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Doxycycline PEP Reduces Bacterial STIs In MSM

Photo Credit: Viktoriia Hnatiuk

The following is a summary of "Doxycycline prophylaxis and meningococcal group B vaccine to prevent bacterial sexually transmitted infections in France (ANRS 174 DOXYVAC): a multicentre, open-label, randomised trial with a 2 × 2 factorial design," published in the October 2024 issue of Infectious Diseases by Molina et al. 

Men who have sex with men (MSM) encounter high sexually transmitted infections (STIs) rates, requiring new interventions.    

 Researchers conducted a retrospective study to assess the effectiveness of post-exposure prophylaxis (PEP) with doxycycline and the meningococcal group B vaccine (4CMenB) in MSM, reducing STI incidence.  

 They designed the study in 10 Paris hospitals where eligible participants were HIV-negative MSM aged 18 or older with recent bacterial STIs who were randomly assigned (2:1) to doxycycline PEP (2 pills of 100 mg each orally within 72 h after condomless sex, with no more than 3 doses of 200 mg per week) or no PEP, and (1:1) to 4CMenB (GlaxoSmithKline, Paris, France; 2 intramuscular injections at enrolment and 2 months) vaccine or no vaccine. Follow-up was for at least 12 months, with 3 months of regular visits. The coprimary outcomes were the risk of a 1st episode of chlamydia or syphilis (or both) after baseline for doxycycline and the risk of a 1st episode of gonorrhea starting at month 3 for the vaccine and analyzed these outcomes in the modified intention-to-treat population.   

 The results showed that 545 male participants were included in the modified intention-to-treat analysis for doxycycline PEP and no PEP groups, and 544 for the 4CMenB vaccine and no vaccine groups. The median follow-up was 14 months (IQR 9–18), and the median age of 545 participants was 40 years (34–48) with no interaction between the 2 interventions (P≥0·1). The incidence of a 1st episode of chlamydia or syphilis (or both) was 8·8 per 100 person-years (35 events in 362 participants) in the doxycycline PEP group and 53·2 per 100 person-years (80 events in 183 participants) in the no PEP group (adjusted hazard ratio [aHR] 0·17 [95% CI 0·12–0·26]; P<0·0001) while incidence of  1st episode of gonorrhea, starting from month 3, was 58·3 per 100 person-years (103 events in 274 participants) in the 4CmenB vaccine group and 77·1 per 100 person-years (122 events in 270 participants) in the no vaccine group (aHR 0·78 [95% CI 0·60–1·01]; P=0·061) with no deaths reported with1 drug-related adverse severe event (fixed-drug eruption) occurred in the doxycycline PEP group along with 6 (2%) participants in the doxycycline group discontinued doxycycline PEP because of gastrointestinal adverse events.   

Investigators concluded that doxycycline PEP effectively lessened the incidence in MSM of chlamydia and syphilis, but the 4CMenB vaccine was not efficient for gonorrhea.    

 Source: thelancet.Com/journals/laninf/article/PIIS1473-3099(24)00236-6/abstract  

MASLD Increases Risk For Serious Bacterial Infection Requiring Hospital Admission

Metabolic dysfunction-associated steatotic liver disease (MASLD) increases risk for serious bacterial infections, which may cause hospital admission, according to study results published in Liver International.

Previous studies have associated MASLD with severe bacterial infection risk. However, the magnitude of the association is not fully understood.

Investigators searched publication databases through April 2024 for observational studies reporting the risk for serious bacterial infection requiring hospital admission among patients with and without MASLD.

A total of 8 studies, 6 cross-sectional and 2 prospective cohort studies, were included in this analysis.

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Incidence rates of serious bacterial infections increased further with greater severity of MASLD, principally higher fibrosis stage.

The pooled study population comprised 26,434,377 patients hospitalized with serious bacterial infection. The patients were a mean age of 60 years, 43.6% were men, and approximately 36% were diagnosed with MASLD.

Using data from cross-sectional studies, MASLD was associated with increased risk for serious bacterial infection requiring hospitalization (adjusted odds ratio [aOR], 1.93; 95% CI, 1.44-2.58; I2=93%). Similar findings were observed in the analysis using data from the prospective studies (adjusted hazard ratio [aHR], 1.80; 95% CI, 1.62-2.0; I2=89%).

Risk for serious bacterial infection requiring hospital admission was even higher among the subset of patients with more severe MASLD, defined as advanced fibrosis or cirrhosis (aHR, 2.42; 95% CI, 1.62-3.61; I2=92%).

These trends were consistent in the subgroup analysis that stratified by study design. No modifying effects were observed for age, gender, BMI, or comorbid diabetes.

No evidence of asymmetry was observed in the funnel plot, indicating low risk for publication bias.

This analysis may have been confounded by combining data from studies using different diagnostic criteria for MASLD.

