Serosurveillance of prevalence of undiagnosed HIV-1 infection in homosexual men with acute sexually transmitted infectionBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7272.1319 (Published 25 November 2000) Cite this as: BMJ 2000;321:1319
All rapid responses
Editor--The serosurveillance study by Catchpole et al(1) looking at
the seroprevalence of HIV 1 infection in homosexual and bisexual men
presenting with an acute sexually transmitted infection made interesting
reading. It is well recognised that sexually transmitted infections
facilitate HIV transmission. Herpes simplex type 2 infection and primary
syphilis increase the infectivity of HIV by compromising mucosal
surfaces(2). Gonococcal and chlamydial urethritis increase shedding of HIV
-1 in semen, therefore increasing HIV transmission risk(3). Further
studies have shown the effectiveness of antimicrobial treatment in
reducing the HIV viral load in semen(4) and randomised controlled
population studies have shown that STI control decreases HIV infection
rates(5). However the sexual health of HIV positive individuals has so far
been relatively neglected.
The casenotes of 86 out of 92 HIV patients who attended the
Genitourinary Medicine(GUM) department in Glasgow between April 1998 and
April 1999 were reviewed, compromising 67 men with a mean age of 44years
and 19 women with a mean age of 31years. 49% of men and 37% of women
received full sexual health screening at the time of their HIV diagnosis.
In this cohort, 4 cases of gonorrhoea, 3 of herpes infection, 1 of
chlamydia and 7 cases of warts were diagnosed after the initial HIV
diagnosis. 32 men and 12 women had no record of sexual behaviour
documented in their casenotes. This data demonstrates that HIV positive
individuals remain at risk of acquiring and transmitting sexual infections
and HIV and are a neglected population for targeting HIV prevention
There are several obstacles to offering sexual infection tests in HIV
clinics. It may be that HIV positive individuals are not perceived to be
at continuing risk of transmitting the virus owing to the (often false)
assumption that this population has discontinued sexual relationships.
Time constraints or embarrassment may make it difficult to broach the
subject of sex and the possibility of acquiring sexual infections. Also,
patients may themselves feel that they are unable to divulge their
continued sexual activity for fear of being judged, or compromising the
long-term relationship with the care provider.
We believe that further prospective sexual behaviour studies of HIV
positive individuals are required and that the sexual health of this
population should be considered as a routine part of care, especially
since antiretroviral therapy has improved survival and the quality of life
in this population.
A Butt (Corresponding author)
Senior House Officer
6, Sandyford Place,
Glasgow, G3 7NB
1. Catchpole MA, McGarrigle CA, Rogers PA, Jordan LF, Mercy D, Gill
ON. Serosurveillance of prevalence of undiagnosed HIV-1 infection in
homosexual men with acute sexually transmitted infection. BMJ
2. Cameron DW, Simonsen JN, D'Costa LJ, Ronald AR, Maitha GM, Gakinya
MN et al. Female to male transmission of human immunodeficiecy virus type
1: Risk factors for seroconversion in men. Lancet 1989;ii:403-07
3. Aitkins MC, Carlin EM, Emery VC, Griffiths PD, Boag F.
Fluctuations of HIV load in semen of HIV positive patients with newly
acquired sexually transmitted diseases. BMJ 1996 ;313:341-2
4. Cohen MS, Hoffman IF, Royce RA, Kazembe P, Dyer JR, Daly CC et al.
Reduction of concentration of HIV 1 in semen after treatment of
urethritis: Implications for prevention of sexual transmission of HIV1.
5. Grosskurth H, Mosha F, Todd J, Mwijarubi E, Klokke A et al.
Impact of improved treatment of sexually transmitted disease on HIV
infection in rural Tanzania: randomised controlled trial. Lancet
Competing interests: No competing interests