title: Understanding recent increases in the incidence of sexually transmitted infections in men having sex with men: changes in risk behavior from risk avoidance to risk reduction.
abstract: OBJECTIVE
  The objective of this study was to explore risk behavior and routes of transmission in men having sex with men (MSM) with newly diagnosed sexually transmitted infections (STIs).
  
  
  METHODS
  A questionnaire on clinical diagnosis and manifestation site for acute STIs was completed by physicians participating in a sentinel study. Patients contributed information on sexual risk behavior and the likely route of STI transmission.
  
  
  RESULTS
  Three hundred fifty-six diagnosis forms and 169 matching patient questionnaires could be analyzed. The most frequent diagnosis was syphilis (n = 147; 33% primary syphilis with ulcer localization 71% genital, 22% anorectal, and 8% oral; 67% secondary syphilis), followed by gonorrhea (n = 136; 59% genital, 34% rectal, 7% pharyngeal) and Chlamydia trachomatis infection (n = 51; 48% genital, 48% rectal, 4% pharyngeal). In 12 patients, more than one infection was diagnosed, and 2 or 3 sites were affected in 11 patients. Approximately 60% of infections were acquired by genital-oral and oral-anal practices. Unprotected anal intercourse (UAI) was reported more often by HIV-positive men (mostly receptive) and men with high partner numbers.
  
  
  CONCLUSIONS
  High partner numbers, an important role of genital-oral sexual practices for the transmission of STIs, and relatively high frequencies of mostly receptive UAI in HIV-positive men are all contributing to increasing STI incidences among MSM.
authors.affiliation: Robert Koch-Institut, Berlin, Germany. marcusu@rki.de
authors.forename: Ulrich
authors.initials: U
authors.lastname: Marcus
authors.forename: Viviane
authors.initials: V
authors.lastname: Bremer
authors.forename: Osamah
authors.initials: O
authors.lastname: Hamouda
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kramer
authors.forename: Matthias
authors.initials: M
authors.lastname: Freiwald
authors.forename: Heiko
authors.initials: H
authors.lastname: Jessen
authors.forename: Michael
authors.initials: M
authors.lastname: Rausch
authors.forename: Bernd
authors.initials: B
authors.lastname: Reinhardt
authors.forename: Alex
authors.initials: A
authors.lastname: Rothaar
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schmidt
authors.forename: Yves
authors.initials: Y
authors.lastname: Zimmer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005858:Germany / Q000453:epidemiology; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D021841:Safe Sex; D018571:Sentinel Surveillance; D012725:Sexual Behavior; D015231:Sexually Transmitted Diseases, Bacterial / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D011795:Surveys and Questionnaires