Self-reported behavior patterns of patients attending a sexually transmitted disease clinic

Delay in Seeking Health Care Services After Onset of Urethritis Symptoms in Men

BACKGROUND

Symptom awareness, behavioral factors, and other barriers associated with timely sexually transmitted infection (STI) health care provision in men is not well studied.

METHODS

Men attending an STI clinic answered a questionnaire regarding their symptoms, sexual behavior, and sociodemographic and behavioral characteristics. Characteristics of symptomatic men were compared between those who did and did not delay seeking health care services. Delayed care seeking was defined as clinic attendance longer than 7 days after symptoms, whereas early care seeking was defined as clinic attendance of 7 days or less.

RESULTS

Over a quarter (n = 43 [27.7%]) of men with urethritis symptoms (urethral discharge or dysuria) delayed seeking care for more than 7 days. Compared with men who sought treatment within 7 days, those that delayed care worried for longer periods that their symptoms were STI-related, were more likely to attempt self-treatment of STI symptoms, were more likely to continue engaging in sexual activity, and were less likely to use a condom during their last sexual encounter. Conversely, men that delayed care seeking were less likely to have urethral discharge on physical examination, to have 5 or more polymorphonuclear leukocytes, and to test positive for Neisseria gonorrhoeae. When compared with men that sought care earlier, men that delayed care seeking had fewer overall and new partners in the past 30 days.

CONCLUSIONS

Our data suggest that over a quarter of men aware of STI symptoms delay seeking health services. Interventions that promote better patient understanding of the importance of symptom recognition and that facilitate timely access to care may provide new opportunities to reduce STI transmission.

Intersectional Epistemologies of Ignorance: How Behavioral and Social Science Research Shapes What We Know, Think We Know, and Don't Know About U.S. Black Men's Sexualities

Epistemologies of ignorance describe how ignorance influences the production of knowledge. Advancing an intersectional epistemologies of ignorance approach that examines how conscious (or unconscious) ignorance about racism, heterosexism, and classism shapes empirical knowledge about Black men's sexualities, we conducted a critical review of the behavioral and social science research on U.S. Black men, ages 18 and older, for two time frames: pre-1981 and the most recent decade, 2006-2016. Our search yielded 668 articles, which we classified into five categories: sexual violence, sexual experiences and expressions, sexual identities, cultural and social-structural influences, and sexual health and sexual risk. We found that most of the research, particularly pre-1981, centered the experiences of White heterosexual men as normative and implicitly constructed Black men as hypersexual or deviant. Most of the research also color-blinded White privilege and ignored how racism, heterosexism, and classism structured Black men's inequities. We also found notable exceptions to these trends. Black men who are gay, bisexual, or who have sex with men, and research on HIV risk were prominent in the past decade, as was research that emphasized the social-structural (e.g., poverty, heterosexism, racism) and cultural (e.g., masculinity, religion) contexts of Black men's lives and sexualities. We provide 10 recommendations to avoid intersectional epistemic ignorance in future research.

Psychosocial Correlates of Sexually Transmitted Diseases and Sexual Activity in Black Adolescent Females

The purpose of this study was to identify personality, demographic, academic, family, and health-related variables that predict a sexually transmitted disease (STD) diagnosis. Subjects were 73 lower-income Black females who presented with an STD diagnosis (n = 24), were sexually active, requested birth control, and had no history of STDs (n = 20), or were not sexually active and presented with a diagnosis unrelated to reproductive health problems (n = 29). Findings revealed that subjects with an STD diagnosis and those who were sexually active tended to be more alike than different and that these two groups differed from the nonse-xually active group. Results are discussed in relation to the existing literature on adolescents and reproductive health care.

Where do patients go for treatment of urethritis?

Background:

Urethritis is characterized by urethral inflammation, and it can result from both infectious and noninfectious conditions. Physicians and other health care providers play a critical role in preventing and treating urethritis.

Objectives:

The aim of this study was to describe and identify predictors of health care seeking behavior among men with urethritis.

