Health Alert – Gay men at risk for antibiotic-resistant gonorrhea

A new editorial published in the New England Journal of Medicine brings to light the concern for the rising rate of antibiotic-resistant gonorrhea in the U.S.

What is Gonorrhea and why am I at risk?

Gonorrhea is the second most commonly reported sexually transmitted infection in the United States, with an estimated 600,000 plus cases every year. It disproportionately affects vulnerable populations such as minorities who are marginalized because of race, ethnic group, or sexual orientation. Men who have sex with men, for example, are among the populations hardest hit by the disease.

Gonorrhea is caused by Neisseria gonorrhea, a bacterium that grows and multiplies quickly in moist, warm areas of the body such as the cervix, urinary tract, mouth, or rectum.

What are the symptoms?

Symptoms include burning while urinating, discharge, and pain during intercourse. Symptoms of rectal infection include anal itching, and sometimes painful bowel movements. Symptoms usually appear two to five days after contracting the infection, although in some cases there may be no symptoms at all, particularly with rectal infection.

What is the danger of infection?

Men with untreated gonorrhea may develop Epididymitis (an inflammation of the epididymis-the long, tightly coiled tube that lies behind each testicle and collects sperm), an inflammation of the prostate gland (prostatitis), and a higher risk of getting bladder cancer.

What can I do?

Most forms of Gonorrhea can still be treated effectively with antibiotics. However, the best defense is still a good offense. Condoms are still your best bet to keep from getting infected in the first place. Limiting the number of sexual partners also helps in preventing the spread of sexually transmitted infections. If you think you may be infected, see a doctor for a proper diagnosis and treatment.

For more information:

New England Journal of Medicine
WebMD
Centers for Disease Control and Prevention

Health Alert – Shigella

Since mid-2011, the Pennsylvania Department of Health has received a number of reports of shigellosis due to Shigella flexeri, a species of Shigella that is infrequently diagnosed in Pennsylvania. The cases have occurred in the southeastern part of the state among men who have sex with men (MSM) who may or may not be HIV-positive.

What is Shigella?

Shigella is one of the bacterial agents that causes acute diarrhea. Symptoms often include cramping, fever and vomiting. The infection spreads easily from person to person by the fecal-oral route since a very small number of organisms are necessary to produce transmission.

How do you catch Shigella?

The Pennsylvania Health Alert Network reports “Shigella outbreaks have been previously reported in MSMs and are usually correlated with having multiple partners combined with unprotected high-risk sexual behavior. The fact that some of these patients are also HIV infected raises added concerns, not only due to the potential for transmission of HIV and other sexually transmitted infections through the same high risk behaviors, but also because immune-compromised individuals can have extended carriage of Shigella.”

What can you do?

Persons with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal. Once someone has had shigellosis, they are not likely to get infected with that specific type again for at least several years. However, they can still get infected with other types of Shigella. Currently, there is no vaccine to prevent shigellosis. However, the spread of Shigella from an infected person to other persons can be stopped by frequent and careful hand-washing with soap.

For more information about Shigella, you can go to the Centers for Disease and Control and Prevention Website

Health Alert – Syphilis Rates on the Rise for Young Black Gay Men

Rates of Syphilis infections have been on the rise in the U.S. for the past several years as reported by the Centers for Disease Control and Prevention (CDC) in their Sexually Transmitted Disease Surveillance, 2010 publication. Across the board, syphilis infections rose 36 percent last year.

However, African-American and Latino men who have sex with men (MSM) were disproportionately affected. Among Black MSM, syphilis had increased a startling 135 percent.

What can you do?

If you are a sexually active African-American or Latino gay man, you need to get tested for Syphilis. It’s an easy blood test that you can get at any local health department. You can also search for other testing centers near you by entering your zip code at the CDC’s website: http://www.hivtest.org/

How do you know if you have it?

You can have Syphilis and not have any symptoms. However, the first stage of syphilis usually involves getting a single sore (called a chancre) on our around the area where the infection entered the body. There can also be multiple sores. The sore is usually firm, round, small, and painless. It lasts 3 to 6 weeks, and it heals without treatment. It is frequently followed by a non-itchy rash that may involve all the body including the hands and feet. If syphilis goes untreated, the infection can cause serious health problems including brain and organ damage.

Can it be cured?

Syphilis can be cured in the early stages of the infection with a simple injection.

For more information about Syphilis, go to the CDC’s website: http://www.cdc.gov/std/Syphilis/STDFact-MSM-Syphilis.htm.

To subscribe to health alert emails, send a message to rgy2@pitt.edu with the word “subscribe” in the subject line.

Hepatitis C surpasses HIV in U.S.

From POZ.com

Chronic hepatitis C virus (HCV) infection is associated with more deaths than HIV infection, according to sobering new data presented by the U.S. Centers for Disease Control and Prevention (CDC) on Tuesday, November 8, at the 62nd annual meeting of the American Association for the Studies of Liver Diseases (AASLD) in San Francisco.

