Category Archives: Health Alerts

Important health information for men who have sex with men

Young men unaware of risks of HPV infection and need for HPV vaccination

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From Eurekalert.com…

Young sexual minority men — including those who are gay, bisexual, queer or straight-identified men who have sex with men — do not fully understand their risk for human papillomavirus (HPV) due to a lack of information from health care providers, according to Rutgers researchers.

A Rutgers study published in the Journal of Community Health, examined what young sexual minority men — a high-risk and high-need population — know about HPV and the HPV vaccine and how health care providers communicate information about the virus and vaccine.

About 79 million Americans are infected with HPV, with about 14 million becoming newly infected each year, according to the Centers for Disease Control and Prevention. As a sexually transmitted infection, HPV can lead to several types of cancer, including anal and penile cancer, and is particularly concerning for sexual minority men due to the high prevalence of HIV and smoking in this community and the low HPV vaccination rates overall among men.

Read the full article.

Health Alert: Get tested for HIV and other STIs

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According to a CDC report, HIV continues to have a disproportionate impact on racial and ethnic minorities, gay and bisexual men, and other men who have sex with men. Yet, 15% of men who are infected with HIV don’t know it.
Also, according to CDC research, cases of gonorrhea, chlamydia and syphilis have risen for the fifth consecutive year.

Some STIs (including HIV) can go unnoticed since symptoms can be mistaken for minor health problems like a cold or sore throat. Some may have no symptoms at all. The only way to know if you’re infected is to get tested.

If you send us your zip code, we can help find local testing near you. Most are free. You can also ask us questions about basic sexual health, including PrEP. Send a message to m4mInformation@pitt.edu. We’re here to help. 

 

Health Alert: New drug-resistant STI spreading among men who have sex with men

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From Out Magazine…

Researchers at the University of Washington have identified a worrisome new bacterial cluster that’s growing in prevalence among men who have sex with men and is resistant to antibiotics.

The drug-resistant strains were identified in Seattle and Montreal, although researchers believe they’re common worldwide. Known as Campylobacter coli, the bacteria cause severe abdominal pain, bloody diarrhea, and fever and are estimated to affect about 1.3 million people in the United States annually. The journal Clinical Infectious Disease published the finding this month.

While the infection usually passes after a few days, it can pose a more serious threat to those with compromised immune systems.

Men who have sex with men are more prone to infection due to sexual practices like anal sex and rimming, according to the researchers. Transmission occurs when fecal matter enters another person’s body, and while it isn’t limited to any one population, gay men are more likely to experience drug-resistant infections because they’re more likely to have recieved antibiotics for similar infections in the past.

“The international spread of related isolates among MSM populations has been shown before for Shigella [another enteric pathogen], so it makes sense to see it in Campylobacter as well,” wrote the study’s lead author, Dr. Alex Greninger. “The global emergence of multidrug-resistant enteric pathogens in MSM poses an urgent public health challenge that may require new approaches for surveillance and prevention.”

Read more on Out Magazine online.

Most Americans have never been tested for HIV

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From CNN…

Most Americans have never been tested for HIV, the virus that attacks and weakens a person’s immune system.

The US Centers for Disease Control and Prevention is hoping to change that.
According to a new report, the agency found that fewer than 40% of people in the United States have been screened for HIV. It recommends that all people 13 to 64 be tested at least once.
Fifty jurisdictions across the country are responsible for more than half of all HIV diagnoses, yet only 35% of the people recommended for testing in those areas were screened in the previous year, the CDC says. And fewer than 30% of people across the country with the highest risk of acquiring HIV were tested in that period.
“Diagnosis and treatment are the first steps toward affording individuals living with HIV a normal life expectancy,” CDC Director Dr. Robert Redfield said in a statement. “As we encourage those at risk for HIV to seek care, we need to meet them in their journey. This means clearing the path of stigma, finding more comfortable ways of delivering health services, as well as learning from individuals already in treatment so the journey becomes easier for others who follow.”

