NASOPHARYNGEAL FLORA IN HIV-SEROPOSITIVE MEN WHO HAVE SEX WITH MEN

Objectives: To assess, in men who were infected with the human immunod eficiency virus (HIV) and who identified themselves as having had sex with men; the nasopharyngeal prevalence of Neisseria gonorrhoeae, N me ningitidis, Corynebacterium diphtheriae, and candida species; oral sex ual behaviour; the relation between oral flora and oral sexual behavio ur. Method: Nasopharyngeal swabs were taken from HN seropositive men f or culture. The men were also asked to complete a self administered qu estionnaire. Results: 390 men were recruited; 286 (73.3%) provided nas opharyngeal samples and questionnaires; 41 (10.5%) provided nasopharyn geal samples only; 63 (16.2%) provided questionnaires only. From the 3 27 nasopharyngeal samples N meningitidis was cultured in 49 (15%) and candida species in 165 (50.5%). Cultures for N gonorrhoeae and C dipht heriae were all negative. Data from the 349 completed questionnaires i ndicated that 285 men were practising oro-penile sex, over 90% did not consistently use condoms; 150 men were practising oro-anal sex, one u sed dental dams. In those providing both nasopharyngeal samples and se xual behaviour data meningococcal carriage was identified in 40 (17.5% ) of the 228 men practising receptive oro-penile sex, compared with on e (2.3%) of the 43 non-practisers (p < 0.025); in 21 (20%) of the 105 men practising insertive oro-anal sex, compared with 17 (12.5%) of the 136 non-practisers (p = 0.12). No correlation was identified between yeast carriage and oro-genital sex. Conclusion: Oro-genital sex, usual ly without barrier protection, is common among HIV infected men who ha ve sex with men. It appears to be associated with increased meningococ cal carriage but is autonomous to candida species isolation. Routine s creening for nasopharyngeal N gonorrhoeae is not deemed necessary.