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Monday, October 17, 2011

Gonorrhea

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There have been reports that increases in gonorrhea infections in


homosexual men is associated with an increase in new HIV-1 infections.


Craib et al. (15) state Our findings are consistent with


previous studies reporting an association between HIV infection and


Custom Essays on Gonorrhea

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non-ulcerative sexually transmitted diseases. Such a direct association


might be explained by postulating that gonorrhoea results in inflamed


rectal mucosa and compromised epithelial integrity, thereby predisposing


an individual to subsequent HIV infection.


Yet, in New York City, the rate of gonorrhea plummeted subsequent to


180, while the rates of HIV-1 and HHV-8 new infections were steeply


increasing subsequent to 180 reaching a peak in 18 to 18.


As concerns HIV-1 new infections, this increase and peak were similar to


San Francisco homosexual men (J Acquir Immune Defic Syndr Hum Retrovirol


17; 1618-18) and to United States new infections (Stine Gerald J.


(18). Acquired Immune Deficiency Syndrome Biological, Medical,


Social, and Legal Issues, rd ed. New Jersey Prentice Hall, pp. -6).


As concerns rates of gonorrhea in a Manhattan STD clinic, whose patients


are primarily homosexual males, the CDC MMWR of 6/1/84 states This


decrease is most evident in the area with the highest rates-- Manhattan


--where reported rectal and pharyngeal gonorrhea rates declined from


485/100,000 in 180 to 01/100,000 in 18--a 5% decrease.


Between 177 and 180, the rates of gonorrhea in Manhattan were


flatlined at a rate of about 460 per 100,000 population.


As concerns these major gonorrhea decreases among NYC homosexuals, the


CDC editorializes The substantial and persistent declines in gonorrhea


among homosexual males in New York City suggest that prevention efforts


have succeeded in reducing the incidence of this short-incubation-period


sexually transmitted infection. Further sustained efforts should help in


reducing the incidence of AIDS among homosexual males.


Strangely, while there were major gonorrhea decreases since 180 in NYC


homosexuals, the homosexual HIV-1 and HHV-8 seroconversion rates in NYC


were increasing subsequent to 180. OBrien et al. (1) state The


patterns of seropositivity to HHV-8 and to HIV-1 were very similar in


this cohort. For both viruses, seroprevalence was high in June 18


(0.4% for HHV-8 and 4.0% for HIV-1), and the estimated relative hazard


of seroconversion peaked during 18.


Hepatitis B vaccine trials in high risk and HBV-negative homosexual men


took place in the late 170s and early 180s. The first NYC participant


was inoculated in 11/78. HBV carriers, who provided the serum for the


vaccine (HBsAg particles prior to 11/78), were New York City homosexuals


attending bathhouses, venereal disease clinics, or other such meeting


places. The NYC trial vaccine and subsequent NYC inoculations involved


three 40 mcg intramuscular injections (Szmuness et al., 180), which


was later changed to three 0 mcg injections.


===============================


Declining rates of rectal and pharyngeal gonorrhea among males--New York


City. MMWR Morb Mortal Wkly Rep 184 Jun 1;(1)5-7


http//www.cdc.gov/epo/mmwr/preview/mmwrhtml/0000048.htm


The rates of rectal and pharyngeal gonorrhea for New York City males


aged 15-44 years has declined from 1 per 100,000 males in that age


group in 180 to 74/100,000 in 18--the lowest level in the past 7


years. This decrease is most evident in the area with the highest


rates--Manhattan--where reported rectal and pharyngeal gonorrhea rates


declined from 485/100,000 in 180 to 01/100,000 in 18--a 5% decrease


(Figure 1). In other areas of New York City, the rates of rectal and


pharyngeal gonorrhea have declined slightly since 180, but the initial


rates outside Manhattan were much lower. Gonorrhea rates for females


15-44 years old have risen over the same period from 587/100,000 females


in that age group to 64/100,000 in 18 (Figure 1).


