April is STD Awareness Month, an opportunity for all of us in the HIV prevention, treatment, and care arena to be reminded of—and educate others about—the vital role that sexually transmitted disease (STD) prevention, testing, and treatment play in comprehensive programs to prevent and treat HIV. Simply stated, having an untreated STD increases the risk of HIV transmission regardless of whether it is the HIV-positive partner or the HIV-negative partner who has the STD. The most recent CDC data revealing that nearly 20 million new STDs occur in the United States each year [PDF 1.57MB] has significant implications for our collective efforts to pursue the National HIV/AIDS Strategy (NHAS) goals of reducing the number of new HIV infections—not to mention the goals of Healthy People 2020.
…having an untreated STD increases the risk of HIV transmission regardless of whether it is the HIV-positive partner or the HIV-negative partner who has the STD.
“We know that individuals who have STDs are at an increased risk of acquiring or transmitting HIV,” said Dr. Gail Bolan, Director of CDC’s Division of STD Prevention. “This is why CDC encourages early detection and treatment of STDs as a means to prevent HIV.”
STDs Increase HIV Acquisition Risk in HIV-Negative Persons
There is substantial evidence that individuals who are infected with STDs have an increased risk of acquiring HIV infection if they are exposed to the virus through sexual contact – in fact, persons who are infected with STDs are at least two to five times more likely than uninfected individuals to acquire HIV infection if they are exposed to the virus through sexual contact. This is because STDs can cause sores, or small lesions on genital skin and increased inflammation in the genital tract, all of which can facilitate the entry of HIV. For this reason, early detection and treatment of STDs is paramount. It is also why HIV testing should always be recommended for individuals who are diagnosed with or suspected of having an STD.
Our ability to detect and treat more STD cases before they put individuals at greater risk of acquiring or transmitting HIV is enhanced by the Affordable Care Act, which offers improved access to clinical preventive services. Under the Act, syphilis screening for all adults at higher risk, STD prevention counseling for all adolescents and adults at higher risk, and chlamydia and gonorrhea screening for women at higher risk are included as recommended preventive services that new private health insurance plans are required to cover at no additional cost to the consumer.
STDs and People Living With HIV
Preventing STDs is important for all sexually active individuals, but especially so for people living with HIV. Because immune dysfunction is a major component of HIV disease, STDs can be more extensive, harder to treat, or recurrent in HIV-positive patients. Unfortunately, the prevention of and screening for STDs among individuals who are already infected with HIV continues to be a challenge. At the 2013 Conference on Retroviruses and Opportunistic Infections (CROI) (held in Atlanta in March), researchers from CDC presented their analysis of data from the Medical Monitoring Project (MMP), a nationally representative surveillance system of people in HIV care, showing that while the majority of HIV-infected adults in care are receiving the recommended treatment and care for their HIV infection, far too few are receiving the recommended screening and prevention services related to other STD infections—like chlamydia, gonorrhea, and syphilis—which can threaten their own health and facilitate further HIV transmission. At CROI, I had the opportunity to talk briefly with Dr. Jonathan Mermin, Director of CDC’s Division of HIV/AIDS Prevention, about this and other important research findings being shared at the conference and their implications for our efforts to respond effectively to HIV/AIDS in the United States.
One of the key takeaway messages from this research is that we need to remember that people living with HIV are sexually active and that we must improve our efforts to ensure that they are receiving STD screening and treatment to benefit them and their partners. In addition, we need to continue to educate people living with HIV—and all sexually active individuals—that consistent and correct condom use is the best way to reduce the risk of STD and HIV transmission during sexual activity.
For more information about the intersection between HIV and STDs, see CDC’s fact sheet “The Role of STD Prevention and Treatment in HIV Prevention” and this recent blog post, Syphilis and HIV: A Dangerous Duo Affecting Gay and Bisexual Men.