"[T]his comprehensive meta-analysis provides evidence of a significant association between MASLD and an increased risk of serious bacterial infections requiring hospital admission (such as pneumonia, meningitis, urinary tract infections, gastrointestinal/abdominal infections or sepsis)," study authors noted. "This association remained statistically significant in those studies whose results were adjusted for age, sex, ethnicity, obesity, type 2 diabetes and other important clinical comorbidities. Incidence rates of serious bacterial infections increased further with greater severity of MASLD, principally higher fibrosis stage."

This article originally appeared on Gastroenterology Advisor

Penis-enhancement Surgeries Are Leaving Some With A Lifetime Of Pain And Regret — What To Know

Penis envy can be deadly.

Many men are going to any lengths to augment the size of their private parts — and some are left with a lifetime of pain and regret.

At best, the procedures can increase girth and the flaccid length of the penis; at worst, they can disfigure, and in rare cases, kill.

Two men, who asked for anonymity, told The Post of botched penis-enhancement surgeries that ruined their lives.

For John, 42, from Austin, Texas, the desire to augment his phallus started around six years ago.

John's troubles began a year after he got a penis implant. LuchschenF – stock.Adobe.Com

"I am like 6-5 and was really athletic and muscular, but I didn't really have the other part to match the enormous size of my body," said John, a music producer for TV shows.

While no woman indicated she was "disappointed" with him in the sack, he was self-conscious about his penis size: 4.5 inches in length when flaccid, and 6.25 inches long when erect.

His unease came despite the fact that his size trumped the average: 3.5 inches flaccid and 5.1 inches erect, according to Medical News Today.

For the first year following insertion of $12,000 silicone penile implant, John was happy. Women he slept with responded with "wow" or "oh my gosh" — which made him feel "like a million dollars," he said.

But the implant became detached — it would "slide around a little bit."

John was content for the first year after a doctor inserted a penis implant like the one pictured. Photo courtesy of Dr James J. Elist / supplied by John Chapple / http://www.JohnChapple.Com

He got the penile prosthesis replaced in 2018, and ended up losing some length and gaining a "very pronounced pubic mound." Then the implant folded on itself and his penis became disfigured. Still, he proposed to his then-girlfriend in 2019.

A third surgery to fix his penis in 2022, with a different doctor this time, left John with a deformed, 3-inch member.

Sex became painful, and it took an emotional toll on the relationship. The day after his fiancee walked out, one of the edges of the implant pierced through his skin.

He went under the knife again, this time to remove the implant. Horrifically, he lost his penis altogether.

It "went completely inside my body," John said. "The only thing I could see was the very tip of the head of my penis. Essentially I have a vagina right now."

John has a corrective surgery scheduled for December involving a penis shaft transplant and skin grafts. He is contemplating filing a malpractice lawsuit.

"It is kind of ironic" that now he wishes he could just have his original penis, which was the source of his "greatest insecurity," he said.

"It's like, 'can I just get back to what I had before any of this started?' Actually, I never will."

John had success for a year after receiving a penile implant. Visual Touch! – stock.Adobe.Com

Sean, in his 30s and from North Florida, wanted to gain more sensation in his penis, nearly two decades after lengthening surgery left him numb in the genitals. In addition he had some small-penis anxiety, although he boasted a tallywacker 3.8 inches long when flaccid, and 6 inches long when erect.

In 2022, he received injections of what he was told was a collagen-producing agent, but it ended up being silicone. As a result, his penis became deformed.

He has gone through a few procedures to fix it and has now been injected with enough silicone to fill a breast implant.

"It almost looks like an hourglass at times," Sean said. "It looks really absurd."

Then things took a dangerous turn.

Sean was diagnosed with a life-threatening bacterial infection in November, and 50% to 60% of the skin around his penis "completely died," he said. The following month an abscess formed, leading to multiple ER visits and many rounds of antibiotics.

Today Sean is healing, following a penis-saving surgery involving a penis-shaft transplant and skin grafts.

John and Sean wanted a little bit more penis, but they ended up with less plus a whole host of problems. Stuartbur – stock.Adobe.Com

"My happiness has been kind of stripped," Sean said.

More than 8,000 men worldwide undergo penis-enlargement procedures annually, according to the International Society of Aesthetic Plastic Surgery.

Dr. Kenneth Carney, an Atlanta urologic and cosmetic surgeon who is treating both John and Sean, said he performs about 300 penis enlargements per year. Of those, about 30% to 40% are to correct other doctors' mistakes.

"I think the main reason these botched cosmetic urology procedures happen is because they're being performed by general practitioners or dermatologists, not by urologists or cosmetic surgeons," Carney said.

In 2017, a "healthy" young Swedish man died during penis enlargement surgery, when fat was injected into the penis shaft, according to Journal of Forensic Sciences.

New York City plastic surgeon Dr. David Shafer, who augments penises with filler that have "an antidote to 'melt' the product if needed," said he has performed more than 7,000 girth-enhancing procedures in the last seven years, mostly without a hitch.

Done properly, penis enlargement surgery can work, Shafer said.

"Men thinking of having the procedure should do their homework and make sure they are being treated by a board-certified doctor with extensive experience in plastic surgery and injectable treatments," he advised.

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