The global monkeypox outbreak appears to mostly affect men who have sex with other men. A study published in the New England Journal of Medicine found that 98% of people diagnosed with the virus between April and June in more than a dozen countries identify as gay or bisexual men, and the WHO says that 99% of U.S. cases are related to male-to-male sexual contact.
That means that the public health systems can target their messaging and interventions to the specific communities most at risk. But it also carries the risk of stigmatizing those populations, while sowing complacency in others that could still be vulnerable.
Public health experts stress that monkeypox is relevant to everyone, since it can spread through skin-to-skin contact and potentially contaminated objects like clothing or towels. And viruses can infect anyone. The U.S. has already documented two cases of monkeypox in children, for example. “While we may be seeing clusters primarily in certain groups of people, viruses do not discriminate by race, by religion, or by sexual orientation,” infectious disease researcher Dr. Boghuma Titanji told NPR.
While the eyes of the nation are on the coronavirus pandemic, another threat to public health has been steadily growing in the United States. We’ve been battling rising rates of sexually transmitted infections (STI) for the last several years. In fact, 2020 marks the fifth consecutive year of increasing rates of gonorrhea, chlamydia and syphilis in the U.S., due in part to significant funding cuts to more than 50% of the nation’s public health STI programs. And now the COVID-19 pandemic has placed an even greater burden on our strained public health system and supply chains, shifting focus from one major public health issue to another.
We can’t risk losing one critical resource that will be essential to ending the STI epidemic — the availability of free and confidential STI testing for adolescents. Prior to the pandemic, national public health efforts were scaling up to improve STI and HIV testing, and quickly link youth to prevention services. Rapid identification and treatment of STIs not only has public health benefits in terms of lowering transmission, but when left untreated, STIs increase the risk of infertility, severe pelvic infection, chronic pelvic pain, ectopic pregnancy and HIV transmission.
While accounting for 25% of the population, adolescents and young adults comprise over 50% of STIs in the U.S. each year. Black, Latinx, and LGBT youth face the greatest burden of infections and risk of complications. Fortunately, significant advances have been made over the last several decades to improve rates of STI and HIV testing among adolescents and young adults. The American Academy of Pediatrics now recommends HIV screening by the age of 16-18 years for all youth regardless of their sexual activity.
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.
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.
According to a study published in the journal Sexually Transmitted Infections, rectal douching might increase the odds of contracting HIV and other STIs — including hepatitis, chlamydia, and gonorrhea.
Researchers state that douching before sex can damage the lining of the rectum, which leads to an increased risk of transmission due to indirect entry into the bloodstream.
Rectal douching is a common practice among gay and bisexual men who prefer the “bottom” role in sex. It’s widely used in an effort cleanse the rectum before having anal sex. According to researchers, nearly half of men who have sex with men engage in the practice.
In this particular study, researchers examined 28 studies involving 21,570 MSM — 46 percent were in the U.S., 35 percent were in Europe, and the rest were in South America, Asia, and Africa, reports NAM AIDS Map. All of the studies were published between 1982 and 2018.
Twenty of the studies were particularly focused on the association between douching and HIV transmission. They found that men who practiced rectal douching were nearly three times as likely to contract HIV.
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.
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.
Though HIV is treatable today, the challenges of navigating the health care system can be stressful for anyone, let alone an individual living with a chronic illness. AIDS Resource Alliance utilizes a team of case managers who are trained to help their clients with insurance, housing, treatment and other issues that impact the lives of persons living with HIV. Twice-monthly support groups give clients a chance to share their experiences and struggles within a safe space where judgment and stigma are not allowed.
AIDS Resource Alliance also provides prevention services to the communities they serve. HIV and STI testing are available free of charge during office hours, as are condoms and other harm reduction materials. Each testing client is also provided with risk-reduction education, and general education services are available to local agencies and organizations who want their members to learn more about HIV and sexual health.
Much has changed since the earliest days of the epidemic, and the staff at AIDS Resource are preparing for the future with programming that addresses the new landscape of HIV in America. PrEP, the daily medication that can prevent HIV infection, is prescribed free in the Williamsport offices, as are the required testing and physical examinations necessary to continue the medication (the cost of the drug is the responsibility of the patient, but the AIDS Resource team can assist the client in applying for programs that assist in covering the cost of the drug.) As the population of people living with HIV enters their 60s and beyond, support group and other focused social activities enable clients to maintain positive social connections. Counseling services are provided free of charge to clients who request them.
One in ten new cases of HIV in gay and bisexual men are linked to gonorrhea and chlamydia infection. That’s the conclusion of a modelling study highlighted by the NCSD (National Coalition of STD Directors) in the US.
The journal, Sexually Transmitted Diseases, published the research this week. Both sexually transmitted infections can increase the risk of HIV transmission taking place: a fact known for some time.
However, with rates of both gonorrhea and chlamydia rising in the US, health experts are concerned how this may impact public health advances in tackling HIV.
Between 2013-2017, the US saw a 22% increase in chlamydia. Gonorrhea diagnosis shot up by 67%. By comparison, there has been a 13% drop in HIV diagnosis over the last eight years.
The precise extent to which chlamydia and gonorrhea increase HIV transmission is unknown. Other biological factors may also play an influence. For this reason, parts of the ‘modelling’ study relied on estimates.
However, researchers from Emory University and the Centers for Disease Control and Prevention (CDC) in Atlanta say their findings should be used by those working in public health to address the issue of STIs and HIV transmission.
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.
In an interview with the Los Angeles Blade about the new study, lead author Phillip Hammack, a professor at the University of California, Santa Cruz, debunked the notion.
“Our data don’t support the idea that we can attribute the rise in STIs to PrEP use, at least not in a direct manner. I personally don’t think that’s what’s happening,” said Hammack.
Instead, Hammack points at the rise of dating apps like Grindr, and a decrease in fear towards contracting HIV, as more likely causes.
“I would speculate it has more to do with a culture shift about sex,” said Hammack. “More people are having sex today. We’re in sort of a quiet sexual revolution when it comes to new identities, new labels, and sexual behavior.”
On the down side, the study also showed that only 4% of men who have sex with men are using PrEP. What’s more, many gay and bisexual men aged 18-25 aren’t getting annual HIV tests. 25% of men who have sex with men in that age range have never gotten an HIV test.
“I worry especially about younger men who didn’t grow up with the concerns of HIV that men of older generations did,” said Hammack in the William Institute press release on the study. “The low rate of HIV testing probably reflects a degree of complacency and cultural amnesia about AIDS.”
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.