Syphilis Outbreak – originally posted in April of 2008

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

Rights of People With HIV Under Assault?

Although a recent New York Times article (posted below) suggests immediate treatment for HIV-positive men has a long-term beneficial effect on health, activist Sean Strub argues the policy focuses too much on prevention and not on the needs of persons living with the disease. His editorial, Medical Ethics and the Rights of People With HIV Under Assault was posted on POZ blogs on April 28th.

HPV and Men – originally posted January 2008

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 

14 percent of gay men in DC are HIV positive

DC Department of Health: 14 percent of gay men in DC are HIV positive–that’s almost five times as high as the overall rate. A quote from their study reads “complacency that the HIV/AIDS epidemic is under control for men who have sex with men has taken a toll.”

It’s pretty convincing evidence that HIV is still very much with us. The pdf link to the official report takes an extra minute to open.

Pitt Men’s Study Director Creates Anal Dysplasia Clinic

Dr. Ross Cranston was recruited to Pittsburgh in 2007 to create an Anal Dysplasia Clinic at the Pittsburgh AIDS Center for Treatment (PACT). The focus of the clinic, which is also open to non-PACT patients, is to address the high incidence of human papillomavirus (HPV or wart virus).  HPV has been associated with anal cancer in gay men – particularly those living with HIV. 

 “As gay men, we run the risk of serious health issues because we don’t pay enough attention to our butts.”  Dr. Cranston states. “So, one of my goals is to promote an ‘anal agenda’ that increases awareness of the medical conditions gay men are more likely to experience.” Putting the issue into perspective, he adds: “Anal health has yet to emerge as an area to which it is deemed appropriate to direct our attention. As a result, gay men in particular are unaware of their increased risk of many anal diagnoses including those related to sex or sexually transmitted infections, such as the development of anal cancer.”   

Patients with an abnormal anal cytology (a test of anal cells that is used to detect abnormalities) are referred to Dr. Cranston for high-resolution anoscopy (HRA). This office procedure involves examining the anal canal using magnification.  If there is evidence of high-grade dysplasia – the precursor to anal cancer – a biopsy may be performed. If high-grade dysplasia is confirmed, Dr. Cranston can then remove the lesion in order to prevent its potential progression to cancer.

“We are currently diagnosing about one case of anal cancer every 2 weeks,” says Dr. Cranston, “which is why I suggest that gay men who are HIV-positive talk to their clinician about anal dysplasia screening and have an annual anal Pap smear.” Although there are no national screening guidelines, Dr. Cranston notes, it is also suggested that HIV-negative men over 40 get tested every two to three years.

Dr. Cranston is an Assistant Professor in the Division of Infectious Disease and the Medical Director of the Pitt Men’s Study.  He began his studies at the University of Edinburgh before moving to London, where he completed a fellowship in HIV and Sexually Transmitted Infection. He moved to the U.S. to conduct doctoral research at the University of California—San Francisco and then spent five years working at the UCLA Center for AIDS Research and Education in Los Angeles, where he established and ran the UCLA Anal Dysplasia Clinic. 

For many years, Dr. Cranston has used his knowledge of anal dysplasia, HPV, and HIV to help countless HIV-positive men. He moved to Pittsburgh in September 2007 with his partner of 11 years, Ian McGowan, who is also employed by the University as a Professor in the School of Medicine, and is Co-Principal Investigator of the Pittsburgh-based Microbicide Trials Network. 

For more information about the anal dysplasia clinic, you can call  412-647-0996 .

Testing Microbicides to Combat HIV

The development of safe and effective prevention strategies against HIV infection is a critical component of the HIV research agenda and, in recent years, the University of Pittsburgh School of Medicine has emerged as a global leader in microbicide development. Ongoing microbicide research is based both in Pittsburgh and at international sites in Africa and India.

A microbicide is a substance designed to prevent transmission of HIV and other sexually transmitted diseases in men and women. It can come in the form of a gel, cream, suppository, film, sponge or ring that releases an active ingredient over time.

The Microbicide Trials Network (MTN) is led by Dr. Sharon Hillier and headquartered at Magee-Womens Research Institute & Foundation in Pittsburgh. The MTN is funded by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health specifically to conduct clinical trials to evaluate the safety and effectiveness of topical microbicides. Several microbicides are being tested in clinical trials and the present network includes a total of 17 sites located in seven countries.

The concept for a microbicide-like product was developed more than 15 years ago by reproductive health specialists and advocates who recognized the need for female-controlled HIV prevention methods. Beyond being effective, microbicides for HIV prevention must be safe and easy to use.

Microbicides first undergo rigorous testing in the laboratory before testing in humans can occur. Phase I trials evaluate safety in a small number of people exposed to study products for brief periods such as one to two weeks. If those study results suggest the product is safe, investigation then progresses to a Phase II trial. Researchers then track safety of the product over greater periods of time.

