Characteristics and Longitudinal Patterns of Erectile Dysfunction Drug Use Among Men Who Have Sex with Men in the U.S.

We investigated the longitudinal relationship between erectile dysfunction (ED) drug use with behavioral factors, including substance use and sexual activities in men who have sex with men from the Multicenter AIDS Cohort Study during 1998–2016 (n = 1636). We used a bivariate random-intercept model to evaluate ED drug use along with other behavioral factors to assess relationships between the two outcomes over time on a population level and also at the individual level. Average ED drug use among men who have sex with men (MSM) with HIV was positively correlated with average use of marijuana (r = .19), poppers (r = .27), and stimulants (r = .25). In this group, testosterone use (r = .32), multiple partners (r = .41), insertive anal intercourse with condom (r = .40), and insertive anal intercourse without condom (r = .43) all showed moderate correlations over time with average ED use (p < .001). Associations among MSM without HIV were similar, with average marijuana use (r = .19) and stimulant use (r = .22) being positively correlated with average ED drug use, and were also correlated with having multiple partners (r = .36), insertive anal intercourse with condom (r = .22), and insertive anal intercourse without condom (r = .18) over time. Positive within-individual associations between ED drug use and multiple partners and insertive anal intercourse with and without condom were observed regardless of HIV serostatus. This study showed that MSM who reported use of ED drugs were also, on average, more likely to use recreational drugs and engage in sexual activities, such as having multiple partners and insertive anal intercourse. Within individuals, average ED drug use was also positively correlated with sexual behaviors.

The Psycho-Social and Socio-Cultural Factors of Crystal Methamphetamine Use Among the Gay, Bi and MSM (GBM) Population

In the United States, men who have sex with men (MSM) remain as the demographic group with the highest HIV incidence rates and account for 53% of new HIV infections in 2006 (Rajasingham, Mimiaga, White, Pinkston, Baden, & Mitty, 2012). One of the reasons accounting for such high rates of HIV transmission between gay, bisexual and MSM (GBM) can be attributed to poly-substance use and the use of crystal methamphetamine (Solomon, Halkitis, Moeller, & Pappas, 2012; Rajasingham et al., 2012). The U.S. Centre for Disease Control and Prevention (2007) reported methamphetamine use in the MSM community is of particular concern due to the high prevalence of HIV and the use of the stimulant. Meanwhile, researchers have found methamphetamine use is closely corrleated to sexual risk taking among GBM and such intimate link between risky sexual behaviour and methamphetamine use have led to a possible double epidemic (Halkitis, Green, & Carragher, 2006). In particular, the use of methamphetamine has been found to be correlated to the frequency of unprotected insertive anal intercourse (UIAI) and unprotected receptive anal intercourse (URAI) among HIV positive and persons with unknown serostatus causal partners over time (Halkitis, Mukherjee, & Palamar, 2009). As an effort to better understand this social pheonemon, this paper focuses on the exploration and identification of the psycho-social and socio-cultural factors of crystal methamphetamine use among the GBM population.

The Psycho-Social and Socio-Cultural Factors of Crystal Methamphetamine Use Among the Gay, Bi and MSM (GBM) Population

In the United States, men who have sex with men (MSM) remain as the demographic group with the highest HIV incidence rates and account for 53% of new HIV infections in 2006 (Rajasingham, Mimiaga, White, Pinkston, Baden, & Mitty, 2012). One of the reasons accounting for such high rates of HIV transmission between gay, bisexual and MSM (GBM) can be attributed to poly-substance use and the use of crystal methamphetamine (Solomon, Halkitis, Moeller, & Pappas, 2012; Rajasingham et al., 2012). The U.S. Centre for Disease Control and Prevention (2007) reported methamphetamine use in the MSM community is of particular concern due to the high prevalence of HIV and the use of the stimulant. Meanwhile, researchers have found methamphetamine use is closely corrleated to sexual risk taking among GBM and such intimate link between risky sexual behaviour and methamphetamine use have led to a possible double epidemic (Halkitis, Green, & Carragher, 2006). In particular, the use of methamphetamine has been found to be correlated to the frequency of unprotected insertive anal intercourse (UIAI) and unprotected receptive anal intercourse (URAI) among HIV positive and persons with unknown serostatus causal partners over time (Halkitis, Mukherjee, & Palamar, 2009). As an effort to better understand this social pheonemon, this paper focuses on the exploration and identification of the psycho-social and socio-cultural factors of crystal methamphetamine use among the GBM population.