1 in 5 new HIV diagnoses are among Latinx gay and bi men

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From pridesource.com…

According to the CDC, one in five new HIV diagnoses in 2017 in the U.S. were among Latinx gay and bisexual men. While HIV rates are stable, or falling in other groups, they rose by 12 percent among these men from 2012-2016. Eighty-four percent of the increase among Latinx gay and bisexual men was in Puerto Rico, Arizona, California, Florida, Illinois, New York, and Texas. By looking at different factors and health outcomes, the authors highlight four policy actions to heighten attention:

  • Strengthen governmental responses to HIV that focus on the unique prevention and care needs of Latinx gay and bisexual men
  • Address the social determinants of Latinx gay and bisexual men’s health.
  • Support immigrants and migrants, including when providing HIV services.
  • Cultivate and support emerging Latinx leaders.

“There is much that we are getting right in our national response to HIV, as exemplified by declining HIV diagnoses and increased HIV viral suppression, yet these outcomes are not being equally shared. By understanding the challenges facing Latinx communities and more strongly embracing Latinx gay and bisexual men, we can turn this around and reduce these disparities,” says Jeffrey S. Crowley, program director of Infectious Disease Initiatives at the O’Neill Institute for National and Global Health Law at Georgetown Law.

Read the full article.

April is STD awareness month: Good health means getting tested

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If you are sexually active, getting tested for STDs is one of the most important things you can do to protect your health. Make sure you have an open and honest conversation about your sexual history and STD testing with your doctor and ask whether you should be tested for STDs. If you are not comfortable talking with your regular health care provider about STDs, there are many clinics that provide confidential and free or low-cost testing.

Below is a brief overview of STD testing recommendations. STD screening information for healthcare providers can be found here.

  • All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.
  • All sexually active women younger than 25 years should be tested for gonorrhea and chlamydia every year. Women 25 years and older with risk factors such as new or multiple sex partners or a sex partner who has an STD should also be tested for gonorrhea and chlamydia every year.
  • All pregnant women should be tested for syphilis, HIV, and hepatitis B starting early in pregnancy. At-risk pregnant women should also be tested for chlamydia and gonorrhea starting early in pregnancy. Testing should be repeated as needed to protect the health of mothers and their infants.
  • All sexually active gay and bisexual men should be tested at least once a year for syphilis, chlamydia, and gonorrhea. Those who have multiple or anonymous partners should be tested more frequently for STDs (i.e., at 3- to 6-month intervals).
  • Sexually active gay and bisexual men may benefit from more frequent HIV testing (e.g., every 3 to 6 months).
  • Anyone who has unsafe sex or shares injection drug equipment should get tested for HIV at least once a year.

You can quickly find a place to be tested for STDs by entering your zip code at gettested.cdc.gov.

New STDs emerging

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From the New York Daily News…

The first worrisome pathogen is Neisseria meningitides, a bacteria that “can cause invasive meningitis, a potentially deadly infection of the brain and spinal cord’s protective membranes,” the health website Mosaic informs us. “More commonly, it’s gaining a reputation as a cause of urogenital infections.”

N meningitides resides in the back of the nose and throat of between 5% and 10% of adults, the site said. There’s a chance people can transmit the bacteria via oral sex or deep kissing.

In 2015, Mosaic said, the bacterial strain mixed with the closely related N gonorrhoeae, which causes gonorrhea — a mutation that allowed the disease to spread more readily.

On the upside, vaccines are available that can protect against all five strains of the gonorrhea bacterium.

Second on the list is Mycoplasma genitalium, one of the world’s smallest bacteria. Between 1% and 2% of people are infected, most of them teens and young adults. Many times it doesn’t cause symptoms, but it can irritate the urethra and cervix, just as gonorrhea and chlamydia do. In women this can lead, like chlamydia, to pelvic inflammatory disease and its associated potential for infertility, miscarriage, premature birth and stillbirth.

While antibiotics exist that will eradicate it, resistant strains are developing, which means it could morph into a superbug.

Third on the list is Shigella flexneri, which one contracts from feces. Shigellosis is one of the bacteria causing dysentery, so is not exclusively contracted via sexual contact. But it might have found a new avenue in anal-oral sex, reported Medscape and the CDC. And given that it is becoming resistant to azithromycin, which also treats gonorrhea, the potential for a superbug is there.

Lymphogranuloma venereum (LGV) is number four on the emerging-STD list, caused by acute Chlamydia trachomatis strains. Its incidence is increasing in Europe and North America, especially among gay and bisexual men, Mosaic reports. A 2016 CDC report documented a cluster of cases among men having sex with men in Michigan. Its symptoms can be subtle, with a fast-disappearing lesion in the genital area, but they can also be even less noticeable, according to the CDC.

