Since mid-2011, the Pennsylvania Department of Health has received a number of reports of shigellosis due to Shigella flexeri, a species of Shigella that is infrequently diagnosed in Pennsylvania. The cases have occurred in the southeastern part of the state among men who have sex with men (MSM) who may or may not be HIV-positive.

What is Shigella?

Shigella is one of the bacterial agents that causes acute diarrhea. Symptoms often include cramping, fever and vomiting. The infection spreads easily from person to person by the fecal-oral route since a very small number of organisms are necessary to produce transmission.

How do you catch Shigella?

The Pennsylvania Health Alert Network reports “Shigella outbreaks have been previously reported in MSMs and are usually correlated with having multiple partners combined with unprotected high-risk sexual behavior. The fact that some of these patients are also HIV infected raises added concerns, not only due to the potential for transmission of HIV and other sexually transmitted infections through the same high risk behaviors, but also because immune-compromised individuals can have extended carriage of Shigella.” 

What can you do?

Persons with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal. Once someone has had shigellosis, they are not likely to get infected with that specific type again for at least several years. However, they can still get infected with other types of Shigella. Currently, there is no vaccine to prevent shigellosis. However, the spread of Shigella from an infected person to other persons can be stopped by frequent and careful hand-washing with soap.

For more information about Shigella, you can go to the Centers for Disease and Control and Prevention Website.

Almost a year ago, the Pitt Men’s Study sent out an alert about the rise in Syphilis cases in Pennsylvania. Unfortunately, the number of new infections is still on the rise. The disturbing fact is that the surge is being driven by cases among men who have sex with men (MSM).

Signs of Syphilis

Syphilis usually begins with the appearance of a sore (called a chancre) about 10 to 90 days after exposure. The chancre is usually
firm, round, small, and painless. The chancre lasts 3 to 6 weeks, and it heals on its own. However, the infection doesn’t go away without proper treatment.

As the disease progresses, it can include fever, swollen lymph glands, rash, sore throat, patchy hair loss, headaches, weight loss,
muscle aches, and fatigue. The signs of this “secondary stage” of syphilis will resolve with or without treatment, but, again, it doesn’t go away.

In its later stages, years later, the disease can cause damage to internal organs, the brain, nerves, eyes, heart, blood vessels,
liver, bones, and joints. Signs and symptoms of the “late stage” include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

What can you do?

Get tested. Syphilis is easily cured in its early stages. A single injection of penicillin will cure a person who has had syphilis for less
than a year.

For more information about MSM and syphilis, you can go to the CDC’s Syphilis and MSM web page

You can also go to the STD testing resource page. Enter your zip code to find testing centers near you.

Men who have sex with men (MSM) still make up the largest percentage of new HIV infections in the U.S. Despite the grass-roots effort to educate gay and bi men since the 1980’s, the number of new infections continues to rise. A recent study conducted by the Centers for Disease Control and Prevention makes the issue clear.

From the Centers for Disease Control and Prevention (CDC) Website…

The CDC estimates that more than one million people are living with HIV in the United States. One in five (or 21%) don’t know they’re infected. Despite increases in the total number of people living with HIV in recent years, the annual number of new HIV infections has remained relatively stable. However, that still means an estimated 56,300 new infections per year. 

 More than 18,000 people with AIDS still die each year in the US. Gay, bisexual, and other MSM are strongly affected and represent the majority of persons who have died. Gay, bisexual, and other MSM of all races remain the population most severely affected by HIV. Here are some facts you need to know:

• MSM account for more than half (53%) of all new HIV infections in the U.S. each year, as well as nearly half (48%) of people living with HIV.
• While CDC estimates that MSM account for just 4% of the US male population aged 13 and older, the rate of new HIV diagnoses among MSM in the US is more than 44 times that of other men and more than 40 times that of women.
• White MSM account for the largest number of annual new HIV infections of any group in the US, followed closely by black MSM.
• MSM is the only risk group in the U.S. in which new HIV infections have been increasing since the early 1990s.

What can you do?

The first thing you can do is get tested. Second, practice safer sex. I know we’re all tired of hearing this but clearly the message still needs to be broadcast loud and clear. There are any number of online resources that will help you to play safe and stay healthy. Just using a condom is only a small part of what you need to know. In addition to our own HIV Education page, you can go to any one of these links to educate yourself and to protect your health:

The Body.com education page   

About.com’s page for gay teens

To check out the CDC’s full report, you can go to the CDC’s Website.

To subsribe to the Pitt Men’s Study Health Alerts, send an email to rgy2@pitt.edu with the word subscribe in the subject line.

Testicular cancer is the most common cancer in men between 20 and 34 years old. It is a disease in which cancer forms in one or both testicles. The testicles are 2 egg-shaped glands inside the scrotum (a sac of loose skin that lies directly below the penis). They are the male sex glands that make testosterone and sperm.

