The Pitt Men's Study

Health Alerts for Gay and

Bisexual Men

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Men who have sex with men (MSM) continue to face dangerous and widespread health issues, many of which are ignored by the local media. A syphilis epidemic among men who find sexual partners in chat rooms, a growing meth epidemic, and a critical lack of hepatitis B vaccinations among our men are all matters of serious concern. One of the reasons why these problems occur and flourish is because of this lack of media attention. As a response, the Pitt Men’s Study and the Pennsylvania Prevention Project provide free Health Alerts to the community via an email listserv.

Those who sign up for the Health Alerts will receive a brief email written by experts in the field and containing links to trusted sites with additional information. Topics may include syphilis, anal cancer, hepatitis B, eating disorders, tobacco addiction, and the growing methamphetamine epidemic – anything that is of vital importance to the health of MSM.

Individuals interested in subscribing to the service can do so by sending an email to PittMensStudyHealthAlerts@stophiv.pitt.edu with the word subscribe in the subject line. You will then receive a confirmation message to verify your email address. After you respond to the verification, you will be added to the list automatically. Members can unsubscribe at any time, and email addresses will be kept private and confidential – they will NOT be sold to another organization or business.

Past Health Alerts

Syphilis * MRSA * HPV * HIV * Anal Cancer

July 2008 - Anal Cancer

Recent studies have shown that gay and bi men are at a high risk of developing anal cancer.

In response, the Pittsburgh AIDS Center for Treatment (PACT) at the University of Pittsburgh, with the guidance of Dr. Ross Cranston, has opened an Anal Dysplasia Clinic. Anal Dysplasia is a precancerous condition in which there are abnormal changes in the cells that comprise the anal canal.

“As gay men, we run the risk of serious health issues because we don’t pay enough attention to our butt’s,” says Dr. Ross Cranston. “Anal health has yet to emerge as an area to which it is deemed appropriate to direct our attention. As a result, gay men in particular are unaware of their increased risk of many anal diagnoses including those related to sex.”

Anal Dysplasia is caused by HPV – human papillomavirus – which can be transmitted by both receptive anal intercourse and close physical contact. However, not everyone with HPV gets cancer. One study shows that 95 percent of gay men with HIV and about 65 percent of gay men without HIV have HPV in their anal canal or the surrounding skin.

HPV can be divided into two groups: low-risk HPV that can cause anal or genital warts, and high-risk HPV that is associated with the development of anal dysplasia.

So what can you do?

Use a condom during intercourse. It can’t always protect you (coming in contact with HPV infected skin outside the condom can also spread the virus), but using a condom can greatly reduce your risk of infection.

You should also have a test to look for precancerous cells called anal cytology, also known as the anal Pap. Catching the condition early on may prevent anal cancer from ever happening.

Recommendations for routine testing of gay and bisexual men have yet to be determined, given the on-going research in this area. However, Dr. Cranston recommends that men over the age of 40 who are HIV negative get an anal Pap test about once every two or three years. HIV positive men should get tested once a year.

What is an anal Pap test?

In this procedure, a health care provider passes a swab into the anal canal and collects cells. These cells are then examined by an experienced pathologist in a lab under a microscope.

What happens if the test is positive?

It takes many years for anal dysplasia to develop into cancer. If the cells show HPV related changes of the kind that could lead to cancer, the patient should undergo a procedure called high-resolution anoscopy where the anal canal is examined using magnification, and a biopsy taken of any abnormal areas. Anal dysplasia can be divided into low-grade and high-grade, with high-grade being the lesion considered most likely to progress to cancer and this is the lesion that should be treated.

Treatment for these anal lesions most commonly involves getting rid of the abnormal cells. This may be done as an office procedure using an infra red probe, but other methods such as surgical excision have also been used. Treatment is very effective in removing lesions, but as they may come back in the same or other areas, it is important to continue to have regular screenings.

What are the symptoms of anal cancer?

The most common symptoms of anal cancer include persistent bleeding, pain or lumps in the anal area. Anyone with these symptoms should be examined by a healthcare professional.

How is anal cancer treated?

If anal cancer is diagnosed, it is most commonly treated with a combination of radiation and chemotherapy. The type of treatment may depend on whether the tumor has spread, and on the size and location of the tumor.

More information:

For more information about the anal dysplasia clinic, you can call 412-647-0996.

For more information about HPV, Anal Dysplasia, and Anal Cancer, you can go to the American Cancer Society’s website by clicking here.

April 2008 - Syphilis and MSM

Officials at the Centers for Disease Control and Prevention (CDC) recently reported that syphilis rates continued to rise in 2007. The disturbing fact is that the surge is being driven by cases among men who have sex with men (MSM), who accounted for 64 percent of the known syphilis infections last year. That's up from five percent in 1999.

Why? Symptoms of syphilis can go unnoticed or misdiagnosed. The CDC's website notes: "Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. [...] Thus, transmission may occur from persons who are unaware of their infection."

What is the danger?

Syphilis is especially worrisome because, if it goes untreated, it can lead to serious health conditions later on in life. It can also complicate other infections such as HIV. It is also important to note that Syphilis can be transmitted through a variety of sexual acts, not just intercourse. So a condom won’t necessarily protect you.

