Patients with sexually transmitted disease: a well-defined HIV risk group in general practice?

Since patients with sexually transmitted disease (STD) form the most apparent risk group for HIV infection in general practice, differences in sexual behaviour in patients with and without STD were studied. Patients fulfilling at least one of four clinical criteria for suspicion of STD were offered four microbiological tests and a serological HIV test and were asked to complete a questionnaire concerning possible HIV exposure. Control patients were selected from a sample of ordinary consulting patients in general practice, without clinical suspicion of STD. The answers to the questionnaires given by six male and 52 female patients with a positive microbiological test for STD were compared with answers given by control patients matched for sex, age, education and geographical region. Females with STD had multiple male partners more often than controls. STD patients were more uncertain whether they had had sex with a HIV-positive person, and they reported more previous gonorrhea than the control patients. The proportion of patients who reported practicing oral sex was the same in both groups, while data for anal sex were insufficient. There were no significant differences in the use of condoms with a new partner, although there was a higher proportion of never-users of condoms among the STD patients. Identifying STD patients on clinical grounds is difficult in general practice. Clinical criteria have limited sensitivity because of asymptomatic infections, and the specificity is low. Patients with microbiologically confirmed STD should receive HIV-related attention, but attention to STD patients alone is not enough. Many people without STD have sexual behaviour which may exposure them to the HIV virus. The only means to a selective approach is increased attention to an appropriate sexual medical history.