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Although recognition of homosexuals is often important, many doctors lack the necessary skill or experience, so to assist them a group of 5,302 men was surveyed using a computer-based data system and 9-1 per cent. were recorded as homosexual. Analysis showed a relatively high proportion of homosexuals among men with syphilis and gonorrhoea, and a low proportion among men with nonspecific genital infection (non-specific urethritis and proctitis) and other infections. All men with secondary syphilis were homosexual. A relatively high proportion of men born in Eire, Spain, and North America were homosexual and a relatively high proportion of men living in the West End of London were homosexual. While these findings will be of most value to those working in STD clinics in London they may also be helpful to those working elsewhere and in other disciplines.
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PMID:Some characteristics of homosexual men. 127 63

Over a 13-year period non-gonococcal neisseriae (NGN) were isolated from 114 of 88,670 patients (0.13%) screened for anogenital gonorrhoea at a Genitourinary Medicine Unit. During the same period there were approximately 9000 anogenital gonococcal infections (10%). The prevalence of NGN was 0.09% (27/31,500) in women, 0.04% (20/52,800) in heterosexual men and 1.5% (67/4370) in homosexual men: the differences in prevalence between women and heterosexual men (P < 0.01) and between heterosexual patients and homosexual men (P < 0.001) are highly significant. Neisseria meningitidis was isolated most frequently and accounted for 85% (99/114) of the NGN. Whenever possible, N. meningitidis was serogrouped and its occurrence correlated with patient symptoms. Eleven of 18 heterosexual men who had meningococci isolated from their urethras had urethritis but co-existing chlamydial infection was excluded in only 5. None of 9 women with cervical colonization had clinical evidence of pelvic inflammation. Only one of 49 men with rectal colonization had proctitis. The management of anogenital NGN infection is discussed in relation to our findings and those of previously published studies. Within each patient group the prevalence and incidence of anogenital NGN were similar at the beginning and end of the study period indicating that levels have not been influenced by the advent of AIDS.
Int J STD AIDS
PMID:Anogenital non-gonococcal neisseriae: prevalence and clinical significance. 842 10

Rectal gonorrhoea (GC) in men may cause anal discharge or proctitis, but these symptoms have been shown to correlate poorly with rectal infection. Culture of Neisseria gonorrhoeae from an exposed site offers a readily available, sensitive and cheap diagnostic test, and is currently the gold standard for diagnosis; however, these results can take a few days and therefore do not offer an instant diagnosis. Gram staining of rectal smears for N. gonorrhoeae has a low sensitivity but a high specificity when performed by experienced personnel. We audited whether rectal microscopy increased the number of patients diagnosed and treated for rectal GC at initial presentation at one inner London genitourinary clinic over a 12-month period. One hundred and thirty-six episodes of rectal GC were identified in 132 men. In all, 134/136 had rectal microscopy of whom, 47/134 (35%) were smear-positive for GC. Of the 136 cases, 90 received antibiotics for GC at their first presentation. Twenty-four of 90 (27%) would not have been treated until culture results were available, if rectal microscopy had not been performed. These results suggest that rectal microscopy remains an important tool and increases the proportion of men treated for GC at their first attendance.
Int J STD AIDS 2006 Apr
PMID:Rectal gonorrhoea in men -- is microscopy still a useful tool? 1705 44

As few studies have compared the clinical features of rectal gonorrhoea in men who have sex with men with or without concurrent chlamydial infection, this longitudinal study was undertaken to address this issue. The cohort consisted of 129 men with rectal gonorrhoea, 34 of whom had concurrent chlamydiae. Symptoms of proctitis in men with rectal gonorrhoea with or without concurrent chlamydial infection were significantly higher than in men with isolated chlamydial infection (27% versus 10% [chi2=17.55; P<0.0001]). There was, however, no significant difference in the prevalence of symptoms between those with rectal gonorrhoea only (28%) and those with concurrent chlamydiae (23%); chi2=0.11; P>0.05). The median prepatent period or rectal gonorrhoea (21 men) was 5.0 days (interquartile range 11.0 days).
Int J STD AIDS 2006 Jun
PMID:Clinical correlates of rectal gonococcal and chlamydial infections. 1673 60

