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Nicholas Bennett,
Infectious Disease Postdoc/Clinician
Department of Pediatrics, University Hospital, Syracuse NY

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The Perth Group make it so much easier for me when they provide their own refutations:

According to the refs at the article they cite:

Examples of high promiscuity (35) and anal intercourse (40) are clearly confounders with a sexually transmitted virus infection and cannot rule out such a thing.

Ref 43 (from 1987) refers to cervical cancer which is now known to be caused by HPV of many types, but predominantly 33 and 31. Semen is once again a confounder. Refs 41 and 42 also refer to anal cancer which is the homosexual equivalent of cervical cancer in women (i.e. is due to HPV).

Ref 47: The authors correlate "semen" carcinogenesis with an agent that activates EBV, a herpes virus. HHV8 is also a herpes virus, and the parallels cannot go unnoticed. This does not show that semen is carcinogenic.

Ref 44, 48 and 49 are from the same author with the same story trying to promote sperm as a carcinogenic agent in rats, mostly from the late 1970s (but I did find more recent publications from the late 1990s). His theory is not accepted by most in the field as necessary to explain anal/cervical cancer although it is interesting enough. It also fails to explain KS's location: if "poppers" are at fault due to inhalation how can semen act on the face and yet not at the level of the anus to cause local KS?

The arguments presented are extremely poor, and do not "better account for the presently available epidemiological data on KS in homosexuals ". HHV8 is no longer a new, unknown infectious agent: will the Perth Group comment on my recent post highlighting the epidemiological and molecular basics of HHV8 and KS? Will they comment on the genome deposited at GenBank under accession NC_003409?

It is reasonably clear that water is not carcinogenic (can they not take a joke?) and I don't think I've ever claimed that HIV is carcinogenic aside from its ability to increase the risk of certain tumours due to immune suppression. HHV8 is fairly clearly carcinogenic since it contains several tumour-causing genes, can be found in all cases of KS (and many of Castleman's disease) and is epidemiologically associated with the various tumours.

Can the Perth Group explain why the ubiquitous exposure of semen is only associated with KS in the presence of HHV8 infection?

Competing interests: None declared