HIV and STDs
Posted January 2008
It is common knowledge that the same sexual behaviors that place someone at risk for an STD (unprotected anal, vaginal and oral sex) also pose risk for HIV. Increasing evidence demonstrates that there is an even stronger link between STDs and HIV. Recent studies in Africa have shown that routine screening and early treatment of STDs in a community can significantly lower the number of new cases of HIV infection. This question and answer sheet is designed to provide you with information about: 1) how an untreated STD can increase a person’s chance of getting or transmitting HIV when engaging in unprotected sexual activity; 2) the importance of routine screening and early treatment of STDs as an approach to preventing new HIV infections; 3) key messages to share with your clients and community about the link between HIV and STDs.
How does the presence of an untreated STD increase a person’s risk of acquiring HIV?
Ulcerative STDs (herpes, syphilis, chancroid) can cause sores or breaks in the skin on and around the genitals. These sores or breaks in the skin provide a site of entry for HIV if the individual is exposed to blood, semen or vaginal secretions containing HIV. Both ulcerative and non-ulcerative STDs (chlamydia, gonorrhea, trichomoniasis) cause the body to bring CD4 cells to the site of infection to fight the STD. CD4 cells are the prime target cells for HIV. The increased number of CD4 cells means that it is easier for HIV from the infected person’s blood, semen or vaginal secretions to find and infect target cells in the uninfected person. Studies show that the presence of an untreated STD increases the risk of getting HIV by 3-5 times.
How does the presence of an untreated STD in an HIV-infected person increase the person’s risk of transmitting HIV to others?
New research has shown that when a person is infected with both HIV and an STD the amount of HIV in the person’s semen or vaginal secretions is significantly increased and the chances of transmitting the virus is 3-5 times higher, compared to a person not infected with an STD. This means that these individuals are more able to infect partners if they have unprotected sexual intercourse. Early treatment of STDs can help reduce the higher level of HIV in the semen and vaginal secretions. Individuals unknowingly infected with both HIV and an STD will be unaware that they can infect others and may be unaware of the importance of HIV/STD risk reduction, testing and treatment.
Why is routine screening, early identification and treatment of STDs important for people living with HIV infection?
New York State Department of Health Clinical Guidelines recommend routine evaluation of risk for STDs at the initial medical visit for all persons newly diagnosed with HIV infection. Thereafter, annual evaluation for STDs is recommended. Evaluation and screening for STDs in people with HIV infection is important for several reasons: 1) STDs can cause increased damage to the body when a person’s immune system is compromised; 2) STDs frequently do not have symptoms and are only detected through medical tests; 3) if left untreated many STDs can cause irreversible problems such as cervical cancer, birth defects or infertility. The progressive nature of untreated STDs underscores the importance of ongoing counseling regarding risk reduction and partner notification services for people living with HIV. These services can prevent the spread of HIV to others and help to protect the person with HIV from exposure to STDs and other strains of HIV.
What are the key messages about HIV and STDs that Providers should share with their clients and communities?
All clinical and non-clinical HIV/STD service providers should educate their patients, clients and communities about:
- how routine screening and early treatment of STDs can help prevent new HIV infections;
- the importance of recommending H IV testing for all individuals diagnosed with an STD;
- the importance of routine screening for STDs because STDs frequently do not have symptoms and are only detectable through screening;
- the general symptoms of STDs- sores, lesions, irritation, discharge;
- the importance of prompt screening and treatment whenever symptoms are present.
Historically, knowledge about STDs has been very low, even in communities where there is high prevalence of STDs. In some cases, STDs may be viewed as unavoidable or may even be viewed as an “initiation” into adulthood. There may be lack of concern about STDs because they may be viewed as easily curable. Education about how STDs can increase a person’s chance of acquiring HIV is critical and may help change the view that STDs are a harmless “fact of life.”
Community HIV/AIDS educators, outreach workers and other health educators should become familiar with basic information about STDs. Educators and outreach workers can play an important role by:
- helping to establish routine screening and early treatment of STDs as a community norm;
- working with clinical providers to ensure availability of in-depth HIV education and risk reduction/harm reduction counseling for individuals at highest risk for HIV/STD;
- providing in-depth education and risk reduction/harm reduction counseling for individuals engaging in HIV/STD risk behavior, especially substance users and their partners;
- educating their communities about local resources for STD screening and treatment and making referrals as needed.
Each county health department in New York State offers STD screening and treatment. STD service providers should:
- work with community educators and health care providers to ensure that STD screening and treatment services are available and accessible;
- routinely recommend and provide voluntary HIV testing to all individuals at risk for or diagnosed with an STD;
- be able to provide or refer clients for HIV testing and a comprehensive array of HIV-related prevention and care services.
Impact of Improved Treatment of Sexually Transmitted Diseases on HIV Infection in Rural Tanzania, Grosskurth, et al, Lancet, Vol 346, August 25, 1995, pp 530-536.
Screening and Treatment of Sexually Transmitted Diseases: An Important Strategy for Reducing the Risk of HIV Transmission, Hitchcock, P, AIDS Patient Care and STDs, February, 1996, pp 10-15.
Factors Facilitating the Sexual Transmission of HIV-1, Sullivan, et al, AIDS Patient Care and STDs, Vol 11, Number 3, pp 167-177.