Orally transmitted STD among gay men

Bill Weintraub

Bill Weintraub

Orally transmitted STD among gay men


Another rare sexually transmitted infection outbreak in London gay men


Edwin J. Bernard, Thursday, October 14, 2004

The Health Protection Agency (HPA) has identified an outbreak of another sexually transmitted infection amongst gay men in London. This time, 14 cases of shigellosis, caused by the bacterium Shigella sonnei, have been reported. Shigellosis is highly infectious, can cause severe, prolonged and sometimes bloody diarrhoea, and can be more serious in HIV-positive people.

This is the third report of a new outbreak of an unusual sexually transmitted infection in gay men in as many weeks. Previously the HPA identified outbreaks of hepatitis A in London and lymphogranuloma venereum (LGV), an unusual form of chlamydia, throughout Europe.

The current outbreak

The HPA is currently investigating 14 cases of S. sonnei in gay men who have become ill since the beginning of August. The majority of cases have been reported by genitourinary (GUM) clinics in North London, but the men reside throughout Greater London. The HPA suggests it is likely that there could be many more men affected. Dr Paul Crook, the HPA's Consultant in Communicable Disease Control said, "we are working closely with NHS colleagues to highlight action that can be taken to prevent this disease."

Learning from previous outbreaks

Outbreaks of S. sonnei amongst gay men have been reported in the United States, Canada, the Netherlands, Germany and Australia.

Reports published after outbreaks in San Francisco in 1996 and Amsterdam between 1997 and 2001 found that HIV-positive gay men were more likely to have contracted the infection.

A report after a 2000 outbreak in Sydney found that visiting a sex venue in the two weeks before onset of illness was the only factor significantly associated with shigellosis.

A report on the 2001 outbreak in Berlin found that almost all of the men affected reported direct or indirect oral-anal sexual contacts in the week before they fell ill.

Symptoms of Shigellosis

S. sonnei causes prolonged, sometimes bloody diarrhoea, or dysentery. Other symptoms include stomach cramps, fever, nausea and sometimes vomiting. The infection can be much more serious in those with reduced immunity to infection, including HIV-positive people. During the 2000 outbreak in Sydney, an HIV-positive man was diagnosed with reactive arthritis due to his infection with S. sonnei. In reactive arthritis, symptoms of joint inflammation can last from three to twelve months, or may develop into a long-term disease in a small percentage of people.

Avoiding S. sonnei

Shigellosis occurs usually one to three days after the ingestion of a very few (10 - 100) S. sonnei organisms, much fewer than salmonella, which is a similar food and faeces (shit)-borne bacterial infection.

Sexual infection can take place when a very small amount of faeces is ingested during oral or anal sex. This includes:

Rimming (oral-anal contact).

Fingering or fisting.

Taking a condom off after anal sex.

Touching sex toys that have been used in the anus.

Sucking or licking the penis or scrotum (cock or balls), if there is a chance that the skin in the groin area is contaminated.

Coming into contact with infected faeces in a backroom or toilet.

Tim Green, Camden Primary Care Trust's Manager of HIV & Sexual Health Promotion adds, "gay men should be aware that they can get this infection from sexual contact and should remember to wash their hands, especially after sex, using the toilet and before eating or preparing food. If they have symptoms they should avoid sex and see their regular doctor."


HPA Press Release. Health Protection Agency advice to gay men in London. October 11th, 2004.

Marcus U et al. Shigellosis - a re-emerging sexually transmitted infection: outbreak in men having sex with men in Berlin. Int J STD AIDS 15: 533-537, 2004.

Bovee LP et al. Shigellosis, a sexually transmitted disease in homosexual men. Ned Tijdschr Geneeskd 147: 2438-2439, 2003.

O'Sullivan B et al. Shigellosis linked to sex venues, Australia. Emerg Infect Dis 8: 862-864, 2002.

Chen M et al. Shigella sonnei: another cause of sexually acquired reactive arthritis. Int J STD AIDS 13:135-136, 2002.

Syphilis through oral sex on the rise

2004-10-21 Reuters Health

NEW YORK (Reuters Health) - Many people mistakenly believe that oral sex is safe, unaware that they can readily catch or pass on syphilis in this manner, according to a report put out by Centers for Disease Control and Prevention.

Moreover, syphilitic sores in the mouth may in turn increase the risk of HIV infection.

Dr. C. Ciesielski and colleagues from the Chicago Department of Public Health found that syphilis is increasingly being spread through oral sex.

"Persons who are not in a long-term monogamous relationship and who engage in oral sex should use barrier protection (e.g., male condoms or other barrier methods) to reduce the risk for sexually transmitted disease (STD) transmission," the team advises.