Patients and Methods:

In total, 98 male patients aged between 16 to 52 years-of-age (mean 30.9 ± 8.0 years), who attended our clinic with symptoms of urethritis, were included in the study. We conducted face-to-face interviews with the patients using a 9-item survey questionnaire. Patients were divided into three groups according to their level of education as follows: group I (n = 44), elementary school; group II (n = 38), high school; and group III (n = 16), university.

Results:

Among the 98 patients evaluated, the source of treatment was physicians in 44 patients (44.9%), drugstores in 38 cases (38.77%), and friends in 16 patients (16.32%). There was a statistically significant difference found between the groups according to the source of treatment (P < 0.001). The most common factors associated with seeking care from other sources, rather than physicians, were economic reasons in 19 patients (35.18%), confidentiality concerns in 24 (44.4%), and ease of access in 11 patients (20.37%).

Conclusions:

A substantial proportion of patients with urethritis sought help from other sources, rather than physicians. The results of our study show that the patients with higher levels of education were more likely to seek help from health care services. It is important to promote the public’s knowledge through informative studies and educational materials in order to encourage patients to seek rapid and effective treatment from proper sources.

Examining the association between neighbourhood characteristics and gonorrhea rates among women aged 15 to 24 years in Montreal, Canada

OBJECTIVE

The reported incidence rate of gonorrhea has more than doubled from 2000 to 2010 in Montréal, increasing in both sexes and all age groups; however, the increase was particularly high in females aged 15 to 24 years. As the reasons for this increase among young women are not fully understood, we wanted to determine whether neighbourhood-level population characteristics were associated with incidence rates in this group, to help target intervention strategies.

METHODS

Incident gonorrhea cases were female residents of Montréal aged 15 to 24 years who met Québec's gonorrhea surveillance definition, with a notification date from 2002 to 2009. Adjusted incidence rate ratios (IRR) were estimated by negative binomial regression and show the change in the incidence of gonorrhea for each unit increase in neighbourhood-level independent variables, which included material and social deprivation indices (plus the latter's combination and components) and ethnic origin. In the final model, independent variables were normalized to facilitate comparison of their respective IRRs.

RESULTS

A total of 837 cases were reported (cumulative incidence rate 5.6 per 100,000). Higher proportions of persons of African, Aboriginal and Caribbean ethnicity were associated with higher rates of gonorrhea, even after adjustment for deprivation indices.

CONCLUSION

Customary methods for gonorrhea surveillance consider individual characteristics of cases as risk factors for disease. However, our results show that gonorrhea is clustered in neighbourhoods that have high proportions of three ethnic origin groups. Findings from this ecological approach suggest that although ethnicity may be strongly correlated with socio-economic status, there are factors in ethnicity that transcend poverty.

The program cost and cost-effectiveness of screening men for Chlamydia to prevent pelvic inflammatory disease in women

BACKGROUND

Because men transmit Chlamydia trachomatis to women, screening men to prevent pelvic inflammatory disease in women may be a viable strategy. However, the cost-effectiveness of this approach requires careful assessment.

METHODS

Data from a demonstration project and longitudinal study that examined screening men for chlamydia were applied to a compartment-based transmission model to estimate the cost-effectiveness of screening men for chlamydia compared with alternative interventions, including expanded screening of women and combining disease investigation specialist-provided partner notification with screening. Cases of pelvic inflammatory disease and quality-adjusted life years lost were the primary outcome measures. A male screening program that screened 1% of men in the population annually was modeled.

RESULTS

A program targeting high-risk men for screening (those with a larger number of partners in the previous year than the general population and a higher chlamydia prevalence) was cost saving compared with using equivalent program dollars to expand screening of lower-risk women. Combining partner notification with male screening was more effective than screening men alone. In sensitivity analyses, the male program was not always cost saving but averaged $10,520 per quality-adjusted life year saved over expanded screening of women.