The majority of New York City rectal and pharyngeal gonorrhea was


reported from one New York City Department of Health sexually


transmitted disease (STD) clinic in Manhattan, whose patients are


primarily homosexual males. At this clinic, culture testing for


pharyngeal and rectal gonorrhea is provided to all males identified as


being at risk for contracting gonorrhea due to same-sex contact. Based


on analyses of second- and fourth-quarter data from each year, the


percentage of positive rectal cultures declined from 0. in 180 to


16.5 in 18, and the percentage of positive pharyngeal cultures


declined from 6.8% in 180 to .4% in 18 (Table 4). First clinic


visits by males decreased by 4.% from 18,44 in fiscal year 180 to


17,65 in fiscal year 18. Reported by S Schultz, MD, S Friedman, MD, A


Kristal, DrPH, DJ Sencer, MD, New York City Dept of Health; Div of


Sexually Transmitted Diseases, Center for Prevention Svs, AIDS Activity,


Center for Infectious Diseases, CDC.


Editorial Note


Editorial Note Since 180, reported pharyngeal and rectal gonorrhea


rates among New York City males 15-44 years old have shown consistent


annual decreases, while the reported rates of gonorrhea for females in


the same age group have increased during the same period. In Manhattan,


the greatest decreases in male pharyngeal and rectal gonorrhea rates


occurred in 18 and 18.


The percent decreases in infection were substantially greater than


either the percent decreases in clinic attendance or total cultures


taken. Hence, it is unlikely that changes in testing or clinic


attendance account for a large portion of the declines. A similar


decrease in gonorrhea incidence has been reported among homosexual males


attending a public clinic in Denver, Colorado (1).


The major gonorrhea decreases in 18 and 18 coincide with the period


of heightened awareness and concern about the incidence of acquired


immunodeficiency syndrome (AIDS) among homosexual males. U.S. Public


Health Service recommendations stress the importance of reducing the


numbers of sexual partners for preventing AIDS among homosexual males


(). Similar recommendations have been developed and widely distributed


by the American Association of Physicians for Human Rights and many


local groups concerned with the health of homosexual males. Recently, a


reduction of the number of sexual partners among homosexual males has


been documented in Madison, Wisconsin (). The substantial and


persistent declines in gonorrhea among homosexual males in New York City


suggest that prevention efforts have succeeded in reducing the incidence


of this short-incubation-period sexually transmitted infection. Further


sustained efforts should help in reducing the incidence of AIDS among


homosexual males.


References


1. Judson FN. Fear of AIDS and gonorrhea rates in homosexual men


(Letter). Lancet 18;II15-60.


. CDC. Prevention of acquired immune deficiency syndrome (AIDS) report


of inter-agency recommendations. MMWR 18;101-.


. Golubjatnikov R, Pfister J, Tillotson T. Homosexual promiscuity and


the fear of AIDS (Letter). Lancet 18;II681. 180 Census data.


Disclaimer All MMWR HTML documents published before January 1


electronic conversions from ASCII text into HTML. This conversion may


have resulted in character translation or format errors in the HTML


version. Users should not rely on this HTML document, but are referred


to the original MMWR paper copy for the official text, figures, and


tables. An original paper copy of this issue can be obtained from the


Superintendent of Documents, U.S. Government Printing Office (GPO),


Washington, DC 040-71; telephone (0) 51-1800. Contact GPO for


current prices.


==============================


Craib KJ, Meddings DR, Strathdee SA, Hogg RS, Montaner JS, OShaughnessy


MV, Schechter MT. Rectal gonorrhoea as an independent risk factor for


HIV infection in a cohort of homosexual men. Genitourin Med 15


Jun;71()150-4


Vancouver Lymphadenopathy-AIDS Study Group, BC Centre for Excellence in


HIV/AIDS, St Pauls Hospital, Canada.


Abstract OBJECTIVE--To determine whether certain sexually transmitted


diseases are independent risk factors for HIV transmission in a cohort


of homosexual men. METHODS--Eligible cases were identified as those who


had seroconverted between November 18 and November 10. Two


persistently HIV-seronegative control participants were randomly


selected for each case from all participants who remained seronegative


in November 10. For cases, risk factor data were taken from an index


visit which was defined as the first seropositive visit, while for


controls these data were obtained from a matched visit which occurred


within two months of the index visit for the corresponding case.


