Heterosexual Transmission of HIV: The Role of Other Sexually Transmitted Infections and Behavior in Its Epidemiology Prevention and Control

Aral, Sevgi O.

doi:10.1146/annurev.pu.14.050193.002315

Cited by 28 publications

(8 citation statements)

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“…C. trachomatis and N. gonorrhoeae are of concern because of the negative effect these infections have on fertility and pregnancy and the synergistic relationship they have with human immunodeficiency virus (HIV) (2–4). Mycoplasma genitalium is an emerging sexually transmitted infection (STI) (5–7) with symptoms similar to those for C. trachomatis and N. gonorrhoeae .…”

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confidence: 99%

Mycoplasma genitaliumpresence, resistance and epidemiology in Greenland

Gesink

Mulvad

Montgomery-Andersen

et al. 2012

International Journal of Circumpolar Health

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ObjectivesGreenland reports the highest rates of chlamydial infection and gonorrhea in the Arctic. Our objective was to determine the presence, and describe the basic epidemiology, of Mycoplasma genitalium for Greenland.Study designCross-sectional study.Methods314 residents from Nuuk and Sisimiut, between the ages of 15 and 65 years, participated in “Inuulluataarneq” (the Greenland Sexual Health Project) between July 2008 and November 2009. Participants provided self-collected samples for sexually transmitted infection (STI) testing and completed a sexual health survey. Descriptive statistics and logistic regression were used to summarize the basic characteristics of STI cases overall and M. genitalium and Chlamydia trachomatis specifically. Clinically relevant characteristics in each full model were gender (male or female), age (in years), age at sexual debut (in years), number of sexual partners in the past 3 months (continuous) and history of forced sex and community.ResultsThe overall prevalence of STIs was 19.0%, specifically: 9.8% for M. genitalium and 9.4% for C. trachomatis; 100% of M. genitalium-positive cases carried macrolide resistance determinants. Being female [OR =3.2; 95% confidence interval (CI): 1.1–9.8] and younger age (OR=0.9; 95% CI: 0.9–1.0) were associated with M. genitalium positivity. Age was also associated with C. trachomatis (OR=0.9; 95% CI: 0.8–0.9) and STI positivity overall (OR=0.9; 95% CI: 0.9–0.9).ConclusionsWe observed a high prevalence of M. genitalium and macrolide resistance in this study. A better understanding of M. genitalium sequelae is needed to inform policy around testing, treatment, control and antibiotic use.

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confidence: 99%

Mycoplasma genitaliumpresence, resistance and epidemiology in Greenland

Gesink

Mulvad

Montgomery-Andersen

et al. 2012

International Journal of Circumpolar Health

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“…4 Indeed, women are twice as likely as men to become infected by a variety of sexually transmitted pathogens, 5 and the efficiency of male-tofemale transmission of HIV is approximately 4 times higher than female-tomale transmission. 6 Aside from the increased biological risk of transmission, women may be at high risk of STI and HIV owing to social and cultural norms of behavior that dictate that women cannot decline sexual intercourse with their partners or insist on the use of barrier methods for protection during intercourse. 7 Moreover, these same social and cultural norms often allow men to seek sexual pleasure outside of the home, thereby possibly increasing the risk of acquiring STIs, including HIV.…”

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confidence: 99%

Effectiveness of Interventions to Prevent Sexually Transmitted Infections and Human Immunodeficiency Virus in Heterosexual Men

Elwy¹,

Hart²,

Hawkes³

et al. 2002

Arch Intern Med

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Our objective was to review systematically studies of interventions to prevent transmission of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) in heterosexual men. Of 1157 studies identified through database and hand searching, 27 met our inclusion criteria. Most interventions targeted specific groups of men (eg, those attending STI clinics) rather than general populations. Few were conducted with men alone, and most focused on behavioral and social psychological rather than morbidity outcomes. Of 8 interventions designed to reduce STI incidence (including HIV), 5 were successful, 2 were unsuccessful, and 1 had equivocal results. Of the 5 successful interventions, 1 was carried out in the workplace, 1 in the military, and 3 in STI clinics.They included on-site individual counseling and HIV testing, mass communications regarding risk reduction, and multiple-component motivation and skills education in STI clinics. More high-quality research into the effectiveness of interventions targeting heterosexual men is needed, especially methodologically sound trials to evaluate effects on morbidity.

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“…Moreover, concurrent STDs, both ulcerative and nonulcerative, in an HIV-infected person may increase the risk of HIV transmission to an uninfected partner. [2][3][4][5][6][7][8] Therefore, characterizing persons with HIV infection who subsequently develop an STD can help in the targeting of educational efforts to a group with a higher probability of transmitting HIV.…”

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confidence: 99%

Risk factors for trichomoniasis among women with human immunodeficiency virus (HIV) infection at a public clinic in Los Angeles County, California: implications for HIV prevention.

Sorvillo

Kovacs²,

Kerndt³

et al. 1998

The American Journal of Tropical Medicine and Hygiene

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Abstract. Persons with human immunodeficiency virus (HIV) infection who subsequently develop an acute sexually transmitted disease have an increased probability of transmitting HIV. Therefore, characterizing such persons can help direct prevention efforts to a group who are likely to be continuing sources of HIV transmission. We assessed the incidence and factors associated with trichomoniasis in a cohort of HIV-infected women receiving care at a public clinic in Los Angeles County, California from 1992 through 1995. Demographic, clinical, and behavioral data were available from medical records and from patient interviews. Trichomonas infection was the most frequently identified sexually transmitted disease and was found in 37 (17.4%) of 212 women representing a crude incidence rate of 14.1 per 100 person-years experience. The crude rate of trichomoniasis was highest in black women (69.0 per 100 personyears), women with a history of trading sex for drugs or money (51.0 per 100 person-years), those using crack or cocaine (35.5 per 100 person-years), women with four or more sex partners (43.0 per 100 person years), and those born in the United States (23.3 per 100 person-years). Among women with severe immunosuppression (CD4ϩ count Ͻ 200), 18.4% (18 of 98) were diagnosed with trichomoniasis. After multivariate analysis using a Cox proportional hazards approach, black race (adjusted rate ratio [RR] ϭ 5.6, 95% confidence interval [CI] ϭ 2.3, 13.3) continued to be strongly associated with Trichomonas infection. Trading sex for money or drugs (adjusted RR ϭ 25.2, 95% CI ϭ 4.3, 148.6) and single marital status (adjusted RR ϭ 3.7, 95% CI ϭ 1.1, 13.0) were independent risk factors for trichomoniasis in nonblack women but not among black women. Data from this study indicate that Trichomonas may be a frequently acquired infection in HIV-positive women. Our findings suggest that HIV-infected women who are black, and nonblack women who trade sex for money or drugs or are unmarried, are at increased risk of trichomoniasis and therefore may be more likely to transmit HIV infection. Local HIV prevention strategies should target such women for intervention efforts.

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Heterosexual Transmission of HIV: The Role of Other Sexually Transmitted Infections and Behavior in Its Epidemiology Prevention and Control

Cited by 28 publications

References 50 publications

Mycoplasma genitaliumpresence, resistance and epidemiology in Greenland

Mycoplasma genitaliumpresence, resistance and epidemiology in Greenland

Effectiveness of Interventions to Prevent Sexually Transmitted Infections and Human Immunodeficiency Virus in Heterosexual Men

Risk factors for trichomoniasis among women with human immunodeficiency virus (HIV) infection at a public clinic in Los Angeles County, California: implications for HIV prevention.

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