CONCLUSIONS

Screening men can be a cost-effective alternative to screening women, but the men screened must have a relatively high prevalence compared with the women to whom screening would be expanded (under baseline assumptions, the prevalence in screened men was 86% higher than that of screened women). These modeling results suggest that programs targeting venues that have access to high-risk men can be effective tools in chlamydia prevention.

Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors

OBJECTIVE

To identify factors that contribute to the racial disparity in HIV prevalence between black and white men who have sex with men (MSM) in the United States.

METHODS

A comprehensive literature search of electronic databases, online bibliographies, and publication reference lists yielded 53 quantitative studies of MSM published between 1980 and 2006 that stratified HIV risk behaviors by race. Meta-analyses were performed to compare HIV risks between black and white MSM across studies.

RESULTS

Compared with white MSM, black MSM reported less overall substance use [odds ratio (OR), 0.71; 95% confidence interval (CI), 0.53-0.97], fewer sex partners (OR, 0.64; 95% CI, 0.45-0.92), less gay identity (OR, 0.29; 95% CI, 0.17-0.48), and less disclosure of same sex behavior (OR, 0.42; 95% CI, 0.30-0.60). HIV-positive black MSM were less likely than HIV-positive white MSM to report taking antiretroviral medications (OR, 0.43; 95% CI, 0.30-0.61). Sexually transmitted diseases were significantly greater among black MSM than white MSM (OR, 1.64; 95% CI, 1.07-2.53). There were no statistically significant differences by race in reported unprotected anal intercourse, commercial sex work, sex with a known HIV-positive partner, or HIV testing history.

CONCLUSIONS

Behavioral risk factors for HIV infection do not explain elevated HIV rates among black MSM. Continued emphasis on risk behaviors will have only limited impact on the disproportionate rates of HIV infection among black MSM. Future research should focus on the contribution of other factors, such as social networks, to explain racial disparities in HIV infection rates.

Men Who Have Sex With Men and Women: A Unique Risk Group for HIV Transmission on North Carolina College Campuses

OBJECTIVE

To better understand the role that men who have sex with men and women (MSM/W) play in the spread of HIV in young adults in North Carolina, we determined the prevalence of MSM/W among newly diagnosed HIV-infected men, compared social and behavioral characteristics of this group with MSM and MSW, and examined the sexual networks associated with HIV-infected college students among these groups.

METHODS

We reviewed state HIV surveillance records for all new diagnoses of HIV in males 18 to 30 years living in North Carolina between January 1, 2000, and December 31, 2004.

RESULTS

Of 1,105 records available for review, 15% were MSM/W and 13% were college students. Compared with MSM, MSM/W were more likely to be enrolled in college, to report >10 sex partners in the year before diagnosis, or have sex partners who were also MSM/W. Sexual network analysis of the HIV-infected college students revealed that MSM/W occupied a central position. Of 20 individuals who described themselves as either MSW or abstinent at the time of their initial voluntary counseling and testing visit, 80% reported that they were either MSM or MSM/W during follow up.

DISCUSSION

MSM/W represent a unique risk group within the population of MSM that deserve further investigation. College MSM/W appear to occupy a unique, central place in the network of HIV-infected students.

Perceptions towards condom use, sexual activity, and HIV disclosure among HIV-positive African American men who have sex with men: implications for heterosexual transmission

Disproportionately high HIV/AIDS rates and frequent non-gay identification (NGI) among African American men who have sex with men or with both men and women (MSM/W) highlight the importance of understanding how HIV-positive African American MSM/W perceive safer sex, experience living with HIV, and decide to disclose their HIV status. Thirty predominately seropositive and non-gay identifying African American MSM/W in Los Angeles participated in three semi-structured focus group interviews, and a constant comparison method was used to analyze responses regarding condom use, sexual activity after an HIV diagnosis, and HIV serostatus disclosure. Condom use themes included its protective role against disease and pregnancy, acceptability concerns pertaining to aesthetic factors and effectiveness, and situational influences such as exchange sex, substance use, and suspicions from female partners. Themes regarding the impact of HIV on sexual activity included rejection, decreased partner seeking, and isolation. Serostatus disclosure themes included disclosure to selective partners and personal responsibility. Comprehensive HIV risk-reduction strategies that build social support networks, condom self-efficacy, communication skills, and a sense of collective responsibility among NGI African American MSM/W while addressing HIV stigma in the African American community as a whole are suggested.