Ciesielski's group saw that patterns of syphilis transmission changed substantially over the period from 1998 to 2002. During the 1990s, they report in the CDC's Morbidity and Mortality Weekly Report, syphilis occurred almost exclusively among heterosexuals. Since 2001, men who have sex with men account for nearly 60 percent of people with syphilis.

To account for these findings, they began interviewing persons with syphilis during 2000 to 2002. In almost 14 percent of cases, oral sex was the subjects' only sexual exposure during the time they were infected; this was reported by 20 percent of gay men with syphilis, and 6 to 7 percent of heterosexual men and women.

These figures don't include possible infection through oral sex when sexual intercourse [sic -- they mean penile-vaginal sexual intercourse or anal penetration] also took place.

People with syphilis in the mouth may not have any symptoms, or the sores may be mistaken for aphthous ulcers or herpes, the authors point out.

The lesions may carry high concentrations of the germ that causes syphilis, and are thus highly infectious. Also, oral lesions may increase the risk of being infected with HIV.

"These data underscore the need for educating sexually active persons regarding the risk for syphilis transmission through oral sex," the investigators write.

SOURCE: Morbidity and Mortality Weekly Report, October 22, 2004.

Commentary by Bill Weintraub:

Both of these articles are about oral-genital / oral-anal contact and STD in promiscuous gay men.

The second, about orally-transmitted syphilis, is fairly routine, except you should note that a person can be symptomless and still be transmitting the pathogen, which is "highly infectious."

And that gay men, who make up perhaps 5% of the population, "account for nearly 60 percent of people with syphilis."

That's a startling figure, and that's what I mean when I talk about a community riddled with a disease, and a social experiment (unbridled promiscuity) which has failed.

Regarding the first article, I wrote about these outbreaks of amoebic, protozoan, and bacterial dysentery, which were very widespread in the late 70s, in Why Be Faithful.

They're usually caused by oral-anal contact, so-called rimming, but you can get the organisms which cause dysentery, as this article points out, from oral sex alone:

"Sucking or licking the penis or scrotum (cock or balls), if there is a chance that the skin in the groin area is contaminated."

Again, oral sex is far riskier than Frot.

Most STIs which are transmitted anally are also vectored orally.

In addition, some dysentaries can be transmitted through eggs borne in sweat -- and the eggs go wherever the sweat goes.

For example: you're with a guy who's sweating, the sweat runs down his ass crack and picks up whatever fecal matter is on the exterior of his anus, and gets on his balls.

He plays with his balls, then rubs his chest; you lick his nip, and you now have, headed for your digestive tract, whatever was in the sweat on his balls.

That's the reality of promiscuity.

Also: after I posted the Reuters article about male circumcision and HPV, I got, predictably, letters of protest.

One guy even wrote claiming there's no evidence that male circumcision is protective against H I V.

That's a lie and it's been deadly for literally millions of people, some of them gay men.

Aside from that huge and conclusive *hard science*, MD/MPH-led, peer-reviewed study out of India (Reynolds SJ et al. Male circumcision is protective against HIV-1 in India. (2003). 41st Annual Conference of the Infectious Diseases Society of America, San Diego.), all you need do is look at a map of Africa and contrast HIV prevalence in Muslim areas with that in Christian-Animist areas.

Sub-Saharan Africa has just over 10% of the world's population, but is home to close to two-thirds of all people living with HIV -- some 25 million. In 2003 alone, an estimated 3 million people in the region became newly infected, while 2.2 million died of AIDS.

-- UNAIDS, 2004 Report

In Africa, AIDS is predominantly a disease of heterosexuals, and men get it from women most often during vaginal sex -- primarily via their foreskins.

When all other risk factors are accounted for -- eg, other STD such as herpes or syphilis, or use of prostitutes -- uncircumcised men are at 8 times greater risk than circumcised men.

So: if a cut guy and an uncut guy visit a prostitute who has HIV, the uncut guy is 8 times more likely to acquire HIV than his cut buddy.

Fact: anal penetration is dangerous.

Fact: oral sex too is very risky -- as we just saw.

Fact: male circumcision is protective against HIV.

I am sick of gay men who want to deny biology and live in a fantasy land of promiscuity and anal penetration and fellatio and rimming and uncut cock.

Fact: pathogens do not care about your fantasies or your half-baked ideologies -- they'll infect you if they can.

And they'll kill you if that's what they do.

Another guy wrote:

"I will fight against anything that suggests that lopping off a piece of a boys penis is somehow "good" or "beneficial".

It *is* beneficial.

Why would you fight against that?

Because it doesn't fit with your a priori view of the universe?

That's what the buttfuck boyz do.

We say anal's a lot more dangerous than Frot -- indeed, that it's the highest risk "sex" act two men can perform -- and they say, "I will fight against anything that suggests that anal isn't peachy keen. Don't worry me with the facts. I have to have my anal sex."

The facts won't go away however.