Signs of Syphilis

Syphilis usually begins with the appearance of a single sore (called a chancre), but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days. The chancre is usually firm, round, small, and painless. The chancre lasts 3 to 6 weeks, and it heals on its own. Note, however, that the infection doesn’t' go away without proper treatment.

As the disease progresses, it may include fever, swollen lymph glands, rash, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs of this "secondary stage" of syphilis will resolve with or without treatment, but, again, it doesn’t go away.

In its later stages, many years after the initial infection, the disease can cause damage to internal organs, the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms of the "late stage" include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

What can you do?

Get tested. All sexually active MSM should receive testing for a wide range of sexually transmitted diseases at least once a year (as recommended by the CDC).

You're not going to hear much about this in the mainstream media and, chances are, your doctor isn't going to recommend being tested for an STD. So it's up to you to take matters into your own hands. Syphilis is easily cured in its early stages. A single injection of penicillin will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available.

Your doctor can perform the test for syphilis. The Allegheny County Health Department also provides free testing. You can find other local testing sites (some will maintain your anonymity) at www.stopHIV.com in the drop-down resources menu, under “PA Service Providers.”

For more information about MSM and syphilis, you can go to the CDC's website at:

http://www.cdc.gov/std/syphilis/STDFact-MSM&Syphilis.htm

Don't risk your health or the health of the community. Get tested now.

February 2008 - MRSA and MSM

A recent New York Times article reported a drug resistant strain of MRSA (Methicllin-resistant Staphylococcus aureus) being spread among gay men in San Francisco and Boston. MRSA infections typically occur in hospitals or other healthcare facilities. However, MRSA can also cause infections in persons who have not recently been hospitalized. This is referred to as community acquired MRSA, and has received a lot of press coverage as of late.

Although the study cited in the Times article noted a disproportionate number of MRSA skin infections among gay men, it is important to note that MRSA is not specific to one population or group of people. Regardless, it is important to understand the risk factors, signs and symptoms, prevention methods and possible treatment options. Community-acquired MRSA is spread through close skin-to-skin contact, openings in the skin such as cuts and abrasion, crowded living conditions, and poor hygiene.

A person who has a MRSA skin infection often has redness, warmth, swelling, pus, and/or pain at the site where a sore or cut is present. Typically, it may resemble a boil or spider bite. MRSA skin infections my also occur at sites covered by body hair or where clothing or towels cause skin irritation or increased rubbing.

Hand washing is key to preventing the spread infection-being sure to use warm water and soap. In addition, covering cuts and scrapes with a bandage until they are healed, avoiding contact with other people's wounds and bandages, and avoiding sharing personal items such as towels or razors serve as prevention methods as well.

If you are concerned about a possible MRSA skin infection, contact your health care provider for treatment. MRSA infections are treatable with antibiotics, despite their resistance. Remember it is important to complete the full course of antibiotics, even if the infection seems to be getting better, unless directed by your physician. In addition, do not share antibiotics or save unfinished antibiotics to use at another time.

To read the New York Times article, click here.

To read the Gay and Lesbian Medical Association's statement on MSRA, click here.

For general information concerning MRSA, click here.

January 2008 – HPV and Men

What is HPV?

Human papillomavirus (HPV) is a sexually transmitted disease that infects the genital area of both men and women (including the skin on and around the anus). Over half of the men in the United States will have HPV at some time in their lives. Often the virus clears up on its own without a health problem but, depending on the strain of HPV, it can cause genital or anal warts. Some strains of HPV can also cause abnormal changes in cells which can become precancerous and result in cancer of the penis or anus. HIV positive men are more likely to get severe and prolonged cases of genital warts which may be resistant to treatment.

How is HPV spread?

HPV is passed through vaginal or anal intercourse but can also be spread through simple skin to skin contact. Because HPV infections often don’t have symptoms, they can be passed on unknowingly.

What are the symptoms?

Genital warts are the first symptoms seen with low-risk strains of HPV infections. They are soft, raised growths that are usually painless. These lesions can also appear in the mouth and throat, although this is rare. Warts usually take 3 weeks to 6 months to appear after exposure but, in some cases, can also take years.

What can I do?

If you are diagnosed with HPV, it is important to tell your sexual partner(s). Transmission of HPV can be minimized by finding alternative ways to express intimacy and avoiding contact with a wart. Condoms are also effective for preventing infection with HPV if they are used correctly and consistently. However, genital warts not covered by a condom can still transmit the virus.

November 2007 - HIV Health Alert

MSM are still being infected with HIV. Here’s why:

Some men become infected because they mistakenly believe their partner is HIV negative. You should treat every sexual partner as if he is HIV positive and only engage in sexual activities that you would perform with someone you knew to be HIV positive.

Depression and alcohol/drug use lead otherwise cautious men to engage in risky sexual behaviors. It is important to be especially cautious during sex when you are feeling down or under the influence of drugs and/or alcohol. If you are feeling depressed or have problems with addiction, get help. You can go to the referrals section of this website to find counseling services.

Not using a condom during anal sex is the most significant risk factor for HIV infection. If you engage in anal intercourse, use a latex condom with a water-based lubricant. Also, withdrawing prior to ejaculation provides even greater protection for receptive sex partners.

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