Historic Increase in Syphilis Infections

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The Pennsylvania Department of Health is reporting an historic increase in the number of new Syphilis infections in the state.

The Health Department is asking anyone who fits the criteria listed here to have a Syphilis test…

  • A rash on the palms of the hands or on the soles of the feet, back, chest, or stomach
  • A lesion (red sore) in the genital, rectal, or oral area
  • Moist papules in the mouth
  • Sudden scalp alopecia (loss of hair)
  • Sudden loss of eyelashes and eyebrows
  • Swelling of the lymph nodes
  • A recent positive test for another STD such as gonorrhea, chlamydia, HIV or Hepatitis C

Send your zip code to m4mInformation@pitt.edu and we’ll send you locations for STD testing. Most are free.

Syphilis is a sexually transmitted infection. If it goes untreated, it can lead to serious health problems including paralysis, blindness, and dementia. However, Syphilis is 100% curable with simple antibiotics.

Syphilis is spread through direct contact with a Syphilis sore during vaginal, anal, or oral sex. You can get Syphilis and not have any symptoms so the only way to know for sure you’re not infected is to get tested.

Several locations around the state have free Syphilis testing. Click on this link to find free testing at a State Health Center near you.

To find out more about Syphilis, go to www.cdc.gov/std/syphilis/stdfact-syphilis.htm

 

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Pitt Men’s Study Health Alerts are presented by the Pitt Men’s Study and the HIV Prevention and Care Project at the University of Pittsburgh Graduate School of Public Health.

Health Alert: Post-Exposure Prophylaxis for HIV (not to be confused with PrEP)

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From redorbit.com…

Post-exposure prophylaxis (PEP) involves taking of Anti-Retroviral Therapy (ART) drugs after potential exposure to HIV infection. This is an emergency HIV treatment usually received within 72 hours after the possible exposure. This should be confused as a cure for HIV but rather a form of preventing infection. It is, in fact, a short course of ARV drugs to stop the exposure to HIV from progressing into a life-threatening condition.

Some facts about PEP:

  • Taking PEP can result in an array of side effects including fatigue and nausea, but it is advisable not to stop taking the medication, instead consult your healthcare provider.
  • The emergency treatment should be started as soon as possible to guarantee its effectiveness. That means, it should be less 72 hours after exposure to the virus.
  • PEP is prescribed by your doctor to be taken daily at the same time for up to 4 weeks. This is according to the World Health Organization’s guideline on PEP use.

Read the full article.

Get more information about PEP from the Centers for Disease Control and Prevention (CDC).

Health Alert: Rates of STDs climbed for the fourth consecutive year in the US

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Rates of syphilis, gonorrhea and chlamydia have climbed for the fourth consecutive year in the United States, the Centers for Disease Control and Prevention (DCD) announced recently. Last year, nearly 2.3 million US cases of sexually transmitted diseases (STDs) were diagnosed, which is the highest number ever reported.

Chlamydia, which remained the most common, is easily transmitted during any form of sexual activity. If not treated, chlamydia can cause permanent damage to the reproductive system. In men, the infection can spread to the tube that carries sperm from the testicles, causing pain and fever.

If not treated, gonorrhea can cause severe and permanent health issues, including problems with the prostate and testicles in men or problems with pregnancy and infertility in women. Gonorrhea is also typically treated with antibiotics but the threat of antibiotic-resistant gonorrhea persists nationwide. 

Syphilis can affect the heart, nervous system and other organs if left untreated. Syphilis is most often transmitted through sexual contact and is 100 percent curable with antibiotics.

Gonorrhea and chlamydia can infect other sites of the body such as the rectum and the throat and diagnosis requires a swab of each site. A urine test alone is not sufficient to diagnose STDs of the throat and the rectum. Additionally, all of these infections can be transmitted through unprotected oral sex.

It is important to remember that even if you don’t have symptoms, you can still be infected. If you’re sexually active, you should get tested for a full range of STDs, including the ones listed here. Don’t be shy about asking your doctor for a full screening. If you need to find free, confidential testing in your area, you can check the PA Department of Health listing here.