Greater risk for HIV infection of black men who have sex with men: a critical literature review

HIV rates are disproportionately higher for Black men who have sex with men (MSM) than for other MSM. We reviewed the literature to examine 12 hypotheses that might explain this disparity. We found that high rates of HIV infection for Black MSM were partly attributable to a high prevalence of sexually transmitted diseases that facilitate HIV transmission and to undetected or late diagnosis of HIV infection; they were not attributable to a higher frequency of risky sexual behavior, nongay identity, or sexual nondisclosure, or to reported use of alcohol or illicit substances. Evidence was insufficient to evaluate the remaining hypotheses.Future studies must address these hypotheses to provide additional explanations for the greater prevalence of HIV infection among Black MSM.

Gender differences in sexual behaviours in response to genitourinary symptoms

OBJECTIVE

To understand gender differences in sexual behaviours in response to genitourinary symptoms.

METHODS

473 (239 female and 234 male) subjects were enrolled at an STD clinic regardless of symptoms or infection status. Subjects completed a 30 day calendar recall interview of genitourinary symptoms, coital activity, sexual partners, and condom use.

RESULTS

Of the total of 473 participants, 261 (55%) reported symptoms (61% women and 39% men). STI prevalence was 73% and 75% for symptomatic women and men, respectively. For black women the probability of coitus was decreased in the presence of vaginal discharge (OR 0.64, 95% CI 0.47 to 0.89). No change in coital activity was seen in non-black women in the presence of vaginal discharge. Having vaginal discharge did increase the likelihood of condom use by their partners (OR 2.48, 95% CI 1.05 to 5.88), if coitus occurred. Urethral discharge was not associated with coitus or condom use in men. However, in men, dysuria was associated with increased likelihood of condom use (OR 4.25, 95% CI 1.57 to 11.56) if coitus occurred.

CONCLUSION

Black women altered both coital activity and condom use behaviours in response to vaginal discharge. In contrast, non-black women did not modify coital activity. Men increased condom use when having dysuria but did not alter coital activity. Changes in sexual behaviours may alter the risk of STI transmission independent of interactions with the healthcare system. STI education and prevention programmes need to better understand these gender and racial differences in developing effective strategies to reduce STI transmission.

Focusing "down low": bisexual black men, HIV risk and heterosexual transmission

INTRODUCTION

Black men who have sex with men (MSM) and women but who do not identify as gay or disclose their bisexual activities to main female partners, also known as men "on the down-low," have been cited as the main reason for the increase in HIV infections in black women.

METHODS

Three online databases (PsychInfo, MEDLINE and AIDSLINE) were searched for scientific articles related to men on the down-low. A total of 24 articles and two conference abstracts were selected for review.

RESULTS

Data from existing studies of MSM reveal low agreement between professed sexual identity and corresponding sexual behavior among black and other MSM; show that black MSM are more likely than MSM of other racial or ethnic groups to be bisexually active or identified; and, compared with white MSM, are less likely to disclose their bisexual or homosexual activities to others. However, black MSM who do not disclose their homosexual or bisexual activities engage in a lower prevalence of HIV risks than black MSM who do disclose; and black men who are currently bisexually active account for a very small proportion of the overall population of black men (2%).

CONCLUSION

The high prevalence of HIV in the black community and the greater likelihood of bisexuality among black men place heterosexual black women at risk for HIV infection. However, the contribution of high-risk heterosexual black men to the rising HIV caseload among black women has been largely ignored. Future research must evaluate the relative contributions of bisexual men and exclusively heterosexual black men to HIV cases among black women.

Risk-taking and health-seeking behavior in men with a history of urethritis: is there a learning curve?

