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The
presence of several sexually transmitted diseases (STDs) substantially
increases the likelihood of both transmitting and acquiring HIV.(1) Thus,
increasing knowledge about and treating STDs can be an effective in
preventing the spread of HIV.
HIV
susceptibility has been found, not just with STDs that create ulcers
(herpes, syphilis and chancroid), but with non-ulcerative STDs
(gonorrhea and chlamydia) as well.
Trichomoniasis, and bacterial vaginosis have also been implicated
in the spread of HIV.(2)
Individuals
infected with STDs are at least two to five times more likely than
uninfected individuals to acquire HIV when exposed to the HIV through
sexual contact.(3)
The
U.S. HIV/AIDS epidemic has evolved recently in ways that suggest that
STDs among heterosexuals are becoming increasingly important.(4
 |
Heterosexual HIV transmission is responsible for the most rapidly
increasing subset of U.S. AIDS cases. |
|
The most striking recent subpopulation increase in AIDS in the United
States is among women, particularly young African-American women, among
whom the burden of other STDs is disproportionately high. |
|
An increasing proportion of all AIDS cases are being reported in the
southeastern United States, an area where syphilis and gonorrhea are
disproportionately high. |
Women
are more likely than men to get STDs because: (5)
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Female anatomy is more vulnerable to STDs. |
|
Male condoms are the main prevention technology for STDs in the United
States, apart from abstinence, and men control their use. |
The
absence of symptoms is an important factor in the spread of STDs.
In one study of women seeking contraceptive or other
gynecological services, about 50 percent of the women with gonorrhea and
70 percent of the women with chlamydia had no symptoms.
Among men even higher percentages of those infected had no
symptoms.(6)
Although
they can be without symptoms for period of time, women ultimately can
suffer severe consequences from STDs:
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Chlamydia can cause pelvic inflammatory disease which in turn can cause
infertility, ectopic pregnancy and chronic pelvic pain.
The infants of women with chlamydia can be infected during
delivery.(7) |
|
Gonorrhea, like chlamydia, is a major cause of pelvic inflammatory
disease, tubal infertility, ectopic pregnancy and chronic pelvic pain.(8) |
|
Syphilis can affect the nervous system, cause blindness, deafness, heart
disease, insanity and result in the birth of a stillborn or crippled
child. |
|
Chancroid causes genital sores and enlarged lymph
nodes.(9) |
|
Herpes, when dormant, causes no problems.
When active it causes painful blisters to form, mostly on the
vulva and in the mouth.(10)
|
Chlamydia,
gonorrhea, syphilis, and chancroid are all bacterial infections and, if
diagnosed, can be cured. Any
consequences of disease, however, such as pelvic inflammatory disease,
cannot be reversed. Herpes,
a virus, cannot be cured, but it can be managed.
In
1998 the reported infection rates for U.S. women were 382 per 100,000
for chlamydia and 132 per 100,000 for gonorrhea. The U.S. syphilis rate
is very low, 3 per 100,000 for both men and women combined, with most
cases of the disease concentrated in the southeast.(11)
One in five Americans older than 12 is infected with the genital
herpes virus.(12)
The
United States has both the highest STD rates among western
industrialized nations and a high prevalence of HIV infection. This unfortunate combination has led the Centers for Disease
Control to conclude that potential impact of enhanced STD control on the
prevention of sexually transmitted HIV infection in the United States is
likely to be substantial.(13)
To
follow up, the United States must:
|
Increase efforts to detect and treat persons suffering from STDs who are
without symptoms. |
|
Make medical treatment for STDs available to those unable to afford
treatment. |
|
Make early detection and treatment of curable STDs a major component of
comprehensive HIV prevention programs at national, state, and local
levels.(14) |
Footnotes
(1) Increased susceptibility. Genital ulcers (syphilis, herpes and chancroid) result in breaks in the genital track lining or skin. These breaks create a portal of entry for HIV. Non-ulcerative STDs (chlamydia, gonorrhea and trichomoniasis) increase the concentration of cells in genital secretions that can serve as target for HIV. Increased infectiousness. When HIV-infected individuals are also infected with other STDs, they are more likely to have HIV in their genital secretions. For example, men who are infected with both gonorrhea and HIV are more than twice as likely to shed HIV in their genital secretions than are those who are infected only with HIV. Moreover, the median concentration of HIV in semen is as much as ten times higher in men who are infected with both gonorrhea and HIV than in men infected only with HIV. Centers for Disease Control and Prevention. 1998. "Prevention and Treatment of Sexually Transmitted Diseases as an HIV Prevention Strategy." July; 3 pages.
(2) HIV spreads in differently with ulcerative and non-ulcerative STDs. Ulcerative STDs: When ulcerative STDs bleed during sex, HIV can come in contact with the partner's vaginal, cervical, oral, urethral, and rectal mucosa. Non-ulcerative STDs: The inflamed tissues of non-ulcerative STDs appear to increase the prevalence of HIV in genital secretions. Page 2. Morbidity and Mortality Weekly Report. 1998. "HIV prevention through early detection and treatment of other sexually transmitted diseases - United States." vol. 47. no. RR-12. 24 pages.
(3) Page 2. Morbidity and Mortality Weekly Report. 1998. "HIV prevention through early detection and treatment of other sexually transmitted diseases - United States." vol. 47. no. RR-12.
(4) Page 6f. Morbidity and Mortality Weekly Report. 1998. "HIV prevention through early detection and treatment of other sexually transmitted diseases - United States." vol. 47. no. RR-12.
(5)
See the discussion in section one of this report for details.
(6)
Page 10.
Morbidity and Mortality Weekly
Report.
1998.
"HIV prevention
through early detection and treatment of other sexually transmitted
diseases - United States." vol. 47. no. RR-12.
(7)
Page 5. Centers for Disease Control and Prevention. 1999. Sexually Transmitted Disease Surveillance
1998. Atlanta.
September.
(8)
Page 13.
Centers
for Disease Control and Prevention. 1999. Sexually Transmitted Disease Surveillance
1998. Atlanta.
September.
(9)
Page 101f. PDR Family Guide to Women's Health and Prescription Drugs.
Montvale, NJ: Medical Economics Data. 1994. 891 pages.
(10)
Page 102. PDR Family Guide to Women's Health and Prescription Drugs.
Montvale, NJ: Medical Economics Data. 1994. 891 pages.
(11)
Page 5, 13 and 23. Centers for Disease Control and Prevention.
1999. Sexually Transmitted Disease Surveillance
1998. Atlanta.
September. The
CDC has recently launched a campaign to eliminate syphilis from the U.S.
(12)
Finding reported in a study by the Centers for Disease Control.
See page A1. Sheryl Gay Stolberg, "U.S. Awakes to Epidemic
of Sexual Diseases," New York Times. March 9, 1998.
(13) The curable STDs for which the U.S. has high rates are chlamydia, gonorrhea, syphilis and chancroid. Page 19. Morbidity and Mortality Weekly Report. 1998. "HIV prevention through early detection and treatment of other sexually transmitted diseases - United States." vol. 47. no. RR-12.
(14) Page 2. Morbidity and Mortality Weekly Report. 1998. "HIV prevention through early detection and treatment of other sexually transmitted diseases - United States." vol. 47. no. RR-12.
For a list
of other materials used on this website, see References.
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