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Gay Men and MSM Health Concerns

The Gay and Lesbian Medical Association (GLMA) has listed 10 health care concerns that men who have sex with men (MSM) should include in discussions with their physicians or other health care providers.

  1. HIV / AIDS, Safer Sex

    That men who have sex with men are at an increased risk of HIV infection is well known, but in the effectiveness of safe sex in reducing the rate of HIV infection is one of the gay community’s great success stories. However, the last few years have seen the return of many unsafe sex practices. While effective HIV treatments may be on the horizon, there is no substitute for preventing infection. Safer sex is proven to reduce the risk of receiving or transmitting HIV. All health care professionals should be aware of how to counsel and support maintenance of safer sex practices.

  2. Substance Use

    Gay men use substances at a higher rate than the general population, and not just in larger communities such as New York, San Francisco and Los Angeles. These include a number of substances ranging from amyl nitrate (“poppers”), to marijuana, Ecstasy and amphetamines. The long-term effects of many of these substances are unknown; however, current wisdom suggests potentially serious consequences as we age.

  3. Depression / Anxiety

    Depression and anxiety appear to affect gay men at a higher rate than in the general population. The likelihood of depression or anxiety may be greater, and the problem may be more severe for those men who remain in the closet or who do not have adequate social supports. Adolescents and young adults may be at particularly high risk of suicide because of these concerns. Culturally sensitive mental health services targeted specifically at gay men may be more effective in the prevention, early detection and treatment of these conditions.

  4. Hepatitis Immunization

    Men who have sex with men are at an increased risk of sexually transmitted infection with the viruses that cause the serious condition of the liver known as hepatitis. These infections can be potentially fatal, and can lead to very serious long-term issues such as cirrhosis and liver cancer. Fortunately, immunizations are available to prevent two of the three most serious viruses. Universal immunization for Hepatitis A and B viruses is recommended for all men who have sex with men. Safer sex is effective at reducing the risk of viral hepatitis, and is currently the only means of prevention for the very serious Hepatitis C virus

  5. STD’s

    Sexually transmitted diseases (STD’s) occur at a high rate in sexually active gay men. This includes STD infections for which effective treatment is available (syphilis, gonorrhea, chlamydia, pubic lice, and others), and for which no cure is available (HIV, Hepatitis A, B or C virus, Human Papilloma Virus, etc.). There is absolutely no doubt that safer sex reduces the risk of sexually transmitted diseases, and prevention of these infections through safer sex is key.

  6. Prostate, Testicular and Colon Cancer

    Gay men may be at risk for death by prostate, testicular or colon cancer. Screening for these cancers occurs at different times across the life cycle, and access to screening services may be negatively impacted because of the issues and challenges in receiving culturally sensitive care for gay men. All gay men should undergo these screenings routinely as recommended for the general population.

  7. Alcohol

    Although more recent studies have improved our understanding of alcohol use in the gay community, it is still thought that gay men have higher rates of alcohol dependence and abuse than straight men. one drink daily may not adversely affect health; however, alcohol-related illnesses can occur with low levels of consumption. Culturally sensitive services targeted to gay men are important in successful prevention and treatment programs.

  8. Tobacco

    Recent studies seem to support the notion that gay men use tobacco at much higher rates than straight men, reaching nearly 50 percent in several studies. tobacco-related health problems include lung disease and lung cancer, heart disease, high blood pressure and a whole host of other serious problems. All gay men should be screened for and offered culturally sensitive prevention and cessation programs for tobacco use.

  9. Fitness (Diet and Exercise)

    Problems with body image are more common among gay men than their straight counterparts, and gay men are much more likely to experience an eating disorder such as bulimia or anorexia nervosa. While regular exercise is very good for cardiovascular health and in other areas, too much of a good thing can be harmful. The use of substances such as anabolic steroids and certain supplements can adversely affect health. At the opposite end of the spectrum, heaviness and obesity are problems that also affect a large subset of the gay community. This can cause a number of health problems, including diabetes, high blood pressure and heart disease.

  10. Anal Papilloma

    Human Papilloma virus infections – which cause anal and genital warts – are often thought to be little more than an unsightly inconvenience. However, these infections may play a role in the increased rates of anal cancers in gay men. Some health professionals now recommend routine screening with anal pap smears, similar to the tests done for women to detect early cancers. Safer sex should be emphasized. Treatments for HPV do exist, but recurrences of the warts are very common, and the rate at which the infection can be spread between partners is very high.