Health Alerts are presented by the Pitt Men’s Study and the HIV Prevention and Care Project at the University of Pittsburgh, with funding from the State Department of Health.

Why STDs are on the rise in America

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From the Economist online…

Much of the increase in STDs has come from gay and bisexual men. Although a relatively small share of the population, they accounted for 81% of male syphilis cases in 2016, according to the Centres for Disease Control. As with heterosexuals, this seems to be because sex is now seen as less risky. That is due to the advent of PrEP, a prophylactic drug cocktail which gay men can take to nearly inoculate themselves from HIV. The reduced chances of catching HIV—along with the fact that a positive diagnosis is no longer a death sentence—seems to encourage men to drop their guard. A recent study of gay and bisexual men, published in the Lancet, a medical journal, found that as more began taking PrEP, rates of consistent condom usage dropped from 46% to 31%. Recent studies have shown that uptake of PrEP is strongly associated with increased rates of STD infection.

All this shows that changing sexual mores, and a reduced fear of the risks of unprotected sex, seem to be at fault—especially since the problem is not just limited to America. England experienced a 20% increase in syphilis diagnoses in 2017 and a 22% increase in those of gonorrhoea. Other countries in western Europe have seen ever worse outbreaks, sometimes exceeding 50%. Dwindling public spending on STD prevention—which in America has fallen by 40% in real terms since 2003—is not helping matters. Yet the chief methods of prevention, abstinence and condoms, are tried and true. Should these options seem too chaste or chaffing, then prospective partners ought to get an STD test (especially since most infections can be cleared up with a simple course of antibiotics). Verified testing is vital since verbal assurances, especially on the cusp of a liaison, can be misleading.

Read the full article.

Does PrEP use lead to higher STI rates among gay and bi men?

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From POZ.com…

Rates of new sexually transmitted infections (STIs) are much higher among men who have sex with men (MSM) taking Truvada (tenofovir disoproxil fumarate/emtricitabine) as pre-exposure prophylaxis (PrEP) than among other MSM. More research is needed, however, to determine whether starting PrEP leads to higher STI rates among MSM.

Publishing their findings in the journal AIDS, researchers conducted a meta-analysis of 18 studies of MSM in which new STI diagnoses were reported. Five of the studies included MSM given PrEP, and 14 were conducted with MSM who were not given PrEP. (One study, the PROUD study, included both a group given PrEP immediately and a group given PrEP on a deferred basis and thus fell into both the PrEP and the non-PrEP categories of studies.)

The researchers found that the rates of new diagnoses of STIs among MSM given PrEP were 25.3 times greater for gonorrhea, 11.2 times greater for chlamydia and 44.6 times greater for syphilis, compared with the rates among MSM not given PrEP. After repeating the analysis but excluding studies conducted before 1999, the researchers found that the results were similar.

Looking to parse apart the contributing factors to the higher rate of STI diagnoses among MSM given PrEP, the meta-analysis’s authors theorized that the regular STI testing that is part of taking PrEP might have led to a higher rate of STI detection. A greater number of sex partners and a higher rate of condomless sex among those given PrEP might also have contributed to their higher STI diagnosis rate.

The study is limited by the fact that, except in the case of PROUD, the researchers compared different populations of MSM from study to study. They also compared groups that tested for STIs at different frequencies and used different variations of STI tests. Additionally, the PrEP studies specifically sought out participants engaging in high-risk sexual behaviors, while the other studies might have had different criteria with regard to sexual risk taking. However, participants in many of the non-PrEP studies were indeed recruited based on some level of reported sexual risk taking.

 

Read the full article.

 

Antibiotic-resistant Gonorrhea on the rise: Are you at risk of drug-resistant STD?

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From techtimes.com…

The World Health Organization (WHO) has warned that gonorrhea, a common sexually transmitted disease, has become harder and sometimes even impossible to treat. Neisseria gonorrhoeae, the bacteria that causes the STD, is so smart it evolves to develop resistance against the antibiotics used to treat infection. [Read the WHO report here]

WHO said that decreasing use of condom, poor infection detection rates, urbanization and travel, as well as inadequate or failed treatments all contribute to the rising cases of antibiotic-resistant gonorrhea. “WHO reports widespread resistance to older and cheaper antibiotics. Some countries — particularly high-income ones, where surveillance is best — are finding cases of the infection that are untreatable by all known antibiotics,” WHO said in a statement. WHO experts said that oral sex is driving the spread of super-gonorrhea. In the United States, about two-thirds of those between 15 and 24 years old have had oral sex.