BACKGROUND AND OBJECTIVES

Studies addressing how past experience with sexually transmitted diseases (STD) influence health-seeking behaviors among at-risk men are few.

GOAL

The goal of this study was to determine whether health-seeking behaviors among men diagnosed with urethritis differ based on whether they report prior urethritis.

STUDY DESIGN

Male STD clinic attendees answered a questionnaire regarding their demographic, sexual, and health-seeking characteristics. The men were stratified based on whether they reported prior urethritis.

RESULTS

Of 466 men, 297 reported prior urethritis. Symptomatic men diagnosed with urethritis who reported prior urethritis did not recognize their symptoms as a possible STD earlier than those reporting no urethritis history; there was also no difference between the groups in their interval to presenting for care once symptoms were recognized as a possible STD. Furthermore, men with prior urethritis were as likely to engage in sex acts once they recognized their symptoms as a possible STD manifestation.

CONCLUSION

Compared with men without prior urethritis, men with urethritis symptoms who reported prior urethritis did not recognize symptoms earlier, alter health-seeking behavior, or curtail sexual activity.

Comparison of STD burden and risk among men with and without regular doctors attending a southern urban STD clinic

BACKGROUND

Studies addressing health-seeking behaviors among men at risk for STD are few; this study examines how having a regular doctor might influence risk-taking or STD prevalence.

GOAL

The goal was to examine demographic, sexual, and health-seeking characteristics of male STD clinic attendees.

STUDY DESIGN

Randomly selected men attending an STD clinic answered a questionnaire regarding the aforementioned characteristics. The men were stratified according to whether they reported having a regular doctor.

RESULTS

Of 467 men, 32% reported a regular doctor. These men were more likely to be older, to be better educated, and to state they would seek care for a medical problem at a doctor's office. The two groups did not differ in STD history or prostitute exposure; men without doctors were more likely to have urethritis and STD, although the men with doctors had substantial STD rates.

CONCLUSION

Public health clinics remain an important safety net for the management of STD, even for men who report a regular doctor.

Sexually transmitted diseases and the increased risk for HIV transmission: implications for cost-effectiveness analyses of sexually transmitted disease prevention interventions

We estimated the annual number and cost of new HIV infections in the United States attributable to other sexually transmitted diseases (STDs). We used a mathematical model of HIV transmission to estimate the probability that a given STD infection would facilitate HIV transmission from an HIV-infected person to his or her partner and to calculate the number of HIV infections due to these facilitative effects. In 1996, an estimated 5,052 new HIV cases were attributable to the four STDs considered here: chlamydia (3,249 cases), syphilis (1,002 cases), gonorrhea (430 cases), and genital herpes (371 cases). These new HIV cases account for approximately $985 million U.S. in direct HIV treatment costs. The model suggested that syphilis is far more likely than the other STDs (on a per-case basis) to facilitate HIV transmission. This analysis provides a framework for incorporating STD-attributable HIV treatment costs into cost-effectiveness analyses of STD prevention programs.

The increasing marginal benefit of condom usage

PURPOSE

Condom use is promoted as a primary strategy for preventing sexual transmission of human immunodeficiency virus (HIV). This paper analyzes how incremental changes in condom compliance rates can affect an individual's risk of acquiring HIV.

METHODS

We developed a simple mathematical model of HIV transmission in which the cumulative probability of HIV infection depended in part upon the percentage of acts in which a condom was used. We applied basic methods of calculus to differentiate the mathematical model with respect to the probability of condom usage. We applied values from published studies to the model to illustrate how the marginal benefits of condom usage vary across different populations.

RESULTS

In general, the marginal benefit of condom usage increases as condom compliance increases.

CONCLUSIONS

The marginal benefits of increased condom usage vary across different risk groups and across different levels of condom compliance. These results offer insight into the motivation behind the decision of whether or not to use condoms, and indicate possible ways to optimize the use of resources devoted to increasing condom usage by at-risk populations.

