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Sexually Transmitted Diseases in Men Who Have Sex with Men: An
Epidemiologic Review.
Current Infectious Disease Reports 2003;5:145-152.
Ciesielski CA.
Abstract
The introduction of highly active antiretroviral therapy (HAART) has led to
dramatic reductions in morbidity and mortality due to HIV infection. However,
the resulting optimism and improved health status produced by HAART appears
to have contributed to unanticipated consequences in men who have sex with
men (MSM): loss of fear of acquiring and transmitting HIV, an increase in
high-risk sex, decreased use of condoms, and a resurgence of gonorrhea and
syphilis. Other factors, such as lack of knowledge of sexually transmitted
diseases (STDs), use of the Internet as a venue to find sex partners, the
increasing use of Viagra (Pfizer, New York, NY) as a recreational drug, and
the apparent expanding role of oral sex in STD transmission are fueling these
trends. Since ulcerative and inflammatory STDs facilitate HIV transmission,
a new wave of HIV infection in MSM may be on the horizon. The rising STD
rates and relapses in high-risk sexual behaviors in MSM, both HIV-infected
and -uninfected MSM, have profound implications for public health and the
clinical management of these patients. Clinicians should be aware of this
turn of events, and implement new screening and counseling guidelines that
have been issued in response to these alarming reports.