STDs and HIV
HIV Counselor Perspectives
V3, N1, Feb 1993
Research Update
Each year in the United States an estimated 12 million people are
infected with STDs; two-thirds of these people are under age 25. [1]
More than 50 organisms and syndromes are recognized as being
sexually transmitted. STDs are caused by a variety of agents,
including bacterial and viral ones. Bacterial STDs include gonorrhea
and syphilis. Medications can be used a preventive therapy as well as
to treat and cure bacterial STDs.
Viral STDs include HIV, genital herpes, hepatitis B, and human
papillomavirus (HPV). Viral STDs can be transmitted through sexual and
non-sexual routes. While treatable, viral STDs are not curable, and
therefore they can recur or they can progress. Fungal and parasitic
agents, including trichomoniasis, can also be transmitted sexually.
STD symptoms typically include one or more of the following: buring
or pain during urination and defecation; itching or burning around the
genitals; mucous discharge or bleeding from the genitals; ulceration
or blistering; rashes on the body; and flu-like symptoms. STD
infections lead to a variety of illnesses, including pelvic
inflammatory disease (PID) and non-gonococcal ufethritis.
After being infected with most STDs, people may remain
asymptomatic, or free of symptoms, for extended periods ranging from
days to several months. During this period, however, people can
transmit the infection to others.
Symptoms related to bacterial or viral STDs often dissipate and
recur. Because of long periods in which an infection may not produce
symptoms, public health and medical experts recommend that people at
risk for STDs seek an STD risk assessment, a physical examination
based on syptoms, and laboratory tests to detect infections that may
be asymptomatic.
Relationship between HIV and Other STDs
HIV and other STDs are related in several ways. They are
transmitted through similar routes and they respond to similar
prevention messages. [2,3]
Researchers have identified a complex relationship between HIV and
other STDs that results in a synergistic interaction -- that is, the
presence of HIV with another STD produces a result affecting the
course of HIV disease that would not be produced if the STD was
absent. [4] Of the major STDs, syphilis, chlamydia, gonorrhea, genital
herpes, trichomoniasis, genital warts, and hepatitis B have been
investigated for their impact on HIV.
Researchers have demonstrated that the presence of STDs, both
ulcerative and non-ulcerative, increases the risk of HIV transmission
about 3- to 5-fold. [4] STDs appear to promot HIV transmission by
causing inflammation and lesions of the genital tract, thus creating
an accessible place of entry for HIV. Ulcerations, which are caused by
syphilis and genital herpes, have been related to increased
susceptibility for HIV transmission. Increased risk of HIV
transmission can also be attributed to non-ulcerative STDs such as
chlamydia, gonorrhea and trichomoniases, which weaken the body's
defenses against disease. However, research related to the
relationship between non-uncerative STDs and HIV is more limited. [4]
Researchers suggest that the debilitating effects of STDs may
accelerate progression of HIV for someone who is infected with HIV. In
addition, for someone with HIV, it appears that the suppressive
effects of HIV on the immune system worsen the symptoms of other STDs
and decrease the healing effects of STD therapies. [4]
It is also possible that the course of an STD may be altered by
HIV. For example, genital herpes ulcers normally heal within two to
three weeks but persist much longer in people with HIV. Similarly,
syphilis treatments sometimes fail or the disease develops more
severely in people with HIV. [5]
Facts about STDs
- Syphilis
- Syphilis is a bacterial STD that produces ulcers in the
genitals, throat and rectum. Effective treatment with penicillin is
widely available; without treatment, heart disease, brain damage,
blindness and death can result. Although the rate of syphilis
infection has declined steadily in the last 50 years, sporadic
outbreaks occurred during the 1980s in some urban areas. The
occurrence was most common among African-American men and women in
urban communities with high HIV incidence. [2] In 1990, 134,000
syphilis cases were reported nationally.
- Gonorrhea
- Affecting as many as one million people each year in this
country, gonorrhea is a bacterial infection that causes inflammation
of the urethra and rectum in men. In women, it causes inflammation
of the cervix, and infections of the uterus, fallopian tubes and
pelvic organs -- leading to PID. Symptoms include pain during
urination or defecation and discharge from the vagina or penis.
