[120 years of contact tracing for sexually transmitted infections in Norway] / Smittesporing ved seksuelt overførbare infeksjoner i Norge gjennom 120 år.

BAKGRUNN: Smittesporing har fått ny aktualitet grunnet covid-19, men har lenge vært viktig i bekjempelsen av seksuelt overførbare infeksjoner. I denne artikkelen vil vi belyse hvordan smittesporingen ved seksuelt overførbare infeksjoner i Norge har endret seg de siste 120 årene. MATERIALE OG METODE: Kildegrunnlaget er årsberetninger fra Kristiania Sundhetskommission og Oslo Helseråd, årsrapporter fra Meldingssystem for smittsomme sykdommer ved Folkehelseinstituttet (MSIS), skjema for innkalling av pasienter, et originalt maskinskrevet manuskript av helseinspektør Harald Christian Gjessing (1896-1988) samt personlige meddelelser fra Øivind Jul Nilsen, seniorrådgiver ved Folkehelseinstituttet. RESULTATER OG FORTOLKNING: Smittesporing er i varierende grad dokumentert i årsberetningene fra Kristiania Sundhetskommission fra slutten av 1800-tallet og fram til dagens MSIS-rapporter. Politiet var sterkt involvert i kontrollen av kjønnssykdommene på slutten av 1800-tallet, men legene overtok mer av ansvaret ut over 1900-tallet. Under den annen verdenskrig ble igjen politiet mer involvert i kontroll og smittesporing. I 1947 kom lov om åtgjerder mot kjønnssykdommer, som stadfestet behandlende leges plikt til å utføre smittesporing. Denne loven ble erstattet av smittevernloven i 1995. Kvaliteten på smittesporingen over tid er noe vanskelig å vurdere, da datagrunnlaget for statistikken har endret seg. Fra å være et moralsk anliggende, med sterke elementer av tvang og hjelp fra sedelighetspolitiet, ble smittesporing etter hvert basert på frivillighet og samarbeid mellom lege og pasient.

Health characteristics associated with chemsex among men who have sex with men: Results from a cross-sectional clinic survey in Norway.

BACKGROUND: Chemsex typically involves drugs such as GHB/GBL, crystal meth and mephedrone, and is increasingly common among MSM. The behaviour has been found to be associated with sexually transmitted infections (STIs) and mental health problems. We aimed to assess the extent of chemsex engagement and associations with different aspects of health, among MSM attending a free specialist walk-in clinic for STIs in Oslo, Norway. METHODS: Anonymous cross-sectional survey data was collected from June to October 2016. Differences in STI health (chlamydia, gonorrhoea, syphilis, HIV diagnoses), mental health (depression/anxiety) and internalised homonegativity between MSM using and not using GHB/GBL, crystal meth, mephedrone, cocaine or ketamine with sex in the last year were assessed descriptively and in a multivariate logistic regression model. The predictors were number of self-reported chlamydia, gonorrhoea or syphilis diagnoses, HIV diagnosis, depression/anxiety, and degree of internalised homonegativity. We adjusted for age, education level and having lived abroad. RESULTS: Of the 518 MSM respondents, 17% reported sexualised use of either GHB/GBL, crystal meth, mephedrone, cocaine or ketamine in the last year (chemsex). We found significant positive associations between chemsex and self-reported HIV diagnoses (adjusted odds ratio [aOR] = 3.26, 95%CI = 1.37-7.76), number of reported chlamydia, gonorrhoea or syphilis diagnoses in the last year (aOR = 1.63, 95%CI = 1.18-2.12), having lived more than one year abroad (aOR = 2.10, 95%CI = 1.20-3.65), but no significant association with depression/anxiety (aOR = 1.02, 95%CI = 0.53-1.93), nor internalised homonegativity (aOR = 0.62, 95%CI = 0.33-1.19). CONCLUSION: Chemsex engagement in Norway is relatively low compared to findings from STI clinics in other European countries, and GHB/GBL and cocaine the two most commonly used drugs with sex. Chemsex was more common among MSM having lived more than one year abroad, reporting HIV diagnoses and a higher number of either chlamydia, gonorrhoea or syphilis diagnoses in the last year. Health care providers need to be made aware of chemsex as a behavioural phenomenon among MSM, and special care should be afforded to MSM living with HIV and being diagnosed with STIs.

Links between chemsex and reduced mental health among Norwegian MSM and other men: results from a cross-sectional clinic survey.

