Even the accidental ingestion of minute amounts of fecal material during sexual activity could deliver a sufficient inoculum. Intimate has a "growing list" of companies that have signed on to accept the Intimate token when it launches at the end of March. Figure 1 View large Download slide Factors that contribute to potentiate transmission of Shigella species among men who have sex with men MSM. Many of these cases occur in children or in health care institutions or are imported through travel abroad. The authors extend the work of Baer at al. An example of strategic positioning is the conscious decision of an HIV-negative person to avoid receptive sex with HIV-positive partners but to still participate with them in other sexual activities that are perceived to be lower risk. Louie Douvis "I was amazed at how broad this issue was," says Callon-Butler. Biological factors in the host likely also participate in the apparent frequency of Shigella infection among MSM; the immunodeficiencies related to the high prevalence of HIV infection among these men may drive transmission [ 8 , 12 ]. Are there other behavioral or biological correlates of susceptibility to Shigella species in this population?
Since these early observations, Shigella infection appears to be more frequent among MSM than among other adult populations, via direct fecal-oral transmission either through accidental inoculation of contaminated stool or through direct oral-anal contact [ 5 , 6 , 7 , 8—9 ]. Are there other behavioral or biological correlates of susceptibility to Shigella species in this population? I would have thought banks would be the last people we would want to be our moral arbiter in society. A very small inoculum of Shigella—as low as 10 organisms—is able to cause disease [ 10 ]. Wolter Peeters Advertisement Fighting bias Callon-Butler says businesses operating in the sex industry often experience discrimination and so struggle to get finance or financial services. HIV infection has several effects on Shigella transmission. This outbreak broadens our view of the transmission dynamics of Shigella species in that population: Specific sexual behaviors among MSM may provide a platform, further enhanced by biological susceptibility caused by HIV-associated immunodeficiency. An example of strategic positioning is the conscious decision of an HIV-negative person to avoid receptive sex with HIV-positive partners but to still participate with them in other sexual activities that are perceived to be lower risk. Leah Callon-Butler, is engagement director at Intimate. HIV infection also may have nonbiological effects on behaviors that may influence the transmission of Shigella infection and other sexually transmitted infections among HIV-positive MSM. This study raises several questions that merit further investigation. It's essentially like a PayPal for the adult industry. Figure 1 View large Download slide Factors that contribute to potentiate transmission of Shigella species among men who have sex with men MSM. By analyzing cases in women and men separately, the authors highlight the likely efficient transmission of Shigella species in MSM. Immunocompromised persons may have extended carriage of Shigella species and may have prolonged symptomatic or asymptomatic shedding at high titer. They also raise important questions about the role of HIV infection in the venereal transmission of this pathogen. The efficiency of this sexual transmission is likely fueled by several elements, both biological and behavioral in nature figure 1. The authors extend the work of Baer at al. Behaviors such as serosorting, strategic positioning, and intentional unsafe anal intercourse with others who are HIV positive may create sexual and behavioral networks of HIV-positive men that potentially enhance sexually transmitted infections among themselves but limit transmission to those who are seronegative for HIV [ 15 ]. Acknowledgments Potential conflicts of interest. Nearly , Shigella infections, causing significant morbidity, are reported each year in the United States [ 2 ]. Louie Douvis "I was amazed at how broad this issue was," says Callon-Butler. Are HIV-positive women at increased risk for shigellosis? Serosorting is defined as having sex with partners of the same HIV status. In the mids, outbreaks of Shigella infection among adults in New York and San Francisco raised the possibility that Shigella species may be sexually transmitted, with most infections occurring in men who have sex with men MSM [ 3 , 4 ]. Many of these cases occur in children or in health care institutions or are imported through travel abroad.
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