Teodora Wi, from the WHO, said that when antibiotics are used to treat infections of the throat such as normal sore throat, these get mixed with the Neisseria species in the throat, which can lead to resistance.

What makes matters more worrying is that many people with gonorrhea in the throat are not aware they are infected and are more likely to transmit the infection via oral sex. “In the US, resistance [to an antibiotic] came from men having sex with men because of pharyngeal infection,” Wi said.

Read the full article.

Undetectable viral load and HIV prevention: what do gay and bi men need to know?

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What does undetectable mean? What about undetectable viral load and HIV transmission? And if I’m living with HIV, can I use “undetectable viral load” as an HIV prevention strategy?

From thebody.com…

Risk of HIV transmission is virtually eliminated when people living with HIV are consistently taking effective HIV medication, (known as antiretroviral therapy or ARVs). It’s well-verified by research, and backed up by many years of real world observation: There have been no cases of transmission in couples where the HIV-positive partner was on meds and had “undetectable” viral load test results for at least six months.

But what does this mean for gay and bi men making decisions about sex, whether in ongoing partnerships, casual dating or anonymous encounters?

Get the answers on thebody.com.

Gay men syphilis rates over 100x greater than straight men

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From medpagetoday.com…

The first state-specific analysis of syphilis among men who have sex with men (MSM) shows they have dramatically higher incidence than men whose only sexual partners are female, the CDC is reporting.

Data from 2015, analyzed with a new methodology, show that the incidence of primary and secondary syphilis among MSM was 309.0 cases per 100,000 people, compared with 2.9 per 100,000 among men who reported sex with women only, according to Alex de Voux, PhD, of the CDC’s epidemic intelligence service, and colleagues at the CDC and Emory University in Atlanta.

The disparity was even more marked when the rate among MSM was compared with the 1.8 cases per 100,000 population seen among women, the researchers reported in the April 7 issue of Morbidity and Mortality Weekly Report.

County-by-county data from the U.S. Census Bureau’s American Community Survey included the number of households with a male head-of-household and a male partner, De Voux and colleagues reported, and that information could be used to estimate the MSM population per county.

For the syphilis analysis, the researchers used data from the 44 states that had information on the sex of partners in at least 70% of reported cases. Those states accounted for 83.4% of all 23,872 reported cases in 2015, De Voux and colleagues reported.

State-specific incidence rates among MSM ranged from 73.1 per 100,000 population in Alaska to 748.3 in North Carolina, the investigators found. Syphilis incidence among MSM was highest in the South and West and four of the five states with the highest rates among MSM — Louisiana, Mississippi, North Carolina, South Carolina, and New Mexico — were in the South.

The overall syphilis among MSM was 167.5 times the rate among women, with state-specific rate ratios ranging from 63.7 in Louisiana to 2,140.3 in Hawaii, De Voux and colleagues reported.

Interestingly, the highest overall syphilis rate in the U.S., seen in 1946, was 70.9 cases per 100,000 population — a rate exceeded by the lowest state-specific rate among MSM in 2015: the 73.1 cases per 100,000 observed in Alaska.

The researchers cautioned that the data are based on 44 states and might not reflect the nation as a whole. Similarly, the estimates rely on the American Community Survey data; under-reporting of same-sex households would skew the outcome.

As well, they noted, the analysis did not include cases in which the sex of partners was unknown and if MSM are less likely than other men to report the sex of their partners, the findings might under-estimate the rate of disease among MSM.

Finally, De Voux and colleagues cautioned, not all cases of syphilis are diagnosed and reported.

Editor’s note: To find free Syphilis testing near you, got to gettested.cdc.gov.

New online tool finds providers of HIV Pre-Exposure Prophylaxis (PrEP) in the US

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PrEP Locator is a national directory of providers of HIV Pre-Exposure Prophylaxis (PrEP) in the US. PrEP Locator seeks to provide patients access to a national, integrated service including both public and private practice providers. An open source tool, PrEP Locator data and map-based widget are easily accessible via API.

logoThe Locator seeks to serve as a common repository for information regarding providers and clinics that prescribe PrEP. The Locator is an open source tool for those who are managing existing directories to share their resources in a common format, so that patients can access a national, integrated PrEP provider location service that includes both public and private practice PrEP providers. Data will be made accessible with open source tools to facilitate patient access through existing organizational websites and mobile apps.

