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STDs as cofactors for the acquisition of HIV infection.


 Given strong evidence that sexually transmitted diseases (STDs) are co-factors for human immunodeficiency virus (HIV) acquisition, integration of STD prevention programs is an essential aspect of acquired immunodeficiency syndrome (AIDS) control. The interaction between STDs and HIV is bidirectional and synergistic. HIV-infected persons with a concomitant untreated STD may have enhanced shedding of the virus, thereby increasing transmission efficiency. Moreover, the impaired immunity in HIV-infected persons with an STD is associated with more severe clinical manifestations of that STD and a compromised treatment response. According to numerous prospective studies, the presence of a concurrent STD at the time of unprotected intercourse is associated with an up to five-fold increased risk of HIV infection. The presence of a genital ulcer and either urethritis or cervicitis are highly predictive of seroconversion. Cervical entropy and lack of circumcision further increase the risk of HIV transmission. Preliminary research findings from Thailand and Tanzania suggest that an aggressive AIDS educational campaign, in conjunction with condom distribution and a large-scale STD diagnosis and treatment program, has the potential to slow the rate of HIV seroconversion.