Certainly, there are other health concerns that gay men and MSM face. And there are other cultural competence issues – gender identity, race, ethnicity, economic status, for example. But the “10 things” list is a way to get the discussions started. Every physician and every health care professional – gay or straight – should know these things. And they should provide an open, comfortable environment in which these issues can be discussed.

How Safe is Oral Sex?

By Dr. Jeffrey Klausner
Department of Public Health San Francisco

My lover had HIV and Hepatitis C. We only had oral sex. How safe am I?

Oral sex has not been associated with HIV transmission. The sexual transmission of Hepatitis C is very rare as well. Hepatitis C is mostly transmitted through contaminated needles, blood transfusions and shared injection equipment. When researchers study Hepatitis C in semen it is very difficult to find the virus, and when they do the amount is very low.

It’s been said that if your gums are bleeding, you could possibly contract HIV via oral sex. Now I’m puzzled.

You’re right, that’s what has been said. But there are no data that show that bleeding gums, sore throats, bad teeth, or mouth sores actually increase the risk of transmission. For years, either we have not had data or had bad data. Now, reliable data shows the risk of HIV from oral sex is either zero or very, very low.

I was wondering how safe oral sex is-giving and receiving.

Questions about oral sex are probably the most common ones I get. In terms of HIV, oral sex both ways is very, very safe. We recently completed a study of men in San Francisco who have only had oral sex and found zero new HIV infections. But, other STDs like syphilis, gonorrhea, chlamydia and herpes are definitely transmitted through oral sex, and oral sex has likely contributed to our current syphilis outbreak.

As you know, many of these infections are easily diagnosed with simple tests and are readily treated. So my advice is: Enjoy oral sex and get regular check-ups. A good check-up includes throat testing for gonorrhea, rectal testing for gonorrhea and chlamydia, urine testing for gonorrhea and chlamydia and blood tests for herpes, syphilis and HIV. We call that the grand slam!

I was recently with a man and he happened to start kissing my chest while I had a white T-shirt on. We noticed that where he was kissing, there was a stain, and there was apparently some blood in his saliva-he bit his lip earlier presumably. He performed oral sex on me as well. I am very worried about Hep. B or C and/or HIV.

Saliva has natural anti-HIV factors and there have been no recent reports of HIV from oral sex. Hep B can be transmitted via oral sex and kissing, but there are very good shots to prevent Hep B. So if you are concerned, get the shots. Hep C has not been transmitted via kissing.

I heard that there have been reports of HIV being spread through oral sex, and other sources have said there haven’t been any report of this. What is the truth.

The truth from the University of California San Francisco and the San Francisco Department of Public Health is that the risk of transmission of HIV via oral sex is very, very, very, very, very low and may be zero. Other sources of information in the U.K. and elsewhere are not based on sound epidemiological data. But remember, other STDs can be transmitted easily via oral sex. So regular check-ups are in order. In those check-ups, get vaccinated against hepatitis A and B, get screened in your throat, ass and urine for chlamydia and gonorrhea and get blood tests for HIV, syphilis and herpes. DEMAND these tests form your doctor, clinic or health department. These tests are out there and essential to maintaining good sexual health. Be kind, be cool and be safe.

What is the latest thinking about unprotected oral sex between men?

A very recent study from Spain confirmed earlier studies that oral sex is safe sex in terms of HIV, and it is very, very uncommon for oral sex to transmit HIV–it may be as low as zero risk. That said, oral sex can transmit gonorrhea, chlamydia, herpes and syphilis, so sexually active men and women who have oral sex should get regular STD check-ups at least every six months, if not more, depending on how many new partners folks have.

All About Herpes

By Dr. Jeffrey Klausner
Department of Public Health San Francisco

Who Got Herpes First?

QUESTION

I tested positive for herpes. Is it possible that my boyfriend of 3-1/2 years could have carried it from before we got together and only recently infected me? Or is it possible I could have carried the virus for a period of time without knowing it? I trust my boyfriend and want to give him the benefit of the doubt here. While I’m not all that experienced, my boyfriend has had many partners before me. I know this sounds stupid, but I told him the only way we’re going to stay together is if we both take a lie detector test. What do you think?

ANSWER

A lie detector test isn’t necessary. The tricky thing with STDs is that many, many times they are asymptomatic – that means, there are no symptoms. About one in five adults in the United States has genital herpes; however, as many as 90% of these infected people don’t know they have the virus. If a person does have symptoms, they could show up anywhere from days after contracting it, to weeks, months or years. So you see, it may be difficult, if not impossible to tell who had the herpes virus in their body first.

