Sexually transmitted disease acquisition among HIV-infected women

Objective: Little data are available on the relationship between HIV infection and other STDs in women. We report on incident and prevalent STDs among HIV infected women followed in a university-based longitudinal care clinic. Methods: All women enrolled in an urban HIV clinic were evaluated at enrollment and follow-up for gonorrhea (GC), chlamydia (Ct), trichomonas (trich), genital herpes (HSV), genital warts, pelvic inflammatory disease (PID), and syphilis. Results: One hundred thirty-seven HIV-infected women (ages 20 and older) were enrolled and followed for a mean of 19.3 months. At enrollment, mean CD₄ count was 390/mm³ (range 1-1288/mm³); twenty of 119 evaluable patients were pregnant (16.8%) and 25 of 117 patients (21.4 %) had at least one STD. Distribution of specific STDs was as follows: One GC (1%), 2 Ct (2%), 12 trich (10%), 6 HSV (5%), and 8 syphilis (6%). An abnormal Pap smear was seen in 100 women (81%); 38 women (31%) had CIN-I or greater. Incident STDs were found in 38 of the 118 patients (32%) who returned for at least one follow-up visit. Distribution of these incident STDs was as follows: 4 GC (3%), 4 Ct (3%), 17 trich (15%), 17 HSV (15%), 4 warts (3%), 3 PID (3%) 5 syphilis (5%). Fifty-three (47%) used long-acting hormonal contraceptives, and none used condoms consistently. Ten patients (8%) became pregnant during follow-up. Conclusions: High rates of STDs among HIV-infected women indicate high-risk sexual behavior, despite intensive counseling at enrollment and follow-up. Risk-reduction messages must stress both consistent condom use and hormonal contraception. Aggressive cervical screening is necessary given the high rate of CIN seen in this population of women.