United Kingdom British association for sexual health and HIV national guideline for the management of epididymo-orchitis, 2020

The British Association for Sexual Health and HIV (BASHH) UK guideline for the management of epididymo-orchitis has been updated in 2020. It offers advice on diagnostic tests, treatment and health promotion principles in the effective management of epididymo-orchitis. Empirical treatment should be started in patients with objective swelling and tenderness on testicular examination. First-line empirical treatment for sexually acquired epididymo-orchitis has changed to ceftriaxone 1g intramuscularly and doxycycline. Higher dose of ceftriaxone in line with the BASHH 2018 gonorrhoea guideline ensures effective treatment of strains with reduced susceptibility. Ofloxacin or doxycycline is recommended in patients with epididymo-orchitis probably due to non-gonococcal organisms (e.g. negative microscopy for gram-negative intracellular diplococci or no risk factors for gonorrhoea identified). Where Mycoplasma genitalium is tested and identified, treatment should include an appropriate antibiotic (e.g. moxifloxacin). If enteric pathogens are a likely cause (e.g. older patient, not sexually active, recent instrumentation, men who practice insertive anal intercourse, men with known abnormalities of the urinary tract or a positive urine dipstick for leucocytes and nitrites), ofloxacin and levofloxacin are recommended. A clinical care pathway has been produced to simplify the management of epididymo-orchitis. A patient information leaflet has been developed.

Alcohol and Condomless Insertive Anal Intercourse Among Black/Latino Sexual-Minority Male Non-PrEP Users

ObjectiveThis study examined factors associated with alcohol use and condomlessinsertive anal sex among a sample of BLMSM (N = 188), self-identified as HIV- negative, ages 18–40. The influence of alcohol use on sexual positioning during condomless anal intercourse among Black and Latino men who have sex with men (BLMSM) warrants research attention because of the pervasive misinformation regarding the risk of HIV transmission and the disproportionate impact of the HIV epidemic for this population.MethodsSelf-report survey questionnaires were administered in real time at bars/clubs; public organized events; local colleges/universities; social media advertisements; private men's groups; and organized events in Los Angeles County.ResultsLogistic regression predicted those reporting risky sex when using alcohol were seven times more likely to report condomless insertive anal sex.ConclusionClear messaging about alcohol moderation, dispelling the myths about strategic positioning, and pre-exposure prophylaxis (PrEP) use among HIV negative BLMSM could potentially reduce HIV acquisition/transmission.

Neisseria Meningitidis Urethritis in a Thai Male

Although Neisseria meningitidis (N. meningitidis) urogenital infections have been reported widely, meningococcal urethritis has not been reported previously in Thailand. A 42-year-old Thai male presented at a sexual health clinic with dysuria and urethral discharge following oral and insertive anal intercourse. N. meningitidis, serogroup C was cultured from a urethral discharge specimen and the patient was treated successfully with standard treatment for gonococcal urethritis. This case reflects a growing trend of reports describing meningococcal urethritis, likely resulting from sexual contact.

Latent classes of partner-seeking venues and sexual risk among men who have sex with men in Paris, France

In France, men who have sex with men (MSM) experience the highest HIV incidence. MSM who use multiple venues such as bars and smartphone apps to find sexual partners have greater HIV and sexually transmitted infection risk than those who use a single physical or online venue. To explore the role of venues and sexual behavior on HIV risk, we used latent class analysis to highlight underlying profiles of 580 MSM in Paris, France. Three latent classes emerged: Multi-venue Users (19%), Non-serosorting App Users (49%), and Serosorting App Users (32%). Multi-venue Users had the highest probabilities of condomless receptive anal intercourse (CRAI) and condomless insertive anal intercourse (CIAI), group sex, and meeting partners at venues such as bars or online. Non-serosorting App Users had the lowest probabilities of CRAI, CIAI, and condomless serosorting. Serosorting App Users had an 87% chance of condomless serosorting. MSM reporting a pre-exposure prophylaxis history had 14 and 5 times the odds of being classified as Multi-venue Users and Serosorting App Users than Non-serosorting App Users. MSM were 3% more likely to be Multi-venue Users than Non-serosorting App Users for every one-year increase in age. Interventions addressing sexual risk behaviors among MSM in France should consider tailored risk-reduction and prevention messaging.

Transactional sex, condomless anal sex, and HIV risk among men who have sex with men

To understand the HIV epidemic among men who have sex with men who engage in transactional sex (MSM-TS) in Paris, France, we sought to examine the association between engagement in transactional sex and HIV risk behaviors among MSM in Paris, France. Users of a geosocial-networking application in Paris were provided an anonymous web-based survey ( N = 580), which included questions about transactional sex and behavioral risk factors for HIV along with sexually transmitted infection (STI)/HIV status. Multivariate analyses showed that engagement in transactional sex was associated with condomless receptive and insertive anal intercourse (adjusted relative risk [aRR] = 1.34, 95% confidence interval [CI] = 1.04–1.72 and aRR = 1.41, 95% CI = 1.04–1.91, respectively). MSM-TS were more likely to have engaged in substance use before or during sex (aRR = 1.35, 95% CI = 1.13–1.62), to have participated in group sex (aRR = 1.37, CI = 1.13–1.62), and to have had an STI during the last year (aRR = 1.68, 95% CI = 1.16–2.45). Transactional sex was not associated with HIV status. MSM-TS in Paris engaged in higher HIV risk behaviors, however, did not have higher rates of HIV infection. Sexual health interventions should continue to target MSM-TS; however, future studies should characterize the social, cultural, and structural factors that interact with individual behaviors to elevate HIV risk for MSM-TS.