Before 2003, lymphogranuloma venereum (LGV) was rare in developed nations. Several large clusters of LGV in men who have sex with men have been reported across Europe and in the United States of America (USA) since 2003. LGV is caused by L1, L2 and L3 serovars of Chlamydia trachomatis and is a sexually transmitted infection. LGV causes genital ulcers, infected inguinal lymph nodes (buboes) and proctitis/proctocolitis. Treatment with a three-week course of doxycycline prevents rectal strictures, bowel obstruction, bowel perforation and possibly death. Clinicians seeing men who have sex with men with inguinal lymphadenopathy and bowel symptoms should be aware of this current epidemic.
Int J STD AIDS 2007 Jan
PMID:Lymphogranuloma venereum: an emerging cause of proctitis in men who have sex with men. 1762 14

Lymphogranuloma venereum (LGV) has recently been reported in men who have sex with men. In a case-control study we compared behavioural and clinical features of 32 men with LGV (cases) and 31 men with non-LGV chlamydial proctitis (controls). LGV was associated with rectal discharge (odds ratio [OR] 4.15, 95% confidence interval [CI] 1.42, 12.2), and there was a tendency to association with HIV infection (OR 3.60, CI 0.67-19.4), sexual contact in the UK (OR 3.03, CI 1.02-9.01) and fisting (OR 5.04, CI 0.98-26.1). LGV should be considered a possible diagnosis in men with rectal discharge.
Int J STD AIDS 2007 Jul
PMID:The clinical manifestations of anorectal infection with lymphogranuloma venereum (LGV) versus non-LGV strains of Chlamydia trachomatis: a case-control study in homosexual men. 1762 5

Chlamydia trachomatis, serovar L2, is the causative agent of lymphogranuloma venereum (LGV), which during recent years has been responsible for various outbreaks reported among men who have sex with men (MSM) in Western Europe, America, Canada and Australia. Samples from nine patients with chronic proctitis, seen at a local hospital were sent to us for identification of C. trachomatis serovar L2. The presence of C. trachomatis serovar L DNA was identified by realtime polymerase chain reaction (PCR) in two patients. They both had high positive C. trachomatis antibody titres (>/=10,000) and were found to be infected with serovar L2b by sequencing after amplification of the omp 1 gene by a nested PCR technique. These two individuals met the diagnostic criteria for LGV serovar L2b infection and, to our knowledge, these are the first cases described in Portugal.
Int J STD AIDS 2010 Apr
PMID:Lymphogranuloma venereum serovar L2b in Portugal. 2037 98

A 41-year-old HIV-positive man who has sex with men (MSM) with a family history of deep vein thrombosis (DVT) presented to the emergency department with an acutely swollen lower limb. The initial clinical diagnosis was of a possible DVT and the patient was anticoagulated. However, investigations subsequently excluded DVT and sexually acquired reactive arthropathy (SARA) was eventually diagnosed. This complication followed an earlier attendance at the emergency department, where proctitis due to lymphogranuloma venereum (LGV) infection went unrecognized. This is the first reported case of LGV infection mimicking a DVT. Prompt recognition and treatment of the initial proctitis may have prevented the development of SARA.
Int J STD AIDS 2012 Mar
PMID:Complicated lymphogranuloma venereum infection mimicking deep vein thrombosis in an HIV-positive man. 2258 80

We report two instances of urethral-to-rectal transmission of Mycoplasma genitalium (MG) in men who have sex with men (MSM) couples. Such clear epidemiological correlation has to our knowledge not been published before. The urethral infections led to clinical symptoms, but the rectal infections did not. The rectum might serve as a reservoir for MG in MSM, but there is also some evidence from the literature that MG can cause proctitis. Our finding raises important questions about the role of MG as a pathogen among MSM. Any correlation with HIV transmission risk is currently unknown and needs further research.
Int J STD AIDS 2012 Jun
PMID:The spread of Mycoplasma genitalium among men who have sex with men. 2280 47

Lymphogranuloma venereum (LGV) is an established cause of proctitis in men who have sex with men (MSM). Currently in the UK, testing for pharyngeal Chlamydia trachomatis (CT) is not routine, and LGV typing is usually only performed in patients with anorectal symptoms. We report four cases where LGV-associated CT DNA was detected from the pharynx in MSM, demonstrating that nucleic acid amplification testing (NAAT) can be used for detecting and typing pharyngeal CT infection. These cases also highlight other possible routes of infection for LGV, and add to the broad spectrum of clinical presentations associated with this infection.
Int J STD AIDS 2013 Jun
PMID:Lymphogranuloma venereum detected from the pharynx in four London men who have sex with men. 2397 Jul 55


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