The best thing you and your boyfriend can do is take a step back and breathe. Learn all you can about herpes so you can talk about it without blaming each other. For more information about herpes, click here. And you and he may want to consider letting your other sexual partners know they may have been exposed. There is a new, easy way to do this online at www.inSPOT.org.

What is Herpes?

Herpes is a sexually transmitted disease caused by two herpes simplex virus (HSV type I and type II). Herpes is transmitted from person to person via direct skin-to-skin contact during oral, anal and vaginal sex. HSV I usually causes fever blisters and cold sores on the mouth, but can also cause sores on the genitals. HSV II usually causes sores on the genitals (vagina, penis, anus) and the skin around those areas. The majority of oral herpes cases are caused by HSV I and the majority of genital herpes cases are caused by HSV II; however, since so many people are now having oral sex, type-I is increasingly appearing in the genitals. HSV is different from other common viral infections because once it is introduced into your system, it lives there forever, often with periodic symptoms or without symptoms at all.

How many people have it?

About 50 to 80% of the adult population in the United States have oral herpes. About one in five adults in the United States has genital herpes; however, as many as 90% of these infected people don’t know they have the virus. There are no accurate numbers as to how many people in San Francisco have herpes as it is not a reportable STD.

Why worry about Herpes?

Genital herpes is seldom a severe or dangerous infection by itself, although it can cause psychological distress because of the nature of the sores and the length of time the virus stays in your system.

The open sores of herpes do play a role in the spread of HIV. A person with a herpes sore is three to five times more likely to acquire HIV if exposed to an HIV-positive sex partner. Also, people with HIV and herpes have an increased amount of HIV fluid in their open herpes sores, which increases the risk of transmitting both diseases to a partner during unprotected sex.

Pregnant women who have a first episode of genital herpes near delivery may transmit herpes to their infant, which could be a serious, even deadly, problem. Fortunately, infection of infants is rare among women with recurrent genital herpes.

What are the symptoms?

Many people have genital herpes but don’t know it because they have no symptoms. Others have very mild symptoms. For the third group, who are symptomatic, the first outbreak is usually the worst. It lasts the longest, is most severe and often very uncomfortable. The initial sores can last five to ten days, first “weeping”, then scabbing over, then healing. In addition to blisters or open sores, a person may have swollen glands, fever, and body aches. Women tend to have more severe symptoms than men.

Genital recurrences after the first outbreak seem to be linked to stress, fatigue, lack of sleep, menstruation, and genital friction (new sexual partner after a time of no sex), although more research is definitely needed about this subject. Usually recurrences are more frequent in the first year after the initial outbreak. Some people have tingling or itching at the site of the sores before they appear, which can help them prepare for an upcoming outbreak. For some people, the recurrences are so mild that they have been mistaken for jock itch, razor burns, insect bites, ingrown hairs, and the like. Outbreaks can appear in different locations over time.

What is a Herpes test like?

In most cases, experienced clinicians can diagnose an initial herpes outbreak by its appearance. There are also viral culture tests available that can tell if herpes is present and which type (HSV I or HSV II). These tests use fluid from an open sore and are most accurate during initial outbreaks and when blisters are present.

There are several new blood tests that are very accurate for diagnosis. These tests also distinguish type (HSV I or HSV II). Speak to your medical provider about these tests if you’re interested.

How is Herpes treated?

There is no cure for herpes. However there are currently three FDA-approved antiviral medications that are available to treat herpes: Zovirax (acyclovir), Famvir (famciclovir) and Valtrex (valacyclovir). Using medication to treat genital herpes can help speed the healing process of an outbreak or be used as a preventative (when taken daily) to help reduce the frequency of future outbreaks.

Valtrex have also been proven effective when taken daily to reduce the risk of transmission of herpes to sex partners. The most common short-term side effects of these drugs are nausea and headaches. Thus far, no long-term side effects have been named.

What can I do if I have Herpes?

In order to reduce outbreaks, keep your stress levels low, eat well, exercise regularly and get lots of rest. Learn to recognize the symptoms that occur during the period before the lesions appear. People often describe a tingling or burning feeling during this time. Taking medications in this time period before an outbreak can abort or reduce the duration.

In order to avoid transmission of the virus to your sex partners, we advise discussing your herpes diagnosis with a prospective partner before you have sex. A potential partner would need to understand that it’s possible for him or her to become infected even if you’re using condoms since not all affected areas can be covered by a condom. Most good relationships can weather the news. Your partner may want to gather information and take some time to adjust to the fact that you have herpes. If you’re in a serious, long-term relationship, your partner might want to test for herpes as he or she might already be infected, but without symptoms. For more information on talking to your sex partners about herpes, click here.

