Researchers from London reported at the ninth annual Conference of the British HIV Association that recreational drug use and specific sex acts like unprotected anal sex and fisting are putting HIV-positive gay men at an increased risk of acquiring hepatitis C, AIDSmap.com reports. Infection with syphilis also was identified as a hepatitis C risk factor. Officials at London's Royal Free Hospital identified 20 cases of acute hepatitis C infection among HIV-positive gay men between October and January. Eight of the men had chronic syphilis at the time they were diagnosed with hepatitis C. All of the men reported having engaged in unprotected anal intercourse in the previous six months, 17 reported engaging in fisting, and 17 reported having had group sex. While only two of the men reported using injection drugs, which is a high-risk activity, 70% reported having shared straws to snort cocaine or ketamine. Additional, larger studies are planned to more accurately gauge the hepatitis C risks associated with syphilis coinfection, unprotected sex acts, and recreational drug use, particularly the sharing of inhalant drug paraphernalia.