonorrhoea. A cross-sectional study was conducted among 1672 MSM attending the Melbourne Sexual Health Centre, Australia, between 31 July 2014 and 30 June 2015. Multivariate logistic regression was conducted to examine the associations between sources of meeting partners and the two aforementioned sexual practices. MSM who used smartphone dating applications were 1.78 (95% CI: 1.38-2.28) times more likely to get rimmed, and 1.63 (95% CI: 1.27-2.09) times more likely to use partner's saliva as a lubricant during anal sex, compared to other sources, after adjusting for age and other sources for meeting partners. These practices are highly associated with gonorrhoea.

Prevalence, incidence and risk factors for pharyngeal gonorrhoea in a community-based HIV-negative cohort of homosexual men in Sydney, Australia

BackgroundPharyngeal gonorrhoea is common in homosexual men and may be important in maintaining community prevalence of anogenital infections.MethodsFrom 2003, all participants in the Health in Men cohort of HIV-negative homosexual...

26. MORE THAN JUST ANAL SEX: THE POTENTIAL FOR STI TRANSMISSION AMONG MEN VISITING SEX ON PREMISES VENUES IN MELBOURNE

Objective: Sex On Premises Venues (SOPVs), where men have sex with other men, provide an environment where the transmission of sexually transmitted infections (STIs) is potentially enhanced. However, the extent to which SOPVs contribute to STI transmission is unknown. This study aimed to obtain detailed data on the types of sexual practices and frequency of these practices among men who have sex with men (MSM) visiting SOPVs in Melbourne, Australia. Methods: In a cross-sectional study, MSM visiting 6 Melbourne SOPVs between December 2006 and February 2007 were asked to complete an exit survey on the types of sexual practices and frequency of such practices they had engaged in at that visit. Of 447 men approached, 150 (34%) participated in the study. Results: The median age of participants was 42.5 years (range 20-79). Among participants who engaged in receptive oral sex (66%) and insertive oral sex (75%), the median number of such acts reported by each man during the visit was 2 (range 1-10) and 2 (range 1-10) respectively. Eleven men (7%) reported receptive oral sex with ejaculation into their mouth with a median of 1 act (range 1-3) per man. Among participants who engaged in receptive anal sex (19%) and insertive anal sex (38%), the median number of such acts per man during the visit was 1 (range 1-4) and 1 (range 1-8) respectively. Eleven men (7%) reported unprotected insertive anal sex with a median of 1 act (range 1-4) per man; 4 (3%) reported unprotected receptive sex. A substantial number of men who did not report any anal sex engaged in practices potentially capable of transmitting infections. Notably, 44 men (29%) reported unprotected rubbing or touching of their penis ('nudging') onto another man's anus without actual anal penetration with a total of 71 other men (median 1 act per man, range 1-10). When specifically asked, 17 (39%) of these men reported that they had not engaged in 'anal sex'. In addition, 32 men (21%) reported being the recipients of 'nudging' with 40 other men. Fourteen (44%) of these men reported not having had any 'anal sex'. Oro-anal sex, whether 'active' or 'passive', was reported by 57 (38%) of men, while 84 (56%) men reported anal penetration using fingers, whether receptive or insertive. A significant minority (11%) of men reported that their ability to have safe sex was compromised by the use of drugs or alcohol. Of note, 58 (39%) men reported having a regular male partner, with whom 23 (40%) had unprotected anal sex. And 13 (9%) reported having a regular female partner, with whom 10 (77%) reportedly had unprotected vaginal or anal sex. Conclusions: The potential for STI transmission between men visiting Melbourne SOPVs and to their partners outside these venues is high. The contribution of what might be perceived as 'safer' sex practices to the transmission of STIs among MSM may have been underrecognised.