BACKGROUND: The use of specific drugs to facilitate, enhance or prolong sexual sessions is referred to as 'chemsex'. The popularity of the behavior seems to be growing, but there is a paucity of information on the mental health aspects associated with chemsex and no data on chemsex from Nordic countries. We investigated the link between chemsex and mental health among men who have sex with men (MSM) and other men in Norway. METHODS: We recruited participants from a walk-in sexually transmitted infections (STI) clinic. Participants completed a piloted, anonymous self-administered survey. It consisted of questions about men's sociodemographic characteristics, mental health, sexual behaviors, substance use, and chemsex. The outcome we investigated was reduced mental health, measured with the validated Hopkins Symptom Check List. We obtained descriptive statistics and performed univariate and multivariate logistic regression analyses. RESULTS: 1013 (96%) of the surveys were complete and could be analysed. The mean age of the sample was 33, 51% were MSM, and 21.7% had reduced mental health. More MSM than other men engaged in chemsex in the past year (17% vs 12%). The most frequently reported chemsex drugs were cocaine and gamma hydroxybutyrate/gamma butyrolactone (GHB/GBL). Men engaged in chemsex primarily to enhance sexual pleasure and excitement, and about half reported almost never or never using condoms for chemsex. In univariate analyses, significant predictors of reduced mental health was chemsex (Odds Ratio [OR] = 1.82), being unemployed (OR = 3.54), and having sex with only women (OR = 0.58). In multivariate analyses, two variables remained significantly associated with reduced mental health: chemsex (adjusted OR = 2.18, 95%CI = 1.25-3.78) and being unemployed (adjusted OR = 4.10, 95%CI = 2.13-7.87). CONCLUSIONS: In our sample of men from an STI clinic in Norway, about 14% self-reported engaging in chemsex in the past year and about a fifth of the men had reduced mental health. Men who engaged in chemsex, which more MSM engaged in than other men, had two times greater odds of reduced mental health. These findings suggest that mental health assistance should be among the interventions offered to men engaging in chemsex.

Chemsex among men - a questionnaire study. / Chemsex blant menn ­ en spørreundersøkelse.

BAKGRUNN: Formålet med undersøkelsen var å kartlegge forekomsten av rusmiddelbruk under sex (chemsex) blant et utvalg av mannlige pasienter ved Olafiaklinikken i Oslo, en poliklinikk for seksuelt overførbare infeksjoner. Vi ønsket også å se hvilke variabler innen psykisk helse, seksuelt overførbare infeksjoner og seksualatferd som var assosiert med chemsex for menn som har sex med menn og menn som har sex med kvinner. MATERIALE OG METODE: Studien var anonym og spørreskjemabasert blant mannlige pasienter ved poliklinikken i perioden 1.7.2016-20.10.2016. RESULTATER: Svarprosenten var 96 (1 050 fikk utdelt skjema, 1 013 ble inkludert). Av disse rapporterte 144 (14 %) bruk av chemsex i løpet av det siste året - 87 (17 %) menn som har sex med menn og 57 (12 %) menn som har sex med kvinner. Av de som hadde hatt chemsex, oppga flere menn som har sex med menn hivinfeksjon, at de hadde hatt syfilis, over ti sexpartnere og hadde deltatt på sexfest det siste året. Flere menn som har sex med kvinner oppga psykiske plager. FORTOLKNING: Det bør utredes nærmere hvordan helsevesenet best kan møte chemsexbrukernes behov. Spesielt er det viktig med informasjon om skadereduksjonstiltak og støtte til de som ønsker å slutte eller redusere bruken av chemsex.

[Lymphogranuloma venerum as ulcerous proctitis in men who have sex with men]. / Lymphogranuloma venereum som ulcerøs proktitt hos menn som har sex med menn.

Lymphogranuloma venerum (LGV), previously lymphogranulma inguinale, is a sexually transmitted infection caused by Chlamydia trachomatis serovar L1-L3. The disease is primarily manifested by a small papule or erosion in the genital region, followed by lymphadenitis and development of abscesses. Proctitis and systemic disease may occur subsequently. LGV has been a rare condition in the western world, but there have been frequent reports from larger cities in Europe and the USA from 2004. Outbreaks have been limited to networks of gay men practising mano-brachial sex ("fisting"). The syndrome may easily be confused with chronic diseases of the gut, bacterial infections and other sexually acquired diseases. We present two HIV-positive gay men where lymphogranuloma venerum was found to be the cause of ulcerative proctitis. The diagnosis was confirmed by a positive Chlamydia test from the anus with subsequent subtyping.

[Surgical treatment of basal cell carcinoma]. / Kirurgisk behandling av basalcellekarsinomer.

BACKGROUND: There are few prospective studies on the recurrence rates of basal cell carcinoma after different surgical modalities. MATERIAL AND METHODS: 263 primary basal cell carcinomas in as many patients were included from five dermatological departments in Norway. Patients on immunosuppressive medications were not included. All diagnoses were confirmed by histopathology. Primary end point was recurrence after five years, secondary end point cosmetic outcome. RESULTS: Observational data were available in 245 patients, in 160 at 5 years. Recurrence rate at 5 years was 7% after both surgical excision and cryosurgery. The cosmetic outcome was satisfactory in most cases. Tumour size was a risk factor for recurrence, localization was not. INTERPRETATION: Excision surgery and cryosurgery achieve low recurrence rates and acceptable cosmetic outcome in basal cell carcinoma.