While penicillin historically has been the most widely used
treatment to cure gonorrhea, strains resistant to penicillin
have developed in recent years. [5] Therefore, suspected
gonorrhea cases are now treated with other medicines, even
though these are often many times more expensive than
penicillin. [1]
- Chlamydia
- Chlamydia, like gonorrhea, causes inflammation of the urethra,
cervix and prostate, and can cause PID and genital ulcers.
Manifestations of chlamydia have both bacterial and viral
characteristics. In women, chlamydia can lead to premature birth,
ectopic pregnancy and sterility. During ectopic, or tubal,
pregnancy, the fetus develops outside the uterus in the fallopian
tubes.
Nationally, as many as four million people across all
ethnic groups may be infected with chlamydia. A person with
this STD can remain asymptomatic for long periods. Accurate and
affordable diagnostic tests have only recently become widely
available. When diagnosed, infections can be cured by taking
tetracycline or other antibiotics. [6] Several studies from
Africa clearly indicate that women with cervical chlamydial
infection are at increased risk of being infected with HIV
through unsafe sexual intercourse. [5]
- Trichomoniasis
- Thrichomoniasis, a parasitic condition estimated to affect three
million people in the United States, has not been thoroughly studied
for its relationship to HIV. Those with the disease may be
asymptomatic for extended periods. In women, trichomoniasis may
cause severe vaginitis, and in men, painful swelling of the penis as
well as epididymitis. Treatment regimens usually involve the drugs
flagyl or metronidaole.
- Genital Herpes (herpes simplex virus types 1 and 2)
- Genital herpes, a viral infection, is an uclerative disease
that causes painful blisters on the genitals, mouth, anus, and
other mucous membranes, and sometimes on the skin of other
areas of the body. Men and women infected with genital herpes
are often asymptomatic for long periods. Women can have a
longer asymptomatic period and a more sever initial
manifestation of disease than men, and women can transmit the
virus during pregnancy and childbirth. Recurrent episodes are
common, but are usually less severe over time. Acyclovir is the
standard treatment for genital herpes.
Various studies estimate that 25% to 50% of all people
in this country are infected with a herpes virus. [1]
Studies have found infection rates two to three times
higher among African Americans and highest among
African-American women. Infection rates are
disporportionately higher among poorer people living in
inner city areas. [5]
- Human papillomavirus (HPV)
- There are more than 60 types of HPV, and millions of
sexualy active people are known to be infected with the virus.
Some types of HPV cause genital infection, and a small number
produce benign genital warts, which are non-ulcerative and
frequently recur. Certain types of HPV are linked to
pre-cancerous lesions or cancer of the cervix, vulva, penis,
anus and throat. HPV cannot be eradicated; treatment usually
involves removal of warts by cold-based therapies such as
liquid nitrogen, or through laser therapy.
While there are no well-designed, prospective studies of
HPV's effects on HIV, it seems clear that the
immunosuppression caused by HIV affects the course of HPV.
A recent study confirmed that gay men with HIV are at
increased risk for HPV infection. [7] In the presence of
HIV, a broader variety of HPV infections tends to occur,
infections often worsen and larger lesions appear. In
people with HIV, HPV infections typically do not respond
as well to therapy.
- Hepatitus B virus
- People infected with hepatitis B may develop
cirrhosis, carcinomas and chronic active hepatitis.
While a vaccine was introduced 10 years ago, and it
is considered effective, incidence has remained
unchanged since then. [8] No special treatments are
recommended for active infection.
In addition to sexual routes of transmission,
hepatitis B may be transmitted to a fetus during
pregnancy or to a child at birth, as well as through
injection drug use. It is estimated that up to half
of all hepatitis B infections are sexually
transmitted. [9] The proportion of hepatitis B cases
attributed to sexual contact between men has declined
in recent years, while the proportion attributed to
heterosexual contact and injection drug use has
increased. Multiple sex partners and high-risk sex
practices, especially receptive anal intercourse,
place both gay men and heterosexuals at increased
risk for hepatitis B transmission. [9]
HIV Counselor Perspectives, V3N1, 2/93
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(Thu Sep 1 20:40:09 1994)
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