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Concept: Anal sex

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Recently, the world has experienced a rapidly escalating outbreak of infectious syphilis primarily affecting men who have sex with men (MSM); many are taking highly active antiretroviral therapy (HAART) for HIV-1 infection. The prevailing hypothesis is that HAART availability and effectiveness have led to the perception among both individuals who are HIV-1 infected and those who are uninfected that HIV-1 transmission has become much less likely, and the effects of HIV-1 infection less deadly. This is expected to result in increased sexual risk-taking, especially unprotected anal intercourse, leading to more non-HIV-1 STDs, including gonorrhoea, chlamydia and syphilis. However, syphilis incidence has increased more rapidly than other STDs. We hypothesise that HAART downregulates the innate and acquired immune responses to Treponema pallidum and that this biological explanation plays an important role in the syphilis epidemic.

Concepts: Antiretroviral drug, HIV, AIDS, Immune system, Epidemiology, Chlamydia infection, Syphilis, Anal sex

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The Italian society of colo-rectal surgery (SICCR) is dedicated to improving the study, prevention and management of the diseases of the colon, rectum and anus. One of the aims of the society is to establish guidelines to the treatment of these diseases. These guidelines are based on the international literature and on the best available evidence. Clinical practice guidelines are one of the most important instruments to provide therapeutic decision-making support, based on the best scientific evidence available at the time. Guidelines are advisory and not prescriptive, susceptible to continual variations secondary to innovations and new scientific evidence. These guidelines are a guide for all colo-rectal surgeons and physicians who approach anal cancer.

Concepts: Scientific method, Medicine, Cancer, Human papillomavirus, Physician, Anal cancer, Rectum, Anal sex

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The aim of this study was to assess the prevalence and associations between anal intercourse and fecal incontinence.

Concepts: Fecal incontinence, Anal sex

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Rectal microbicides are needed to reduce the risk of HIV acquisition associated with unprotected receptive anal intercourse. The MTN-007 study was designed to assess the safety (general and mucosal), adherence, and acceptability of a new reduced glycerin formulation of tenofovir 1% gel.

Concepts: Iron, Rectum, Anal sex, Potassium permanganate

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Apart from penile-anal intercourse, other anal sexual practices (rimming, fingering and saliva use as a lubricant for anal sex) are common among men who have sex with men (MSM). The aim of this study is to evaluate whether these anal sexual practices are risk factors for rectal gonorrhoea in MSM.

Concepts: Sexual intercourse, Epidemiology, Oral sex, Human sexual behavior, Chlamydia infection, Homosexuality, Sodomy, Anal sex

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Squamous cell carcinomas of the anus and anal canal represent a model of a cancer and perhaps the first where level 1 evidence supported primary chemoradiotherapy (CRT) in treating locoregional disease with curative intent. The majority of tumours are associated with infection with oncogenic subtypes of human papilloma virus and this plays a significant role in their sensitivity to treatment. However, not all tumours are cured with CRT and there remain opportunities to improve outcomes in terms of oncological control and also reducing late toxicities. Understanding the biology of ASCC promises to allow a more personalised approach to treatment, with the development and validation of a range of biomarkers and associated techniques that are the focus of this review.British Journal of Cancer advance online publication, 6 December 2016; doi:10.1038/bjc.2016.398 www.bjcancer.com.

Concepts: Cancer, Disease, Oncology, Human papillomavirus, Lung cancer, Anal cancer, Squamous cell carcinoma, Anal sex

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This study investigated how frequently a group of young heterosexual Australians (ages 15 to 29) saw a range of behaviors represented in pornography over the previous 12 months. Participants were recruited to an anonymous online survey. Those who reported having viewed pornography in the past 12 months (n = 517) indicated how frequently they saw each of a list of 17 behaviors when they watched pornography in the past 12 months. Men’s pleasure (83%) was seen frequently by the highest proportion of young people surveyed, followed by a man being portrayed as dominant (70%). Women were more likely to report frequently seeing violence toward a woman (p < 0.01). Men were more likely to report frequently seeing heterosexual anal sex (p < 0.01), ejaculation onto a woman's face (p < 0.01), women portrayed as dominant (p < 0.01), a man being called names or slurs (p < 0.01), and violence toward a man that appears consensual (p < 0.01). Younger age was significantly associated with frequently seeing women's pleasure (p < 0.05), violence toward women which appeared consensual, and all types of violence (p < 0.01). Older age was associated with frequently seeing men's pleasure (p < 0.01) and heterosexual anal sex (p < 0.05). Our findings draw attention to the gendered ways that behaviors in pornography are seen and identified by young heterosexual audiences.

Concepts: Female, Gender, Gender role, Woman, Transgender, Homosexuality, Sodomy, Anal sex

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Background: Gamma-hydroxybutyrate (GHB) use among gay and bisexual men (GBM) has increased in recent years. It is commonly cited as a sexual-enhancement drug. There is, however, little evidence for factors associated with GHB use or the consequences of its use among GBM. Aim: Factors associated with GHB use, its relationship to sexual risk behaviour, and the contexts, consequences, and motivations for its use were examined. Methods: The Following Lives Undergoing Change (Flux) Study is an online prospective observational study of Australian GBM. At baseline, a total of 3190 GBM provided details about their use of GHB. Data on frequency, methods, pleasures and consequences of their drug use, alongside key demographic variables were collected. Results: Mean age was 35.0 years. One in five men (19.5%) had a history of GHB use and 5.4% reported use within the past 6 months, with 2.7% having used it monthly or more frequently. Overdose had been experienced by 14.7%, this was more common among men who used GHB at least monthly. Being HIV-positive, having more gay friends, greater social engagement with gay men who use drugs, a greater number of sexual partners, group sex, and condomless anal intercourse with casual partners were independently associated with GHB use in the past 6 months. Greater social engagement with gay men who use drugs and group sex were independently associated with at least monthly use. More frequent GHB use was independently associated with experiencing overdose among GHB users. Conclusion: Most men used GHB infrequently and it was often used explicitly to enhance sexual experiences, often in the context of intensive sex partying. Men who used GHB frequently, were at greater risk of overdose and other negative health outcomes. GHB use should be considered alongside other drugs that have been implicated in sexual risk behaviour and HIV transmission. Harm-reduction interventions need to consider the particular impact of frequent GHB use.

Concepts: HIV, LGBT, Observational study, Drug addiction, Homosexuality, Bisexuality, Anal sex, Men who have sex with men

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The aim of this study was to systematically review the findings of publications addressing the epidemiology of anal HPV infection, anal intraepithelial neoplasia and anal cancer in women.

Concepts: Cancer, Disease, Cervical intraepithelial neoplasia, Human papillomavirus, Papillomavirus, Lung cancer, Anal cancer, Anal sex