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Advanced Neurology Sexual behavior and multiple sclerosis

Table 2. Outcome of diagnosis with multiple sclerosis (G35) between (a) adults engaging in all forms of high‑risk sexual behavior
versus adults not engaging in high‑risk sexual behavior; (b) males engaging in high‑risk homosexual and/or bisexual behavior
versus males engaging in high‑risk heterosexual behavior; (c) females engaging in high‑risk homosexual and/or bisexual
behavior versus females engaging in high‑risk heterosexual behavior; cohorts are matched for age, race, and ethnicity
Cohort N Patients with outcome Risk Risk ratio Odds ratio P‑value
of multiple sclerosis (95% CI)
High-risk sexual behavior versus absence of high-risk sexual behavior
Adults engaging in high-risk 220,969 742 0.336% 0.959 0.959 0.4103
sexual behavior (0.867, 1.060) (0.867, 1.060)
Adults not engaging in high-risk 220,969 774 0.350%
sexual behavior
Male same-sex high-risk behavior versus male opposite-sex high-risk behavior
Males engaging in same-sex 12,593 53 0.428% 2.789 2.797 <0.0001
high-risk behavior (1.653, 4.708) (1.655, 4.727)
Males engaging in opposite-sex 12,593 19 0.153%
high-risk behavior
Female same-sex high-risk behavior versus female opposite-sex high-risk behavior
Females engaging in same-sex 7,128 116 1.627% 2.275 2.296 <0.0001
high-risk behavior (1.639, 3.156) (1.649, 3.196)
Females engaging in 7,128 51 0.715%
opposite-sex high-risk behavior
Abbreviation: EBV: Epstein–Barr virus.

A B C may be hindering the development of adequate treatment
and identification strategies for this patient population
already known to be at risk for negative health outcomes
due to societal and health-care inequalities [8-10] .
Our findings may be useful for a range of providers
interested in comprehensive patient care, not only those
who focus on the LGBTQ+ population. Patients present
for care with a wide variety of concerns, and sexual
health is an important aspect of overall wellness . The
[4]
strong association noted in our study could help identify
Figure 1. Odds ratio (OR) of multiple sclerosis diagnosis between individuals in the prodromal stage of MS development.
(A) adults engaging in all forms of high-risk sexual behavior versus
adults not engaging in high-risk sexual behavior (OR: 0.96; P = 0.4103); The prodrome may be useful for successful intervention
(B) females engaging in high-risk homosexual and/or bisexual behavior in slowing or stopping MS progression, but a prerequisite
[18]
versus females engaging in high-risk heterosexual behavior (OR: 2.30*; is successful identification . As all patients in our study
*P < 0.0001); (C) males engaging in high-risk homosexual and/or bisexual disclosed their patterns of sexual behavior to a health-
behavior versus males engaging in high-risk heterosexual behavior care provider, our data are reflective of individuals who
(OR: 2.80*; *P < 0.0001) – all cohorts are matched for age, race, ethnicity,
infectious mononucleosis, and Epstein–Barr virus seropositivity. may have shown prodromal symptoms and have a known
personal factor that may increase a provider’s index of
Americans . Our results generate further questioning suspicion for MS.
[13]
around whether negative MS outcomes may analogously As with all retrospective database studies, our study
apply to this sexual minority population. Regarding was limited by the de-identified, aggregate nature of the
pharmacologic treatment, recent research has shown data which prevented us from longitudinally investigating
that men who have sex with men are far more likely than specific characteristics or obtaining detailed socioeconomic
the general population to use pre-exposure prophylaxis status information, which could be a confounding factor.
medications or to have been immunized with the recent It is also worthwhile to note that patients engaging in
monkeypox vaccine, which may interact in unforeseen exclusively same-sex or opposite-sex behavior may not
ways with common therapies for MS [11,12] . The gap in identify with any specific sexual identity. Up to 11% of
research for individuals engaging in same-sex behavior individuals identifying as heterosexual may have same-

Volume 2 Issue 4 (2023) 4 https://doi.org/10.36922/an.1383