The discouraging findings, presented by Scott Holmberg, MD, MPH, chief of the CDC’s Division of Viral Hepatitis Epidemiology and Surveillance Branch, come from data involving 21.8 million deaths reported to the National Center for Health Statistics between 1999 and 2007. The only cases included in the analysis involved reports that specified HIV, AIDS, HCV or hepatitis B virus (HBV) infection as possible contributors to the deaths.

Most viral hepatitis deaths occurred in people in the prime of their lives. About 59 percent of people who died of complications related to hepatitis B were between the ages of 45 and 64. The impact of chronic hepatitis C was even more substantial—roughly 73 percent of the deaths related to HCV were in baby boomers.

Not surprisingly, death rates were highest among certain populations. For example, people coinfected with both HBV and HCV faced a 30-fold increase in the risk of death from liver disease or related complications. Alcohol abuse was associated with a four-fold increase in the risk of death. Coinfection with HIV nearly doubled the risk of death from HBV-related complications and quadrupled the risk of death from HCV-associated liver disease.

To read the full article, go to POZ.com.

Post and Pre-Exposure Prophy-laxis: How Effective Are They?

by Bill Buchanan, Clinic Coordinator of the Pitt Men’s Study

I remember a more genteel and demure time when people, if they had to refer to condoms (and they tried not to), called them prophylactics. We use prophylaxis all the time, whether it’s that annual flu shot, buckling up in the car, looking both ways before crossing the street, or using a condom when having sex (whether to prevent pregnancy or avoid a sexually transmitted disease).

When a possible exposure to HIV occurs, one can take highly-active antiretroviral therapy (HAART or drug cocktails) in an effort to try to stop the establishment of an infection. This method of prophylaxis has been used in the medical community as a way to prevent HIV infections, and it has proven to be fairly effective following accidental work-related exposures such as needlesticks. We call this Post-Exposure Prohylaxis or PEP.

Important caveats with PEP are that medications must be started as soon as possible after the exposure and that PEP is not 100%effective. People usually stay on PEP for a month, and can experience the side effects (not to mention the expense) associated with these potent medications. PEP’s not perfect, but it does cut the number of infections from work-related, accidental exposures and is an accepted medical practice.

What is not entirely clear is how effective PEP is in preventing infection after a sexual exposure. Our recommendation is to use condoms correctly and consistently, and should an accidental sexual exposure occur, get into care immediately either by calling your doctor or going to an emergency room where you    can be evaluated. PEP should never be seen as a substitute for safer sex practices – it is at best a backup for when safer sex practices fail.

Another strategy, PrEP (or Pre-Exposure Prophylaxis), made the news a few months back when the results of an interesting but controversial study were released. Men who have sex with men and transgendered women were given the anti-HIV oral drug Truvada to take daily in the hope that by having the drug in their systems it would reduce their risk of infection if safer sex
failed. The trial reported a reduction in HIV infections of 44% in the main analysis, but in sub-analyses it was reported that adherence to the drug critically affected the degree of protection.

That sounds better than nothing until you realize that condoms are 95% effective when used correctly and consistently. If you look at those numbers a different way: approximately 60% of those who took the drug got infected anyway. Additional drawbacks to oral PrEP in the US are:

• The expense (almost $40 a day and probably not covered by insurance).

• Finding a doctor willing to prescribe it.

• Having to take a very potent medication daily (and dealing with the possible side effects).

• Its potential ineffectiveness if one is exposed to drug-resistant strains of HIV.

• PrEP has no effect on the transmission of other sexually transmitted diseases like a condom does.

• Worth repeating – its effectiveness is far less than that of condoms (which are cheap and readily available).

Our recommendation is that people not use oral PrEP. Until an effective HIV vaccine is found, condoms and other risk reduction methods are the best bet to avoid HIV infection. The staff of the Pitt Men’s Study is more than willing to discuss safer sex, risk reduction, PEP and PrEP with you at your next visit (or call us at 412-624-2008 or 1-800-987-1963), and free condoms and
lube are available at our clinic.

If this were that more genteel and demure time, I would pour you a cup of Earl Grey in a cup of Lenox china and chat. But there’s no time for all that civility. Condoms: 95% effective. PrEP: approximately 60% ineffective. Do the math.

New three-in-one HIV med approved

From POZ online:

Complera, a complete single-tablet regimen containing Janssen Therapeutics’ Edurant (rilpivirine) and Gilead Sciences’ Viread (tenofovir) and Emtriva (emtricitabine), was approved August 10 by the U.S. Food and Drug Administration (FDA), according to an announcement byGilead. Complera, the second all-in-one fixed-dose combination tablet for people living with HIV, is approved for those starting antiretroviral (ARV) therapy for the first time.

The approval of Complera is supported by 48-week data from two Phase III randomized studies (ECHO and THRIVE) conducted by Tibotec, a subsidiary of Janssen, evaluating the safety and efficacy of Edurant compared to Sustiva (efavirenz) among first-time treatment takers, with both drugs typically used in combination with Truvada (tenofovir plus emtricitabine). Both regimens were comparable in terms of efficacy, with fewer volunteers in the Edurant group experiencing side effects, notably the central nervous system problems associated with Sustiva use.

Read the full article on POZ.

