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  • Review Article
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The role of sexually transmitted diseases in HIV transmission

Nature Reviews Microbiology volume 2, pages 33–42 (2004)Cite this article

Key Points

  • Sexual transmission is the main route for the spread of HIV. HIV transmission can be divided into two aspects, infectiousness and susceptibility. Sexually transmitted diseases (STDs) are one of the most important ways that the efficiency of HIV transmission is increased.

Factors that increase transmission

  • HIV infectiousness can be affected by levels of HIV in the bloodstream, the levels of HIV in the genital fluids, the stage of disease, the presence of STDs, the infectiousness of the viral variant and other factors.

Factors that increase susceptibility

  • HIV susceptibility can be affected by mucosal integrity, HLA types, co-receptor variations, hormones, the presence of STDs and other factors.

STDs and HIV transmission

  • STDs increase both the likelihood of transmission and the susceptibility to HIV. STDs increase infectiousness through effects on HIV shedding, HIV replication, increases in viral diversity and through co-transmission of HIV with STDs. STDs increase susceptibility by mucosal disruption, immune changes in the genital tract and effects on the genital tract microenvironment.

STDs and community-based studies

  • Some trials have documented that the most important difference between areas of high HIV prevalence and low prevalence is not sexual behaviour but the differences in rates of certain STDs. Large intervention trials have shown mixed results in reducing HIV incidence by reducing STDs; explanations for this include the age of the HIV epidemic and the role of herpes infection

Abstract

More than 42 million people worldwide are now infected with HIV, in spite of sustained prevention activities. Although the spread of HIV has been primarily sexual, epidemiological studies have indicated that the efficiency of the spread of HIV is poor, perhaps as infrequently as 1 in every 1,000 episodes of sexual intercourse. However, sexually transmitted diseases (STDs) that cause ulcers or inflammation greatly increase the efficiency of HIV transmission — by increasing both the infectiousness of, and the susceptibility to HIV infection. STDs might be particularly important in the early stages of a localized HIV epidemic, when people with risky sexual behaviour are most likely to become infected. In China, eastern Europe and Russia, there has been a remarkable increase in the incidence of STDs in recent years, and this is reflected in the rapid increase in the spread of HIV in these areas. Targeted STD detection and treatment should have a central role in HIV prevention in these emerging epidemics.

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Figure 1
Figure 2: The HIV co-receptors.
Figure 3: The effects of urethritis on the viral load of HIV in semen.
Figure 4: The effects of Trichomonas vaginalis infection on the viral load of HIV in semen.
Figure 5: Bacterial vaginosis.

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Acknowledgements

We would like to thank M. Hobbs and S. Edupuganti for their review of the manuscripts, and to M. Hobbs for her help with editing the figures.

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Authors and Affiliations

  1. Division of Infectious Diseases, University of North Carolina, Chapel Hill, 27599-7030, North Carolina, USA

    Shannon R. Galvin & Myron S. Cohen

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  1. Shannon R. Galvin
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Correspondence to Myron S. Cohen.

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DATABASES

Infectious Disease Information

bacterial vaginosis

chlamydia

gonorrhoea

HIV

syphilis

trichomonas

LocusLink

CCR5

CD4

CXCR4

Glossary

HIV DISCORDANT COUPLE

Two sexual partners in, usually, a stable monogamous relationship, in which one person is infected with HIV and the other is not.

SEROCONVERSION

The appearance of antibodies in the serum after exposure to an antigen.

CLADE

A group of species derived from a single ancestor that includes all the descendants of that ancestor.

HUMAN LEUKOCYTE ANTIGEN

Also known as major histocompatibility complex (MHC), it is a glycoprotein that is found on the surface of cells that present antigen for recognition by T cells.

MUCOSAL NEOPLASM

Usually carcinomas, such as cervical carcinomas, that are associated with certain types of HIV.

COHORT STUDIES

Studies in which subsets of a defined population are identified.

CHANCROID LESIONS

Single or multiple painful, necrotizing ulcers at the site of infection, which are frequently accompanied by painful swelling and suppuration of regional lymph nodes.

ADJUSTED-ODDS RATIO

The estimated odds ratio after any confounding factors have been taken into account.

UNIVARIATE ANALYSIS

Examines the effect of one variable.

MULTIVARIATE ANALYSIS

Analysis that considers several dependent variables simultaneously.

INGUINAL ADENOPATHY

Swelling of the lymph nodes that are located in the groin.

ADJUSTED-RISK RATIO

The estimated risk ratio after any confounding factors have been taken into account.

LANGERHANS CELLS

Dendritic, antigen-presenting cells that contain characteristic racquet-shaped granules, known as Birbeck granules, and which express the CD1a antigen. Principally found in the stratified squamous epithelium.

SQUAMOUS EPITHELIUM

An epithelium consisting of flattened cells. Can be simple (for example, endothelium) or stratified (for example, epidermis).

COLUMNAR EPITHELIUM

An epithelium that is formed of a single layer of cells, which are taller than they are wide.

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Galvin, S., Cohen, M. The role of sexually transmitted diseases in HIV transmission. Nat Rev Microbiol 2, 33–42 (2004). https://doi.org/10.1038/nrmicro794

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