Dukers et al. Respond to "Sexual Practices Associated with HHV8 Infection"

Although we pursued comprehensiveness in listing potential biases in our paper (1), Martin and Osmond (2) correctly noted an additional form of bias caused by the difficulty to accurately pinpoint the moment of infection. Although this may be a problem, recent observations in our cohort suggest a relatively short window-period. Among seroconverters with transient human herpesvirus 8 (HHV8) viremia before or at seroconversion, the period between detection of virus and detection of antibodies was short and was only rarely longer than 3 months (J. Goudsmit, University of Amsterdam, unpublished manuscript). Therefore, the extent to which sexual practices are measured after the actual moment of infection will probably be limited. Some bias cannot be excluded, but it is not likely that this leads to important spurious associations. Although inaccurate reporting of behavior might still influence our results (as is the case in any study design), our study is more sensitive in estimating an association with specific sexual behavior compared with previous studies, as we included a large number of incident cases and as most other studies were cross-sectional. Although we identified orogenital sex as the most important risk factor for HHV8 seroconversion, which was previously unrecognized, transmission by other routes cannot be ruled out. It was suggested that controlling for human immunodeficiency virus (HTV) might attenuate the potential risk for anogenital receptive sex. However, whether or not HTV was included in the multivariate model, the estimated risk for anogenital receptive sex (corrected for all other sexual techniques) was far from statistical significance. Still, assuming that transmission by anogenital and/or oroanal sex is possible, statistical significance may not be reached when transmission efficacy of these techniques is very low, as suggested by Martin and Osmond. Although we agree with their statement that because of such universal practices as kissing and penile-oral intercourse saliva may transmit inefficiently, the transmission efficacy of receptive anogenital or insertive oroanal sex may even be lower as less or no virus is detected in semen and feces, respectively (3). Since the start of the HTV/acquired immunodeficiency syndrome (AIDS) epidemic, prevention campaigns for homosexual men have focused on anogenital sex. As a result, homosexual men reduced their number of partners and the frequency of unprotected anogenital contacts, and the HTV incidence declined strongly. However, these prevention campaigns appeared to have had less impact on sexual practices other than anogenital receptive sex as, for example, in our cohort the frequency of unprotected orogenital contact has remained constantly high over the years. Sexual practices other than anogenital receptive sex can be of significant importance in the transmission of sexually transmitted diseases, as is well known for hepatitis A and B, for example, and as we have now suggested for HHV8. Therefore, we fully agree with Martin and Osmond that the prevention message for homosexual men should not be targeted toward the risk of a specific sexual technique but toward safe sex in general, including safe oral sex.

Sexual transmission and prevention of the hepatitis viruses A-E and G.

OBJECTIVES: To assess current knowledge about the potential for sexual transmission of the hepatitis viruses A-E and G and how to prevent any such transmission. METHOD: A search of published...

Oral sex and transmission of non-viral STIs.

OBJECTIVES: To review the literature on the role of oral sex in the transmission of non-viral sexually transmitted infections (STIs). METHOD: A Medline search was performed using the keywords oro-genital...

Nasopharyngeal flora in HIV seropositive men who have sex with men.

OBJECTIVES: To assess, in men who were infected with the human immunodeficiency virus (HIV) and who identified themselves as having had sex with men; the nasopharyngeal prevalence of Neisseria gonorrhoeae,...

Oro-anal sex and the occurrence of Kaposi's sarcoma.

Oro-anal sex and the occurrence of Kaposi's sarcoma.

Sexually transmitted diseases, T cell subsets, and sexual practices in homosexual men attending an STD clinic.

Sixty three homosexually active men and 42 heterosexual men answered questionnaires regarding aspects of their social life and sexual practices. Assessment of past sexually transmitted disease showed the homosexual group to have had a significantly greater incidence of syphilis, gonorrhoea, perianal warts, and cytomegalovirus infections. T cell subset counts were carried out, and results for 60 of the homosexual men and 39 of the heterosexual men showed that the homosexuals had a significantly greater mean T cell suppressor cell count (p = 0.0019). The mean T helper cell count was not significantly different between the two groups, but it was significantly more (p = 0.033) in the more promiscuous homosexuals (who had more than 20 sexual partners a year) than in the heterosexuals. No relation was found between T cell subset counts and evidence of past cytomegalovirus infection. The practice of passive anal intercourse, oroanal sex, and swallowing semen during oral sex did not appear to influence T cell subset counts in the homosexuals.