Anal is dangerous.

Non-circumcision dramatically increases risk.

Guys, try to figure this out.

While I'm against anal penetration and promiscuity and promiscuous oral sex and rimming under any circumstances, I'm not against men being uncut.

But we now know that male circumcision is protective against HIV and probably HPV too.

(Baldwin, SB; Wallace, DR; Papenfuss, MR; et alia. Condom Use and Other Factors Affecting Penile Human Papillomavirus Detection in Men Attending a Sexually Transmitted Disease Clinic. (2004, October). Sex Transm Dis. 2004; 31(10):601-607.)

That has to be factored into our lives.

And for a sexual subculture to embrace both promiscuity and non-circumcision is insane.

Because if you're promiscuous and you're uncut, you're at even greater risk than if you're promiscuous and cut.

Yet that's precisely what gay male subculture did in the 70s and still does.

What it expresses is a cultural and communal deathwish -- a belief that you deserve to die because you love men.

And no culture -- or its agents -- which believes that an act as debased and sexless and deadly as anal penetration is the pinnacle of intimacy can be trusted to speak the truth about sex or circumcision or anything else.

I believe that men who love men deserve to live -- fully, and as men.

But if we're going to do that, we can't turn our backs on science, and we can't ignore the biological realities.

Biologically, this is about mucosal linings.

The anus and rectum have a mucosal lining; as does the vagina; and the mouth; and the foreskin.

Most sexually-transmitted pathogens need and thrive on those mucosal linings.

That's why male circumcision is protective -- it removes a very great vulnerability.

According to the scientific studies, the skin on the inside of the male foreskin is "mucosal," similar to the skin found on the inside of the mouth [or vagina or anus and rectum]. This mucosal skin has a high number of Langerhans cells, which are HIV target cells, or doorway cells for HIV.

The rest of the skin on the penis is more like the outer skin on the rest of the body, a barrier that protects against germs.

"HIV looks for target cells, like the Langerhans; it's a lock and key," said Edward C. Green, senior researcher at Harvard University, who has been looking at circumcision and HIV in Africa for 10 years. "The rest of the skin on the penis is armorlike."

"The rest of the skin on the penis is armorlike."

That's the benefit circumcision provides.

Without decreasing pleasure.

There's never been any credible evidence that circumcision reduces male genital pleasure.

Of course, you can still be uncircumcised.

And I am NOT advocating that uncircumcised adults be circumcised.

But if you are uncircumcised, you need to pay attention to what we've been learning about circumcision and risk.

For example, you can't stick your dick in a hole full of shit and rectal secretions, which contain even more HIV than semen or blood.

(Zuckerman, RA, Whittington, LH, Celum, CL, et al. (2004, July 1). Higher Concentration of HIV RNA in Rectal Mucosa Secretions than in Blood and Seminal Plasma, among Men Who Have Sex with Men, Independent of Antiretroviral Therapy. J of Inf Dis 190 (1): 156-162.)

Because you're very vulnerable.

Nor should any of you, cut or uncut, be promiscuous cock2cock.

Do you really want your dick makin it with every other dick on earth?

Based on what some of you try to post in Frot Club, I think you do.

You shouldn't.

Promiscuity inevitably disappoints.

Because it's emotionally isolating.

What's more, being promiscuous in this community means having sex with analists, many of whom are silent carriers of STIs; at the end of the day, you end up bemoaning your loneliness while worrying about STD.

There are two characteristics that you see sought for over and over again on the big gay / analist "dating" sites:

1. Masculinity.

The buttfuck boyz are on a never-ending quest for a masculine "man into anal" without stopping to think that every time that man gets fucked his masculinity is eroded and damaged; that he becomes less of a man and more of a queen every time his butt is reamed.

2. D/D Free, U B 2 = disease and drug free, you be too.

They want a disease-free man who's available for "hook-ups" and promiscuous sex.

How long will a man who's into hook-ups remain disease free?

Or drug-free, given the anything-goes mindset of hook-up culture.

Like the superiority of uncut cock, these are fantasies.

And it's the pursuit of these literally fucked-up-the-ass fantasies that leads to such disappointment and bitterness and disease among gay men.

You have the power to stop playing these stupid and destructive games.

By telling your prospective mates, I only do Frot, and only when I see an LTR in our future.

Recently someone tried to post in Frot Club about "adult casual sex."

"Adult casual sex" is like "safe promiscuity" -- it's an oxymoron.

Casual sex isn't adult -- it's juvenile.

The immature leaping from one loveless encounter to another.

Put your m2m energy into one other man.

Your life will be better, your sex hotter, and your mutual love will grow and become ever more amazing.

Related articles:

an anus is not a vagina

Do Gay Men Have to be Promiscuous?

About Promiscuity, Str8 guys, Boytoys, and Men Who Love Men


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