To the Editor: Dr Osmond and colleagues1 noted the lack of consensus as to the route of
KSHV transmission in homosexual men. Recent studies1- 3
have suggested that KSHV, also known as human herpesvirus 8 (HHV-8), is primarily
transmitted among homosexual men through deep kissing or oral sex. While this
hypothesis is consistent with much of the data, it fails to explain why HHV-8
is much more prevalent in homosexual than in heterosexual men, since deep
kissing and oral sex are common in both groups. Nor can differences in HHV-8
prevalence be solely attributed to numbers of sex partners, because even commercial
sex workers have a lower prevalence of HHV-8 than do homosexual men.4 Thus, the higher prevalence of HHV-8 among homosexual
men may be related to sexual practices, such as anal sex, that are more prevalent
among this population. Several findings of Osmond et al are consistent with
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