Delayed presentation to clinics for sexually transmitted diseases by symptomatic patients. A potential contributor to continuing STD morbidity

OBJECTIVE

To determine the proportion of symptomatic patients attending public sexually transmitted disease (STD) clinics who fail to seek care within 7 days of the onset of STD symptoms and their self-reported reasons for delays in obtaining care.

DESIGN

Interviewers administered 23-item questionnaire to a cross section of STD clinic clients between April and September 1995.

SETTING

Five urban STD clinics in the United States (Birmingham, AL; St Paul, MN; San Francisco CA; Seattle, WA; and Raleigh, NC).

RESULTS

Of 1,621 patients with genitourinary symptoms, over one third (35% of men, 37% of women) presented to STD clinics only after 1 week or more of symptoms. Men with genital warts (73%) or with nongonococcal urethritis (23.1%) or symptomatic men who were recent contacts to sex partners with STDs were significantly more likely to delay clinic attendance more than a week than men with gonorrhea (6.5%, p < 0.001 for each). Overall 43.8% of women receiving specific clinical diagnoses other than genital warts delayed clinic attendance for more than 1 week. When asked why they delayed clinic attendance, respondents were most likely to respond that they had hoped their symptoms would "go away" (48.5% of men and 49.4% of women who waited a week or more before seeking care).

CONCLUSION

A substantial proportion of patients with genitourinary symptoms attending public STD clinics delay seeking care for a week or more, increasing their likelihood of complications and of transmission of infection to others. Interventions to promote more timely clinic attendance may help reduce STD morbidity in the United States.

Health care seeking behaviors related to sexually transmitted diseases among adolescents

OBJECTIVES

This study identified social, cognitive, and behavioral factors associated with how adolescents seek health care for sexually transmitted diseases.

METHODS

Data for male and female adolescents (n = 208) attending a clinic specializing in sexually transmitted diseases were examined.

RESULTS

Symptomatic female adolescents required greater time to obtain care than asymptomatic female adolescents or symptomatic male adolescents. Factors affecting duration of care seeking interval included perception of barriers to care, lower self-efficacy for response to a sexually transmitted disease, greater perceived seriousness of sexually transmitted diseases, previous history of sexually transmitted diseases, and stigma.

CONCLUSIONS

Improved secondary sexually transmitted disease prevention efforts among adolescents require reductions in barriers to care and improved symptom recognition by adolescents.

Socioeconomic differences in sexually transmitted disease rates among black and white adolescents, San Francisco, 1990 to 1992

This paper examines the effect of socioeconomic position on the differences in the 3-year rates (1990 to 1992) of reported cases of gonorrhea and chlamydia between Black and White adolescents, aged 12 to 20 years, residing in San Francisco. The crude relative risks for Blacks were 23.4 (95% confidence interval [CI] = 20.4, 27.8) for gonorrhea and 9.3 (95% CI = 8.3, 10.3) for chlamydia. Adjusting for poverty and occupational status, the relative risks were 28.7 (95% CI = 22.5, 36.1) for gonorrhea and 8.9 (95% CI = 7.4, 10.6) for chlamydia. This study demonstrates that factors other than poverty and occupational status account for the racial/ethnic differences in the rates of gonorrhea and chlamydia among adolescents in San Francisco.

AIDS in bisexual men in the United States: epidemiology and transmission to women

BACKGROUND

Homosexual and bisexual men with acquired immunodeficiency syndrome (AIDS) differ, and bisexual men play an important role in the sexual transmission of human immunodeficiency virus (HIV) to women.

METHODS

To describe AIDS in these groups, we examined AIDS cases reported nationally through June 1990.

RESULTS

Among 65 389 men who reported having had sex with men since 1977, 26% were bisexual. More Black (41%) and Hispanic men (31%) than White men (21%) reported bisexual behavior. Bisexual men were twice as likely to report intravenous drug use (20%) as were homosexual men (9%), regardless of race or ethnicity. Among 3555 women with heterosexually acquired AIDS, 11% reported sexual contact with a bisexual man and no other risk factor, although in some states approximately half reported such contact. In 1989, the AIDS rate due to sex with a bisexual man was three and five times higher among Hispanic and Black women, respectively, than among White women.

