Homosexuality and Infectious Diseases: Bedfellows

• In the mid-20th century, male homosexuals constituted about 8% of men afflicted with anal cancer; by the mid-1980s, this figure had risen to 72%. (1) The transmission of certain types of human papilloma viruses explains the association of anal intercourse with anal cancer. (2) In an examination of 3,391 Danish men in registered homosexual partnerships, followed for an average of 4.6 years, the incidence of anal cancer was 31-fold higher and the incidence of Kaposi’s sarcoma was 136-fold higher compared to Danish men in general. (3) Anal carcinomas among male homosexuals can approach 4-7 inches in diameter. (4)
• During 1982-1989, MSM constituted less than 10% of individuals with hepatitis-A. (5) During the first 6 months of 1991, 29% of the hepatitis-A cases in Denver, 66% in New York City, 50% in San Francisco, 56% in Toronto, 42% in Montreal, and 26% in Melbourne consisted of homosexuals. (5) Between Nov 1998 and May 1999, among the reported cases of hepatitis-A in Columbus, Ohio, 66% of the men were MSM. (6)
• In a sample of 735 MSM in San Francisco, 4.6% had hepatitis-C and 81% had hepatitis-B infection. (7) Hepatitis-B appears to be transmitted 8.6-fold more efficiently than HIV-1 among homosexual men, according to a study. (8)
• Not only did homosexuals bring about the AIDS epidemic in America, the weakened immune system of AIDS patients brought a resurgence of tuberculosis too. Health care workers that deal with AIDS patients risk getting tuberculosis. (9)
• During the 1990s, syphilis occurred predominantly among African-American heterosexuals in the South and in large cities. (10) In Seattle, syphilis declined from 1987 to 1996, but a syphilis outbreak occurred around 1997. The outbreak was traced to a cluster of homosexuals. 68% of syphilis patients were MSM, among whom 66% were also HIV-positive. Most MSM were 30 years or older (i.e., old enough to know what they were doing) and had recruited many anonymous partners. (11)
• As above, a syphilis outbreak occurred among MSM during January-July, 2000 in southern California. (10) 57 among 66 syphilis-afflicted homosexuals knew their HIV status; 34 (60%) of the 57 reported that they were HIV-positive. The year of HIV diagnosis was known for 27 of the 34 HIV-positive homosexuals; the median time since diagnosis of HIV infection was 4 years (range: 0-19 years). (10) Once again, homosexuals who knew that they were HIV-positive still went on to have unprotected sex.
• As of 2003, the incidence of syphilis was on the rise in San Francisco, mostly occurring among MSM, and two-thirds of the new cases were occurring in individuals already infected with HIV. (12)
• A syphilis outbreak occurred during 1999-2000, in Oslo, Norway; of 60 cases examined at a hospital, 55 were men, and 43/55 men were MSM. (13)
• From 1990 to 2001, early infectious syphilis and (ano)genital gonorrhoea among those attending an outpatient STD clinic of the Amsterdam municipal health service sharply increased; homosexual men were almost entirely responsible for this increase. (14) Syphilis increased mostly among men aged 35 years or older and gonorrhoea increased mostly among younger men. (14)
• It hardly needs mentioning who gets rectal gonorrhoea. Homosexuals also get gonorrhoea in the penis (urethral gonorrhoea) and mouth (pharyngeal gonorrhoea). (15) Rectal gonorrhoea and pharyngeal gonorrhoea are often symptomless; (16) besides, a visual examination of the perianal region of male homosexuals will often misdiagnose rectal gonorrhoea as trauma due to a variety of homosexual practices, i.e., the male homosexual community is ideally poised to function as a reservoir of the gonorrhoea pathogen.
• Between 1997-1999, among Swedish men who contracted gonorrhoea, 28.9% were homosexual. (17) Among Swedish men who contracted gonorrhoea from overseas travel, 11.4% were homosexual; among men who contracted the STD domestically, 41.1% were homosexual. (17)
• During the period 1994-1999, in Denmark, the incidence of gonorrhoea among MSM was 30 times that among heterosexual men. (18)
• A 2004 U.S. report mentioned increasing drug-resistant gonorrhoea among MSM; the incidence of this drug-resistant form of gonorrhoea was 12-fold higher in MSM compared to the general population. (19)
• Parasitic intestinal infections are common among homosexuals; they result from the consumption of faecal material via rimming and other sexual practices (see here). A sexual transmission of typhoid, and a first of its kind in the U.S., occurred among a group of male homosexuals in 2000 (see here). Amebic liver abscess, a disease usually found in developing tropical countries is found elsewhere among individuals who have visited these countries and also among MSM. (20)
• Between December 1999 and November 2001, multidrug-resistant C. jejuni jejuni was found in the intestines of some male homosexuals in Montreal, Canada, and appeared to have been acquired via sexual activity. (21)
• A 1990 report from a Ft. Lauderdale, FL clinic noted that up to 55% of homosexual men with anorectal symptoms had gonorrhoea, 80% of the patients with syphilis were homosexual men, 15% of asymptomatic homosexual men had Chlamydia, and about 1 in 3 male homosexuals had active anorectal herpes simplex infection. (22) Additionally, intestinal infections that normally result from eating food contaminated with human feces were rampant in the homosexual community. (22)
• A 2003 U.S. report mentioned the emergence of a multi-drug-resistant bacterial skin infection among homosexual men in some cities and also some prisons. In the past, this infection was mainly limited to hospitals. (23)
• Until recently, the hepatitis-C virus has been mainly transmitted via sharing needles for intravenous drug use and blood or plasma transfusions. (24) However, male homosexuals have started to make a significant contribution to the spread of the hepatitis-C virus via risky sexual behaviours. (24)
• A study examined STD patients most likely to re-infect themselves soon after treatment. Among 17,466 patients attending 3 STD clinics in England between 1994 and 1998, 14% re-infected themselves within 1 year. (25) Groups that were the most likely to get re-infected were: (25)
  • 17% of individuals reporting three or more partners in the recent past. [1]
  • 20% of 12- to 15-year-old women. [2]
  • 25% of Caribbean attendees of African origin. [3]
  • And, of course, 22% of homosexual men. [4]

Clearly, not all risky sexual behaviors follow from a lack of knowledge of risks. An STD infection is the ultimate form of safe-sex education with respect to definitively convincing the afflicted that they need to practice safe sex; however, such education fails to convince some individuals. Can classroom education for such individuals be expected to fare better? Besides, sometimes the only way to avoid the risks associated with some risky activity is to avoid the activity altogether, which is asking too much of homosexuals and bisexuals in general.

Footnotes:

[1] Adjusted OR = 1.53; 95% CI = 1.34-1.73, compared to those with a single partner in the recent past.

[2] Adjusted OR = 1.90; 95% CI = 1.13-3.18, compared to women, ages 20-24 years.

[3] Adjusted OR = 1.87; 95% CI = 1.63-2.13, compared to whites.

[4] Adjusted OR = 1.30; 95% CI = 1.07-1.58, compared to heterosexual men.

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