Scientific Presentations – Fourth International Workshop on KSHV and Related Agents, University of California, Santa Cruz
August 4-8, 2001
Evaluation of specific sexual practices as routes of KSHV transmission among homosexual men
JN Martin, B Forghani, C Cossen, A Cheng, A Graves, B Klencke and DH Osmond.
UCSF and CA Dept of Health Services
Background: The formation of a public health message to homosexual men on how to avoid KSHV infection still awaits ascertainment of the specific route of transmission. Although the specific mode of spread is still unknown, the consensus that saliva is the body fluid that most often harbors KSHV indicates that any act that passes saliva merits consideration. Recently, kissing has been hypothesized as the major route of spread, but how this universally practiced act could explain the localization of KSHV within homosexual men remains a question.
Methods: Homosexual men, participating in the San Francisco Men’s Health Studies, completed self-administered questionnaires about the number of partners in their entire lifetime with whom they had practiced the following specific sexual acts: unprotected insertive or receptive penile-anal intercourse, unprotected insertive or receptive penile-oral intercourse, insertive or receptive oral-anal intercourse (rimming) or “deep” kissing. KSHV seropositivity was determined by an EIA containing whole virion lysate. The odds ration (OR) reported compare men practicing a particular act most frequently to those practicing the least frequently.
Results: A total of 394 homosexual men were evaluated (35% HIV-infected); KSHV prevalence was 47%. Median number of male lifetime intercourse partners (any type) was 100 (IQR 35-300). In unadjusted analyses, KSHV seropositivity was associated with total male (p<0.001), but not female (p=0.87) intercourse partners, and all of the specific acts performed with other men (all p,0.001). There was, however, large correlation in the practice of the specific acts (correlations from 0.48 to 0.86). In multivariable logistic regression, there was no evidence for an association between KSHV seropositivity and kissing (OR=1.5, p=0.87), but there were associations seen for insertive penile-oral intercourse (OR=6.3, p=0.04), insertive penile-anal intercourse (OR=2.5, p=0.08). To help explain the association with receptive anal intercourse, 65% of 20 randomly chosen men reported their partners used saliva as a lubricant for anal intercourse. Even with adjustment for sexual practices, inhaled nitrite use during sex was associated with KSHV infection (OR=2.4, p<0.01).
Conclusion: No evidence was found for kissing as a route of KSVH transmission. Instead, the practices of insertive penile-oral, insertive penile-anal, and to a lesser extent receptive penile-anal intercourse with other men were associated with KSHV seropositivity. That the practice of these latter acts with male partners is either anatomically limited to or behaviorally favored by men would serve to explain why KSHV has remained localized within homosexual men without significant spread to women or heterosexual men.
Last modified: November 2, 2012