Sexually transmitted infections and HIV: epidemiology and interventions

Although the association of HIV and sexually transmitted infections (STIs) has been well known for 25 years, there is insufficient attention to STIs by many HIV providers, in part because patients are asymptomatic or have nonspecific symptoms and because of provider demands and focus. Optimal patient care requires frequent testing for STIs as well as obtaining an accurate medical history, which requires building trust with patients and asking direct but open-ended questions about risks and symptoms. Increased vigilance will also help practitioners avoid missing these infections. Herpes simplex virus type 2 infection has highly variable clinical manifestations, and diagnosis is needed before considering episodic or suppressive treatment. However, suppressive treatment of herpes simplex virus type 2 infection has not been shown to reduce risk of HIV acquisition. The increase in syphilis rates continues; screening is inexpensive and treatment is highly effective. Quinolone resistance rates in gonorrhea are increasing, complicating treatment in some locales. Cases of proctitis caused by chlamydial infection with lymphogranuloma venereum strains have been observed in the United States and Europe.