Mantel-Haenszel methods and logistic regression were used to compare


differences in risk factors for seroconversion between cases and


controls. RESULTS--A total of 15 cases and 50 controls were eligible


for this study. Cases were significantly more likely to have had


reported any gonorrhoea (17% versus 6%; OR = .4; 5% CI 1.51-5.7) or


syphilis (7% versus %; OR = .78; 5% CI 1.-10.7) than controls


during the seroconversion period. Multivariate logistic regression


revealed rectal gonorrhoea to be independently associated with risk of


seroconversion (odds ratio = .18; p = 0.044), whereas urethral


gonorrhoea (p = 0.47) and pharyngeal gonorrhoea (p = 0.44) were not


after inclusion of rectal gonorrhoea. In addition, the following


variables were also shown to exert an independent effect on


seroconversion frequency of anal intercourse, use of illicit drugs,


number of male sexual partners, and lack of a post-secondary education.


CONCLUSIONS--In this observational study, rectal gonorrhoea was found to


be associated with HIV seroconversion after adjustment for a number of


HIV risk factors. We cannot rule out that rectal gonorrhoea was not


directly associated with HIV infection but rather with other residual


lifestyle factors not fully adjusted for in the analysis. However, the


relationship with gonococcal involvement of a specific anatomic site


lends support to a biological association between gonorrhoea and HIV


infection, rather than to alternative non-biologic explanations. Our


findings are consistent with previous studies reporting an association


between HIV infection and non-ulcerative sexually transmitted diseases.


Such a direct association might be explained by postulating that


gonorrhoea results in inflamed rectal mucosa and compromised epithelial


integrity, thereby predisposing an individual to subsequent HIV


infection.


==============================


OBrien TR, Kedes D, Ganem D, Macrae DR, Rosenberg PS, Molden J, Goedert


JJ. Evidence for Concurrent Epidemics of Human Herpesvirus 8 and Human


Immunodeficiency Virus Type 1 in US Homosexual Men Rates, Risk Factors,


and Relationship to Kaposis Sarcoma. J Infect Dis 1


Oct;180(4)1010-1017.


Viral Epidemiology Branch, National Cancer Institute, EPS 8016,


Rockville, MD 085, USA. obrient@exchange.nih.gov


Abstract We examined human herpesvirus 8 (HHV-8) seroprevalence and


seroincidence among 45 homosexual men from New York City (NYC) and


Washington, DC (DC) who have been followed since 18. An


immunofluorescence assay measured antibodies to a latent HHV-8 nuclear


antigen. Seroprevalence was 0.4% in 18; seroincidence was


approximately 15%/year during 18-18 but fell sharply thereafter. NYC


men had a higher seroprevalence (odds ratio, .4; P.001) and


seroincidence (rate ratio, .1; P=.01) than DC men. Risk of Kaposis


sarcoma (KS) was increased in seropositive men (adjusted relative


hazard, .58; P=.0). Among men who were seropositive for both human


immunodeficiency virus type 1 and HHV-8, the 10-year cumulative risk of


KS was %; time from coinfection to KS diagnosis ranged from 15 to 154


months (median, 6.5 months). This study shows an epidemic of HHV-8


among US homosexual men in the early 180s that was associated with a


high risk of developing KS.


==============================


Szmuness W, Stevens CE, Harley EJ, Zang EA, Oleszko WR, William DC,


Sadovsky R, Morrison JM, Kellner A. Hepatitis B vaccine demonstration


of efficacy in a controlled clinical trial in a high-risk population in


the United States. N Engl J Med 180 Oct ;0(15)8-41.


Abstract We assessed the efficacy of an inactivated hepatitis B vaccine


in a placebo-controlled, randomized, double-blind trial in 108


homosexual men known to be at high risk for hepatitis B virus infection.


The vaccine was found to be safe and the incidence of side effects was


low. Within two months, 77% of the vaccinated persons had high levels of


antibody against the hepatitis B surface antigen. This rate increased to


6% after the booster dose and remained essentially unchanged for the


duration of the trial. For the first 18 months of follow-up, hepatitis B


or subclinical infection developed in only 1.4 to .4% of the vaccine


recipients as compared with 18 to 7% of placebo recipients (P


0.0001). The reduction of incidence in the vaccinees was as high as


.%; none of the vaccinees with a detectable immune response to the


vaccine had clinical hepatitis B or asymptomatic antigenemia. A


significant reduction of incidence was already seen within 75 days after


randomization; this observation suggests that the vaccine may be


efficacious even when given after exposure.





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