https://doi.org/10.4081/jbr.2026.13781
Sexual behavior as a risk factor for T. Gondii infection in HIV patients
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Published: 16 February 2026
The relationship between sexual behavior and Toxoplasma gondii (T. gondii) infection has gained attention following the discovery of the parasite's presence in semen and ejaculate. Certain sexual behaviors, such as the frequency of sexual activity and inconsistent use of condoms during oral or anal sex, can increase the risk of T. gondii infection. This study aims to investigate the relationship between sexual behavior and T. gondii infection in Human Immunodeficiency Virus (HIV) patients. A cross-sectional study was conducted involving 197 HIV patients on Antiretroviral (ARV) therapy from the Jakarta, Bogor, Bekasi, and Depok regions of Indonesia, supported by four foundations. Serological status for T. gondii infection (IgG-positive) was determined using the Enzyme-Linked Immunosorbent Assay (ELISA) method. Demographic and sexual behavior data were collected through a structured questionnaire. The results revealed that risky sexual behavior significantly increased the probability of T. gondii infection with adjusted Prevalence Ratio (aPR): 6.00; 95% Confidence Interval (CI): 3.38–10.64; p < 0.001. Furthermore, sexual behavior models applied to predict T. gondii infection showed sensitivity, specificity, and accuracy rates of 92.25%, 82.4%, and 88.83%, respectively. The study showed that risky sexual behavior, particularly unprotected oral and anal sex, is associated with an increased risk of T. gondii infection in HIV patients. These findings emphasize the need for screening sexual behaviors as part of routine care in HIV management, particularly in stages I and II. Early identification of high-risk behaviors can help to inform treatment decisions and guide public health interventions, including sexual health education and prevention strategies in primary healthcare settings.
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1. Fang EE, Nyasa RB, Ndi EM, et al. Investigating the risk factors for seroprevalence and the correlation between CD4+ T-cell count and humoral antibody responses to Toxoplasma gondii infection amongst HIV patients in the Bamenda Health District, Cameroon. PLoS One 2021;16:e0256947.
2. Teimouri A, Goudarzi F, Goudarzi K, et al. Toxoplasma gondii infection in immunocompromised patients in Iran (2013–2022): a systematic review and meta-analysis. Iran J Parasitol 2022;17:443-57.
3. Dawson AC, Ashander LM, Appukuttan B, et al. Lamb as a potential source of Toxoplasma gondii infection for Australians. Aust N Z J Public Health 2020;44:49-52.
4. Lusambo NN, Kaimbo DWK, Ngoyi DM, et al. Risk factors for ocular toxoplasmosis among uveitis patients in Kinshasa, DR Congo. BMJ Open Ophthalmol 2023;8:e001198.
5. Marques CS, Sousa S, Castro A, da Costa JMC. Detection of Toxoplasma gondii oocysts in fresh vegetables and berry fruits. Parasites Vectors 2020;13:180.
6. Disko R, Braveny I, Vogel P. Examination of human seminal fluid for Toxoplasma gondii. Z Tropenmed Parasitol 1971;22:6.
7. Martínez-García F, Regadera J, Mayer R, et al. Protozoan infections in the male genital tract. J Urol 1996;156:340-9.
8. Flegr J, Klapilová K, Kaňková Š. Toxoplasmosis can be a sexually transmitted infection with serious clinical consequences: not all routes of infection are created equal. Med Hypotheses 2014;83:286-9.
9. Hlaváčová J, Flegr J, Řežábek K, et al. Association between latent toxoplasmosis and fertility parameters of men. Andrology 2021;9:854-62.
10. Tong WH, Hlaváčová J, Abdulai-Saiku S, et al. Presence of Toxoplasma gondii tissue cysts in human semen: toxoplasmosis as a potential sexually transmissible infection. J Infect 2023;86:60-5.
11. Alvarado-Esquivel C, Sánchez-Anguiano LF, Hernández-Tinoco J, et al. High seroprevalence of Toxoplasma gondii infection in female sex workers: a case-control study. Eur J Microbiol Immunol 2015;5:285-92.
12. Christiansen C, Maus D, Hoppenz E, et al. In vitro maturation of Toxoplasma gondii bradyzoites in human myotubes and their metabolomic characterization. Nat Commun 2022;13:1168.
13. Cerutti A, Blanchard N, Besteiro S. The bradyzoite: a key developmental stage for the persistence and pathogenesis of toxoplasmosis. Pathogens 2020;9:234.
14. Bonamente M, Chen Y, Zimmerman D. Maximum-likelihood regression with systematic errors for astronomy and the physical sciences: methodology and goodness-of-fit statistic of Poisson data. Astrophys J 2024;980:139.
15. Barros AJD, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 2003;3:21.
16. Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004;159:702-6.
17. Martínez-García F, Regadera J, Mayer R, et al. Protozoan infections in the male genital tract. J Urol 1996;156:340-9.
18. Saki J, Sabaghan M, Arjmand R, et al. Spermatogonia apoptosis induction as a possible mechanism of Toxoplasma gondii-induced male infertility. Iran J Basic Med Sci 2020;23:1164-71.
19. Ullmann J, Kodym P, Flegr J, et al. Oral sex as a potential route for Toxoplasma gondii transmission: experiment with human semen and laboratory mice model. Acta Parasitol 2024;69:1314-8.
20. Kaňková Š, Hlaváčová J, Flegr J. Oral sex: a new, and possibly the most dangerous, route of toxoplasmosis transmission. Med Hypotheses 2020;141:109725.
21. Copen CE, Chandra A, Martinez G. Prevalence and timing of oral sex with opposite-sex partners among females and males aged 15–24 years, United States 2007–2010. CDC Natl Health Stat Rep 2012;56:1-14.
22. Flegr J, Kuba R. The relation of Toxoplasma infection and sexual attraction to fear, danger, pain, and submissiveness. Evol Psychol 2016;14:1474704916659746.
23. Boyer KM, Holfels E, Roizen N, et al. Risk factors for Toxoplasma gondii infection in mothers of infants with congenital toxoplasmosis: implications for prenatal management and screening. Am J Obstet Gynecol 2005;192:564-71.
24. Petersen E, Vesco G, Villari S, Buffolano W. What do we know about risk factors for infection in humans with Toxoplasma gondii and how can we prevent infections? Zoonoses Public Health 2010;57:8-17.
25. Lindsay DS, Dubey JP. Toxoplasma gondii: the changing paradigm of congenital toxoplasmosis. Parasitology 2011;138:1829-31.
26. Baldwin JI, Baldwin JD. Heterosexual anal intercourse: an understudied high-risk sexual behavior. Arch Sex Behav 2000;29:357-73.
27. Leichliter JS, Chandra A, Liddon N, et al. Prevalence and correlates of heterosexual anal and oral sex in adolescents and adults in the United States. J Infect Dis 2007;196:1852-9.
28. Nistal M, Santana A, Paniaqua R, Palacios J. Testicular toxoplasmosis in two men with the acquired immunodeficiency syndrome (AIDS). Arch Pathol Lab Med 1986;110:744-6.
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