How do I avoid getting Herpes?

Condoms provides some, but not complete protection, against transmission of the herpes virus. If you or your partner has herpes, abstain from sexual activities when sores are present. Communication is a wonderful tool to help you and your partner(s) make decisions about what’s right for each of you at any given time.

Genital Warts: Everything You Ever Wanted to Know About Them

Provided by the Department of Public Health San Francisco

Genital Warts (or condyloma) is a Sexually Transmitted Disease (STD) caused by the human papilloma virus (HPV). The virus may cause wart-like bumps to form on the penis, in and around the vagina, on the cervix (opening to the womb), around the anus (butt), and rarely on the mouth. The virus is passed between people during anal, vaginal, and sometimes oral sex. These are NOT the same warts commonly found on hands and feet.

How are genital warts spread?

Many people carry the wart virus on their penis, in and around the vagina, or in and around the anus/rectum. Only a small number of these people develop warts that can be seen. It is passed with skin to skin contact during anal or vaginal sex. The wart virus is very common in adults who are sexually active.

How do I know if I have warts?

Not everyone with the genital wart virus will have signs of disease. You may have painless wart-like growths on or in your sex organs or around your anus (butt). The warts may vary in size and be bumpy or flat. Sometimes special tests are needed to detect the wart virus.

Are genital warts serious?

They can be. For most people warts are only a bother, and are treated if you wish. If a woman has warts on the cervix (opening to the womb), they can be a problem. It is rare, but sometimes having warts can cause a woman to have a pap smear that is not normal, (including changes that may lead to cancer). For this reason, women with warts on the cervix should have a pap smear test (part of a pelvic exam) every six months to one year. Men and women who have warts on or inside the anus should have an exam every year.

What can I do if I have genital warts?

  1. Be sure you see a clinician (licensed medical provider).
  2. Keep all your return treatment appointments.
  3. Your sex partner(s) should also be seen and treated.
  4. If you may be pregnant, tell your clinician.
  5. If you have sex, it is always a good idea to use a condom to avoid getting STDs. However, condom use is not a 100% protection from the wart virus.

How are genital warts treated?

A clinician puts a cold liquid chemical on the warts to remove them.
You may need to come back more than once to finish the wart treatment.
You may need longer treatment if you have HIV. The warts may increase in size and number more quickly. Tell your clinician if you are HIV positive.

Will the warts come back?

Warts may return, even after treatment, this is because the virus stays in your skin once you are infected. You can pass the virus to your sex partners during vaginal or anal sex, even when you don’t have warts you can see.

How can I avoid getting genital warts?

Check yourself often for signs of actual warts; these can be treated. But remember: we treat the wart, not the virus, which stays in the skin.
Use condoms (rubbers) every time you have sex. Condoms reduce your risk for getting warts, but they won’t guarantee protection. Condoms also help to prevent other STDS.

Risk Factors for Cervical Cancer

  • Early onset of sexual intercourse (< 18 years of age)
  • Multiple sex partners (3+ lifetime)
  • Male partners with multiple partners
  • Sexual partners of men whose previous sex partners developed cervical cancer
  • Cigarette smoking
  • History of HPV infection (subtypes 16, 18 – not external)

Protective Factors

  • Celibacy
  • Life-long mutual monogamy
  • Use of condoms and spermicides

No Association with Cervical Cancer

  • Herpes simplex I or II
  • Uncircumsized male partner
  • Jewish ethnicity
  • Multiple pregnancies
  • Use of oral contraceptives

WARNING: HIV is also an STD! All STDs are spread by having unsafe sex. When you get infected with an STD, you could also be getting HIV. Protect yourself. Use condoms!

Gay-Friendly Medical Providers Survey

FDH & Associates is putting together a list of gay and gay-friendly medical and health providers who practice in Montana. We’ll put together a list of providers whom we will mail a questionnaire that will ask if they want to be put on the list of providers. This questionnaire will not identify you as the person who identified them. It will simply state that they have been identified as a care provider who has provided healthcare services to gay and lesbian people in Montana.

iQuit: A Quit Site for LGBT Smokers

Do you want to quit smoking? Researchers at the University of California, San Francisco are looking for lesbian, gay, bisexual, and transgender smokers to take part in a FREE Internet-based smoking treatment program.

iquit.medschool.ucsf.edu