African American primary care physicians' perceptions and practices regarding smoking cessation therapy.

African American smokers (34% of males and 23% of females) need formal interventions to assist them in quitting smoking, a major method of preventing premature mortality from smoking-related illnesses. The purpose of this study was to examine African American primary care physicians' perceptions and practices regarding smoking cessation counseling. A national random sample (n=202) of primary care physicians was asked about their perceptions and practices regarding smoking cessation therapy. Most (89%) placed themselves in the maintenance stage for asking their patients about their smoking status and regularly documented the smoking status of their patients (70%). Most physicians did not comply with all of the components of the U.S. Public Health Services' smoking cessation guidelines (e.g., 5 A's and 5 R's). The component most often implemented of the 5 A's was to "advise" patients to quit (89%), and "arrange" followup was the least frequently (60%) used component. Perceived barriers to engaging in smoking cessation interventions were time (38%) and patients not interested in quitting (19%). Although physicians used many of the steps in the 5 A's and 5 R's, they were far less compliant in recommending nicotine replacement therapy, prescribing pharmacotherapy, and providing support and/or follow-up for patients who were willing to quit smoking. Physicians need more academic preparation in providing smoking cessation counseling since few received such training in medical school (31%) or during their residency programs (18%).

Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men.

We examined HIV infection and estimated the population-attributable risk percentage (PAR%) for HIV associated fellatio among men who have sex with other men (MSM). Among 239 MSM who practised exclusively fellatio in the past 6 months, 50% had three partners, 98% unprotected; and 28% had an HIV-positive partner; no HIV was detected. PAR%, based on the number of fellatio partners, ranges from 0.10% for one partner to 0.31% for three partners. The risk of HIV attributable to fellatio is extremely low.

Increased sensitivity of DNA amplification testing for the detection of pharyngeal gonorrhea in men who have sex with men.

We compared ligase chain reaction (LCR) assay with standard culture for the detection of pharyngeal Neisseria gonorrhoeae infection in men who have sex with men (MSM) presenting at a sexually transmitted diseases clinic in San Francisco. Pharyngeal specimens were obtained from 200 MSM who reported performing fellatio during the previous 2 weeks. Confirmatory testing of discrepant specimens was conducted using N. gonorrhoeae pilin proteins. Prevalence of pharyngeal N. gonorrhoeae was 6% by culture or 11% by LCR. The sensitivity and specificity of LCR were 94.7% and 97.8%, respectively, compared with values of 47.4% and 100% for culture. Prevalence of pharyngeal N. gonorrhoeae infection, as determined by DNA amplification testing, was higher than that suggested by traditional culture. Results support the use of DNA amplification testing in the oropharynx. The high prevalence of pharyngeal N. gonorrhoeae infection among MSM suggests that routine screening should be considered in efforts to reduce the burden of gonorrhea in this population.