Risk Factors

There are factors that raise a man’s risk of getting this disease:

• An undescended testicle – One or both testicles don’t move from the abdomen into the scrotum during fetal development.
• Certain types of moles – An unusual condition that causes many spots or moles on the back, chest, abdomen and face.
• HIV Infection – Men infected with HIV have an increased risk, especially true for men who have AIDS.
• Carcinoma in situ (CIS) – CIS is a condition in which germ cells grow into a tumor but does not yet invade normal tissues. CIS in the testicles may become cancer over a number of years and does not cause a lump or any symptoms.
• Young age – Young men have a higher risk of getting testicular cancer. It is the most common cancer between the ages of 20 to 34, the second most common cancer between the ages of 35 to 39, and the third most common cancer between the ages of 15 to 19.
• A personal history of testicular cancer – Men who already had testicular cancer have a higher risk of developing a tumor in the other testicle.
• A family history of testicular cancer – Men with a family history of testicular cancer may have a higher risk of developing testicular cancer.
• Congenital abnormalities – Men born with abnormalities of the testicles, penis, or kidney, as well as those with a hernia in the groin area, where the thigh meets the abdomen, may be at increased risk.

Signs

Possible signs of testicular cancer include:

• a painless lump or swelling in either testicle
• heaviness or aching in the abdomen or scrotum
• pain or discomfort in a testicle or in the scrotum
• dull ache in the lower back, abdomen, or groin

 Treatment

If testicular cancer is found, the treatment depends on the stage of the cancer. Three standard treatments are used:

• Surgery. Surgery removes the testicle and some of the lymph nodes (organs that fight infection). Tumors that have spread to other places in the body may be partly or entirely removed by surgery.
• Radiation therapy. High-energy x-rays or other types of radiation kill cancer cells.
• Chemotherapy. Drugs are used to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing.

Self Exam

Most men find the cancer in their testicles themselves. This fast and simple exam can help you find this cancer early. Do the exam after a warm bath or shower every month. Also ask your health care provider to do a testicular exam as part of your regular checkup.   

The Testicular Cancer Resource Center provides information about how to do a testicular cancer self examination.  Go to http://tcrc.acor.org/tcexam.html for more information. 

For more information, go to…

National Cancer Institute: http://www.cancer.gov/cancertopics/factsheet/sites-types/testicular

Officials at the Centers for Disease Control and Prevention (CDC) recently reported that syphilis rates continued to rise in 2007. The disturbing fact is that the surge is being driven by cases among men who have sex with men (MSM), who accounted for 64 percent of the known syphilis infections last year.  That’s up from five percent in 1999. It is important to note that Symptoms of syphilis can go unnoticed or misdiagnosed. The CDC’s website notes: “Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. […] Thus, transmission may occur from persons who are unaware of their infection.” 

 What is the danger?

Syphilis is especially worrisome because, if it goes untreated, it can lead to serious health conditions later on in life.  It can also complicate other infections such as HIV.  It is also important to note that Syphilis can be transmitted through a variety of sexual acts, not just intercourse.  So a condom won’t necessarily protect you. 

Signs of Syphilis

Syphilis usually begins with the appearance of a single sore (called a chancre), but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days. The chancre is usually firm, round, small, and painless. The chancre lasts 3 to 6 weeks, and it heals on its own. Note, however, that the infection doesn’t’ go away without proper treatment.

As the disease progresses, it may include fever, swollen lymph glands, rash, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs of this “secondary stage” of syphilis will resolve with or without treatment, but, again, it doesn’t go away.

In its later stages, many years after the initial infection, the disease can cause damage to internal organs, the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms of the “late stage” include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

What can you do?

Get tested.  All sexually active MSM should receive testing for a wide range of sexually transmitted diseases at least once a year (as recommended by the CDC).

You’re not going to hear much about this in the mainstream media and, chances are, your doctor isn’t going to recommend being tested for an STD. So it’s up to you to take matters into your own hands. Syphilis is easily cured in its early stages. A single injection of penicillin will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available.    

Your doctor can perform the test for syphilis. The Allegheny County Health Department also provides free testing. You can find other local testing sites (some will maintain your anonymity) at http://www.stopHIV.com in the drop-down resources menu, under “PA Service Providers.”    

For more information about MSM and syphilis, you can go to the CDC’s Syphilis and MSM web page

What is HPV?

Human papillomavirus (HPV) is a sexually transmitted disease that infects the genital area of both men and women (including the skin on and around the anus). Over half of the men in the United States will have HPV at some time in their lives.  Often the virus clears up on its own without a health problem but, depending on the strain of HPV, it can cause genital or anal warts.  Some strains of HPV can also cause abnormal changes in cells which can become precancerous and result in cancer of the penis or anus. HIV positive men are more likely to get severe and prolonged cases of genital warts which may be resistant to treatment. 

How is HPV spread?

HPV is passed through vaginal or anal intercourse but can also be spread through simple skin to skin contact.  Because HPV infections often don’t have symptoms, they can be passed on unknowingly. 

What are the symptoms?

Genital warts are the first symptoms seen with low-risk strains of HPV infections.  They are soft, raised growths that are usually painless.  These lesions can also appear in the mouth and throat, although this is rare.  Warts usually take 3 weeks to 6 months to appear after exposure but, in some cases, can also take years. 

What can I do?    

If you are diagnosed with HPV, it is important to tell your sexual partner(s).  Transmission of HPV can be minimized by finding alternative ways to express intimacy and avoiding contact with a wart.  Condoms are also effective for preventing infection with HPV if they are used correctly and consistently.  However, genital warts not covered by a condom can still transmit the virus