The Clinical Manifestations and Treatment of Sexually Transmitted Diseases in Human Immunodeficiency Virus-Positive Men

Abstract

Sexually transmitted diseases (STDs) occur commonly in sexually active human immunodeficiency virus (HIV)-positive men. STDs may have atypical presentations, can cause significant morbidity in persons with HIV infection, and may increase the risk of HIV transmission. Thus, the appropriate diagnosis and treatment of STDs in this population are extremely important. The clinical manifestations and treatment of several common STDs in HIV-positive men are reviewed. Further research is needed to define effective management and screening strategies for STDs in men with HIV infection.

A Case of Ocular Syphilis in a 36-Year-Old HIV-Positive Male

“…Some studies suggest that syphilis facilitates HIV transmission by increasing expression of its CCR5 receptors or inducing expression of the HIV-1 gene in human monocytes [5]. HIV infection alters the natural history of syphilis leading to unusual and more aggressive clinical manifestations as well as earlier neurologic involvement [6]. …”

“…In HIV-infected patients, syphilitic involvement of the eye has been shown to occur earlier than in HIV-uninfected patients [6]. Furthermore, ocular syphilis in the setting of untreated HIV is more frequently bilateral and more likely to involve the posterior chamber than in those without HIV [13].…”

“…Lumbar puncture serves to both confirm the diagnosis of neurosyphilis and subsequently judge the efficacy of treatment [7, 13]. A positive CSF VDRL is highly specific for neurosyphilis, although insensitive [6]. CSF examination may also reveal a lymphocytic pleocytosis or elevated protein; however, such findings may also be seen in HIV-infected patients without syphilis.…”

Intoxication at Last Sexual Intercourse and Unprotected Sex among HIV-Positive and HIV-Negative Individuals in Uganda: An Event-Level Analysis

“…Multivariable analyses of the intoxication-unprotected sex were conducted separately among HIV-negative and HIV-positive individuals, adjusting for covariates empirically shown to confound [31–36] and/or moderate [17–23] the relationship. Understanding the intoxication-unprotected sex association among HIV-negative individuals is important for preventing the acquisition of new HIV infections [29, 37]. Knowledge of the association is equally critical among PLWHAs because unprotected sex can transmit the virus to previously uninfected individuals, increase infections with other strains of the virus that may seriously compromise the effectiveness of antiretroviral therapy and shorten life expectancy [29, 37].…”

“…Understanding the intoxication-unprotected sex association among HIV-negative individuals is important for preventing the acquisition of new HIV infections [29, 37]. Knowledge of the association is equally critical among PLWHAs because unprotected sex can transmit the virus to previously uninfected individuals, increase infections with other strains of the virus that may seriously compromise the effectiveness of antiretroviral therapy and shorten life expectancy [29, 37]. …”