PrEP Locator is presented by Emory University, in partnership with M•A•C AIDS Fund. The project is led by Dr. Aaron Siegler, Research Assistant Professor of Epidemiology at Emory University’s Rollins School of Public Health. The project is guided by a coalition of partners with expertise in the field of HIV prevention: PleasePrEPMe.org, Greater Than AIDS represented by the Kaiser Family Foundation, National Alliance of State & Territorial AIDS Directors (NASTAD).

Gay men headed for an STD epidemic?

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From Slate.com…

Earlier this month, Poz magazine’s Benjamin Ryan drew attention to a concerning new study out of Northern California’s health system: Using data gathered from July 2012 through June 2015, researchers found that, among a cohort consisting mostly of same-sex–attracted men on the HIV-prevention regimen PrEP, “quarterly rates of rectal gonorrhea and urethral chlamydia increased steadily and about doubled after one year.” In other words, guys on the fantastically effective pill-a-day Truvada program were avoiding HIV infection—there were no new transmissions for regimen-adherent patients over the study period, in fact—but they seemed to be getting other sexually transmitted diseases relatively often.

Read the full article.

Health Alert – Rates of STD infection still at record high

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The Centers for Disease Control and Prevention (CDC) has recently been reporting a record increase in cases of syphilis, chlamydia and gonorrhea—after these diseases had been on the decline for several previous years. HIV infections continue to increase as well, especially among men who have sex with men (MSM).  Even worse, catching both HIV and one or more STDs can lead to particularly rapid and damaging health outcomes.

As a result, health experts across the country (including here at the Pitt Men’s Study) recommend that all sexually active men get a full screening for STD, especially HIV, Gonorrhea, Chlamydia, and Syphilis.

To find testing near you, go to the CDC’s testing locator and enter your zip code to find local free testing. The best way to protect your health is to get tested.

CDC sending out an SOS over soaring rates of STDs

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From the New York Daily News…

Every year, the Centers for Disease Control and Prevention (CDC) releases an annual report of a national overview of sexually transmitted diseases (STDs).

The report for 2015 was not encouraging at all. In fact, it was quite discouraging as such STDs as chlamydia and gonorrhea were at an all-time high, including higher rates of syphilis.

Sexually transmitted diseases are typically not discussed in polite conversation. But the less they are talked about, the more of a hidden epidemic they are becoming.

We need to realize that anyone who has sex — oral, anal or vaginal intercourse and genital touching — can get an STD. It doesn’t matter whether you are straight, married, single or gay, everyone is at risk.

Read the full article.

Gonorrhea treatment showing signs of failing

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From Project Q Atlanta…

Federal health officials warned of new signs that gonorrhea is growing resistant to current treatments, a development more troubling for gay men who face a higher risk of the sexually transmitted disease than other populations.

Findings of a new study from Hawaii prompted the Centers for Disease Control & Prevention to raise a warning flag on Wednesday during its 2016 STD Prevention Conference in downtown Atlanta. The findings showed that the current treatment for gonorrhea – a shot of ceftriaxone and an oral dose of azithromycin – was losing its effectiveness in a cluster of infections in Hawaii.

That’s more troubling than data released in July that showed emerging drug resistance and limited treatment options for gay men at a time when infections among them are on the rise, federal officials said during a press conference Wednesday.

“It seems that in the battle between humans and pathogens, gonorrhea is a formidable opponent,” said Jonathan Mermin (photo), director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD & Tuberculosis Prevention.

“We are seeing troubling signs that treatments are failing us. We may be running out of options for treating gonorrhea,” he added.

Gonorrhea is one of the most common sexually transmitted diseases in the country and it impacts gay men more severely than other populations. The CDC has said about 56 percent of gonorrhea cases in the U.S. are among men and of those, 48 percent are estimated to be gay men. Put another way, men who have sex men face a gonorrhea incidence 17 times greater that seen in heterosexual men and nearly 14 times that seen in women, based on the 2014 STD Surveillance Report.

Read the full article.