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.
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