CONCLUSIONS

Differences between bisexual and homosexual men with AIDS and the relative importance of AIDS in women due to sexual contact with bisexual men should be considered in the development of HIV prevention programs.

Race and the prevalence of syphilis seroreactivity in the United States population: a national sero-epidemiologic study

We used the 1978 National Health and Nutrition Examination Survey to examine the prevalence of positive syphilis serologies in the US population. Analysis of risk markers--gender, age, marital status, education, income, and residence--indicates that all except gender are associated with syphilis seroreactivity, independent of race. Controlling for associated risk markers, the Black-White odds ratio of syphilis seroreactivity is 4.7 (95% CI = 2.7, 8.2). Current knowledge of racial differences in sexual and health care behavior does not explain the Black-White difference in the prevalence of syphilis seroreactivity.

The impact of sexually transmitted diseases on minority populations

Sexually transmitted diseases (STD) are more prevalent among some minority populations in the United States than they are among the white majority. Primary and secondary syphilis occurs 45 times as often among non-Hispanic blacks as among non-Hispanic whites and 13 times as often among Hispanics as among non-Hispanic whites, according to morbidity reports received in 1988 by the Centers for Disease Control. Gonorrhea is reported more commonly among some minorities, with 1988 rates per 100,000 population being 54 for whites, 1,801 for blacks, and 201 for Hispanics. The reasons for the higher incidence of STD among some minorities are unknown. Data on racial differences in behavior and disease susceptibility are meager and do not account for the observed differences. Poverty, which is more common among some minorities than among the white majority, is closely associated with the prevalence of STD and may be a link between membership in a minority population and an increased risk.

Sexually transmitted diseases and the use of condoms in a cohort of homosexual men followed since 1983 in Finland

High rates of sexually transmitted diseases (STDs) were recorded among 235 homosexually active men at the start of a prospective follow-up study in June 1983 in Finland. The vast majority (88.5%) reported at least one STD, the most common of them being pubic lice (64.7%) followed by gonorrhoea (42.9%) and non-gonococcal urethritis (26.4%). Those 31 (13.2%) who were seropositive for HIV at the end of the study, had experienced more episodes of STDs than the seronegative individuals (p = 0.0027). Nine HIV seroconversions were noted during the follow-up of 5-40 months, all in individuals who had practised "unsafe" sex. The study participants were repeatedly given detailed advice for avoiding HIV infection, and a tendency towards "safer" sexual practises resulting in a decrease in incidence of most STDs, was noted during the course of the study. However, further spread of HIV is to be expected because 57% of the men still reported practising and sex at the end of the follow-up, and 42% of them without condoms.

The gay report on sexually transmitted diseases

Most studies of sexually transmitted diseases in homosexual men have examined prevalence in clinic populations; for comparative purposes, we analyzed data from a survey of 4,329 gay men conducted in 1977. Among 4,212 respondents to the self-administered questionnaire, 66.8 per cent reported previous infection with pediculosis; 38.4 per cent, gonorrhea; 24.1 per cent, nonspecific urethritis; 18.1 per cent, venereal warts; 13.5 per cent, syphilis; 9.7 per cent, hepatitis; and 9.4 per cent, herpes. Number of different lifetime sexual partners best predicted histories of symphilis (r = .249), gonorrhea (r = .402), and the other diseases; frequency of checkups, years as a practicing homosexual, and furtive sexual activities were among the many other significant correlates of venereal infections. Respondents most often sought examinations from private physicians (39.4 per cent); those who visited gay clinics were examined most often and felt most positive about their medical care. Gay men who participated in the survey reported frequent infections with many of the same sexually transmitted diseases often seen in private medical practices, public VD clinics, and gay health centers. Since high rates of disease are related to large numbers of different partners, frequent exposures with anonymous contacts, and anal intercourse, we recommend frequent examinations for those whose life-styles include these characteristics.