Partnership-level correlates of sexual risk taking within the sexual partnerships of young transwomen in San Francisco, California

ObjectivesLittle is known about the sexual networks of young transwomen, leaving a major gap in what we know about transmission dynamics and the elevated rates of HIV in this population. The objective of this study was to understand partnership-level factors associated with condomless anal sex among young transwomen.MethodsA secondary data analysis of the sexual partnerships of young transwomen was conducted using baseline data from the SHINE study. Generalised estimating equation logistic regressions were used to assess for partnership-level associations between partnership type, age, injection drug use and racial concordance, HIV seroconcordance, sexual role and condomless receptive (CRAI) and insertive anal intercourse (CIAI).ResultsOur analysis included 187 young transwomen that reported a total of 464 sexual partnerships where they had at least one episode of anal sex in the past 6 months. We found casual (n=232 or 50%) and commercial partnerships (n=106 or 22.8%) to be significantly associated with a lower odds of CIAI (OR=0.53, 95% CI 0.32 to 0.86 and OR=0.39, 95% CI 0.18 to 0.82) and CRAI (OR=0.30, 95% CI 0.19 to 0.47 and OR=0.35, 95% CI 0.2 to 0.62) compared with main partnerships (n=126 or 27.2%). Additionally, HIV-positive seroconcordant (n=25 or 5.4%, OR=4.05, 95% CI 1.44 to 11.40) and injection-drug using partnerships (n=25 or 5.4%, OR=3.66, 95% CI 1.34 to 9.95) were found to be significantly associated with an increased odds of CIAI among participants compared with HIV-negative seroconcordant (n=330 or 71.1%) and non-using partnerships (n=338 or 72.8%), respectively.ConclusionYoung transwomen, like other populations, engage in condomless sex more often with main than casual and commercial partners, suggesting a need for interventions that address sexual practices with steady main partners.

Cross-sectional study of urethral exposures at last sexual episode associated with non-gonococcal urethritis among STD clinic patients

ObjectiveAlthough Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) are major causes of non-gonococcal urethritis (NGU), up to 50% of cases are of unknown aetiology. We sought to identify urethral exposures at last sexual episode associated with NGU and non-CT/non-MG NGU to identify anatomical sites from which aetiologically relevant micro-organisms may be acquired.MethodsWe enrolled STD clinic patients with and without NGU assigned male sex at birth and age ≥16 into a cross-sectional study. NGU was urethral symptoms or visible discharge plus ≥5 polymorphonuclear leucocytes without Neisseria gonorrhoeae. Urine was tested for CT and MG (Aptima). We used logistic regression to estimate the association between urethral exposures at last sex and NGU separately among cisgender men and transgender women who have sex with men (MSM/TGWSM) and cisgender men who have sex with women (MSW).ResultsBetween 8 August 2014 and 1 November 2017, we enrolled 432 patients, including 183 MSM/TGWSM (118 NGU+, 65 NGU−) and 249 MSW (126 NGU+, 123 NGU−). The mean age was 34; 59% were white. CT and MG were detected in 72 (30%) and 49 (20%) NGU+ participants, respectively. Compared with MSM/TGWSM reporting only non-urethral exposures at last sex, those reporting insertive anal intercourse (IAI) only (adjusted OR (AOR)=4.46, 95% CI 1.09 to 18.19) and IAI with insertive oral sex (IOS) (AOR=7.88, 95% CI 2.67 to 23.26) had higher odds of NGU. MSM/TGWSM reporting IOS only had no significant increased odds (AOR=1.67, 95% CI 0.58 to 4.85). Compared with MSW whose only urethral exposure at last sex was vaginal sex (VS), MSW reporting IOS and VS had similar odds of NGU (OR=0.84, 95% CI 0.50 to 1.41). The results were similar for non-CT/non-MG NGU.ConclusionsAmong MSM/TGWSM, IAI may lead to transmission of yet-unidentified rectal micro-organisms that cause non-CT/non-MG NGU, in addition to transmission of known pathogens. Sites of urethral exposure appear less important for understanding NGU risk among MSW due to minimal variation in behaviour.