Finally, Phase III trials are performed to establish the product’s effectiveness. This type of study is conducted in a large number of participants, and usually involves multiple centers. Studies may be designed to compare one product’s effectiveness with another’s and/or with an inactive agent, or placebo. The data resulting from a Phase III trial are often used by regulatory agencies to determine if a product should be approved for widespread use.

Public health experts estimate microbicides that are even 60 percent effective against HIV could prevent upwards of 2.5 million infections over a three-year period.  More research is focusing on the development of rectal microbicides. One current trial involves assessment of rectal safety of microbicide products originally formulated for the vagina, as it is assumed that once vaginal microbicides are licensed they will also be used in the rectum. In addition, a team lead by Dr. Ian McGowan are developing microbicide products formulated specifically for rectal use.

For information about microbicides, the following websites offer a variety of views and news including research and advocacy efforts. They are:  http://www.mtnstopshiv.org/; http://www.ipm-microbicides.org/; http://www.global-campaign.org/; and http://www.microbicide.org/.

Persons interested in participating in upcoming local microbicide research studies at the University of Pittsburgh are encouraged to call Anne Davis at  412-641-3381  .

Health Department Tests Online Partner Notification

The Allegheny County Health Department has begun testing an online partner notification system. The online system is designed to send anonymous “e-card” messages to persons who may have been exposed to a sexually transmitted disease. “The way it works,” explains Raymond Yeo, a University of Pittsburgh consultant involved in creating the system, “is that if I were to test positive for Syphilis or HIV, for example, I would go online with a Department of Health representative and send email messages to all the people I’ve had sex with.” Yeo works for Pitt’s Graduate School of Public Health as an online sexual health educator. “The internet has become a major venue for finding sexual partners,” Yeo went on to explain, “so the Pennsylvania Department of Health needed to create a method of contacting people who may have been exposed to sexually transmitted diseases when the only contact information they have is an email address.”

The e-card message informs recipients that a person they’ve hooked up with (for sex) tested positive for an undisclosed sexually transmitted disease and encourages him or her to also get tested. Messages also contain a unique identification number that medical providers and clinics can use to determine what infection they should test for. This number is also reported back to the Department of Health for the purpose of tracking state-wide outbreaks.           

“If you receive an e-card from the Pennsylvania Department of Health, telling you that you’ve been exposed to a sexually transmitted disease, you can take it seriously because the system is controlled by the Health Department staff…which pretty much eliminates the possibility of it being a hoax or a spam message,” Yeo added. “It’s important that this system succeeds in what it was designed to do. Folks who are hooking up on the Internet for sex are getting infected at higher rates than folks who don’t…and if we don’t find a way to contact them, and they don’t get tested, it will only lead to bigger health problems for our community.” 

People who have been exposed to a sexually transmitted disease, in cases where additional contact information is available (such as a phone number or mailing address), are contacted via traditional methods. For more information about the Pennsylvania Health Department Online Notification System, you can contact Mr. Yeo at the University of Pittsburgh’s Graduate School of Public Health by calling  (412) 383-2940 . You can also go to the Partner Notification Website at http://www.pastatehealth.org/.

High Rate of Hepatitis C Infection in Gay Men

Recent outbreaks of the Hepatitis C virus (HCV) among men who have sex with men have been reported in Europe and the United States. Doctors believe that a significant number of cases were transmitted through sexual contact. “This finding is alarming,” says Pitt Men’s Study Physician Assistant Kristen D’Acunto. “HCV is usually associated with injection drug use because it’s primarily spread through exposure to infected blood.”

Information posted on the Website Stopaids.org suggests the high rate of infection among gay men may be the result of rough anal play. “‘Rough anal play’ relates to the specific sexual practices of gay men involved in the initial research, who were also HIV-positive,” explained Dr. Ross Cranston, the Pitt Men’s Study Medical Director. “This finding makes sense since these practices are more likely to result in mucosal tears resulting in bleeding, and so increase the risk for HCV transmission.”

Symptoms of acute HCV include jaundice, fatigue, abdominal pain, dark urine, loss of appetite and nausea. “It is also possible to have no symptoms at all,” D’Acunto is quick to point out. “Currently there is no vaccine and treatment is both difficult to undertake and has a limited success rate in HIV-positive individuals. So it’s important to use a condom during anal sex. It’s also important to get tested for HCV so that you can learn how to avoid spreading it to others.”  

“HCV infection is determined by a simple blood test,” adds Dr. Ross Cranston. “If it comes back positive, that means you have been infected with the virus. It’s important to note that some people recover from HCV without treatment. However, most people are chronically infected, which means the virus is in your system permanently. These are the folks that can go on to experience disease progression with abnormal liver function, the development of cirrhosis, and ultimately liver cancer.” 

Form more information about HCV, you can go any of these helpful links:

http://www.hivandhepatitis.com/

http://www.thebody.com/content/art6050.html

http://www.stopaids.org/news/hepc.pdf