You can read about the specifics of Complera on AIDSmeds.com

People living with HIV disproportionately affected by hepatitis

From Dr. John Ward, Director, Division of Viral Hepatitis, CDC :

May is Hepatitis Awareness Month, an observance intended to remind us of the high, under-recognized hepatitis-associated disease burden in this country and of the often neglected opportunities for prevention and care. An estimated 3.5 – 5.3 million Americans have chronic viral hepatitis, which is a leading cause of primary liver cancer. People living with HIV are disproportionately affected by viral hepatitis and the related adverse health outcomes. Of those infected with HIV, more than 25% are co-infected with Hepatitis C and an estimated 10% with Hepatitis B.  While highly active antiretroviral therapy has extended the life expectancy of HIV-infected persons, liver disease (much of which is related to Hepatitis C) has become the most common non-AIDS-related cause of death of among this population.

HIV, Hepatitis B, and Hepatitis C share common modes of transmission. People living with HIV who are also living with viral hepatitis are at increased risk for serious, life threatening complications.  As a result, all persons living with HIV should be tested for Hepatitis B and Hepatitis C by their doctors. Co-infection with hepatitis may also complicate the management of HIV infection.

In order to prevent co-infection with Hepatitis B, the Advisory Committee on Immunization Practices recommends universal Hepatitis B vaccination of susceptible patients with HIV/AIDS.  Hepatitis A and Hepatitis B vaccines are also recommended for all men who have sex with men, users of illicit drugs, and others at increased risk of infection. There is no vaccine for Hepatitis C.

In 2010, an interagency work group of U.S. Department of Health and Human Services (HHS) experts was created to develop a comprehensive strategic action plan to respond to the viral-hepatitis-associated disease burden. The HHS Action Plan for the Prevention, Care and Treatment of Viral Hepatitis describes opportunities to improve coordination of viral hepatitis prevention activities across HHS, and the framework needed to engage other agencies and nongovernmental organizations in prevention and care. Various strategies throughout the plan outline methods of integration of HIV and viral hepatitis in education, prevention and services.  The HHS Action Plan was released on May 12.

This article comes from blog.AIDS.gov.

HIV at “critical levels” in Philadelphia

From the Philadelphia Gay Issues Examiner:

HIV has reached critical levels in Philadelphia. The City of Philadelphia has just begun a campaign called Freedom Condom. The goal of this campaign is to reduce the infections of HIV and other STDs among teenagers in Philadelphia. According to the City of Philadelphia Department of Health, men who have sex with men in Philadelphia have more than a 40% chance of getting HIV by having unprotected sex. There are an estimated 16,905 people living with HIV or AIDS in Philadelphia.

These statistics are shocking but true. HIV has become the ultimate threat to the gay community, especially for gay African-Americans and Hispanics. There are many reasons why HIV is spreading so rapidly in Philadelphia but one of the main reasons is that there is an increase use of unprotected sex among gay men and ignorant myths about how the virus is transferred. There are many myths that HIV is transferred by hugging, kissing, or shaking hands with someone who is HIV positive. These myths are completely wrong. Before understanding how HIV is spread, understanding what is HIV is most important. HIV stands for Human Immunodeficiency Virus, meaning that the virus can only be transmitted between humans. HIV attacks the body’s immune system by invading and taking over the CD4+ T cells.

Continue reading on Examiner.com

Nearly 50 Percent of Gay Men with HIV Don’t Know They’re Infected

From the Centers for Disease Control and Prevention (CDC) Website:

CDC estimates that more than one million people are living with HIV in the United States. One in five (21%) of those people living with HIV is unaware of their infection. Despite increases in the total number of people living with HIV in the US in recent years, the annual number of new HIV infections has remained relatively stable. However, new infections continue at far too high a level, with an estimated 56,300 Americans becoming infected with HIV each year.

More than 18,000 people with AIDS still die each year in the US. Gay, bisexual, and other men who have sex with men (MSM)† are strongly affected and represent the majority of persons who have died. Through 2007, more than 576,000 people with AIDS in the US have died since the epidemic began.

By risk group, gay, bisexual, and other MSM of all races remain the population most severely affected by HIV.

  • MSM account for more than half (53%) of all new HIV infections in the U.S. each year, as well as nearly half (48%) of people living with HIV.
  • While CDC estimates that MSM account for just 4% of the US male population aged 13 and older, the rate of new HIV diagnoses among MSM in the US is more than 44 times that of other men and more than 40 times that of women.
  • White MSM account for the largest number of annual new HIV infections of any group in the US, followed closely by black MSM.
  • MSM is the only risk group in the U.S. in which new HIV infections have been increasing since the early 1990s.

Potential heart risk when combining HIV drugs

The Food and Drug Administration issued a warning recently that potential heart risks when combining two HIV drugs. The agency said preliminary data suggest Roche’s Invirase and Abbott Laboratories’ Norvir can affect the electrical activity of the heart when used together. Changes to the heart’s electrical activity can delay the signals that trigger heart beats. In some cases the problem can cause irregular heart rhythms, leading to lightheadedness, fainting, and even death.

You can read the full Reuters article here.