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Efforts to control sexually transmitted diseases as a means to limit HIV transmission: Pros and cons

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Abstract

A large body of literature suggests that treatment of sexually transmitted diseases (STDs) has a measurable effect on reducing HIV infectiousness and susceptibility at both the individual and general population levels. Recent research includes biological studies on genital herpes and genital shedding of HIV-1; two large-scale, community-based clinical trials in Africa; and the use of mathematical modeling to further explore data from these landmark trials. These studies suggest that a combination of improved STD services, syndromic management, and periodic mass treatment tailored to the dynamics of the HIV/AIDS/STD epidemic in a given population can help reduce overall HIV transmission.

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References and Recommended Reading

  1. Fleming DT, Wasserheit JN: From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect 1999, 75:3–17. A review of literature providing biological evidence of the cofactor effect of specific STDs and STD symptoms on enhancing HIV transmission. Discusses implications for policy decisions and the design of future interventions.

    Article  PubMed  CAS  Google Scholar 

  2. HIV prevention through early detection and treatment of other sexually transmitted diseases—United States recommendations of the Advisory Committee for HIV and STD Prevention. MMWR Morb Mortal Wkly Rep 1998, 47 (RR-12):1–24.

  3. Consultation on STD Interventions for Preventing HIV: What is the Evidence? Geneva: UNAIDS/WHO; 2000.

  4. Rotchford K, Strum AW, Wilkinson D: Effect of coinfection with STDs and of STD treatment on HIV shedding in genital-tract secretions. Sex Transm Dis 2000, 27:243–248.

    Article  PubMed  CAS  Google Scholar 

  5. Cohen MS, Hoffman IF, Royce RA, et al.: Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. Lancet 1997, 349:1868–1873. Blood and semen concentrations of HIV-1 RNA were measured in men at baseline and after STD treatment. Concentrations of HIV in seminal plasma were significantly higher in men with urethritis, and these levels decreased after STD treatment.

    Article  PubMed  CAS  Google Scholar 

  6. Ghys PD, Fransen K, Diallo MO, et al.: The associations between cervicovaginal HIV shedding, sexually transmitted diseases and immunosuppression in female sex workers in Abidjan, Côte d’Ivoire. AIDS 1997, 11:F85-F93.

    Article  PubMed  CAS  Google Scholar 

  7. Mostad SB, Overbaugh J, DeVange DM, et al.: Hormonal contraception, vitamin A deficiency, and other risk factors for shedding of HIV-1 infected cells from the cervix and vagina. Lancet 1997, 350:922–927.

    Article  PubMed  CAS  Google Scholar 

  8. Mbopi-Kéou F, Grésenguet G, Mayaud P, et al.: Interactions between herpes simplex virus type 2 and human immunodeficiency virus type 1 infection in African women: opportunities for intervention. J Infect Dis 2000, 182:1090–1096.

    Article  PubMed  Google Scholar 

  9. Grosskurth H, Mosha F, Todd J, et al.: Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomized controlled trial. Lancet 1995, 346:530–536.

    Article  PubMed  CAS  Google Scholar 

  10. Wawer MJ, Sewankambo NK, Serwadda D, et al.: Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial. Lancet 1999, 353:525–535. Report of a community-based clinical trial proving that periodic mass treatment to control STDs decreases HIV transmission. Despite reductions in prevalence of active syphilis, trichomoniasis, and bacterial vaginosis, the trial found mass treatment to have no effect on HIV prevalence in the study cohort.

    Article  PubMed  CAS  Google Scholar 

  11. Moss GB, Overbaugh J, Welch M, et al.: Human immunodeficiency virus DNA in urethral secretions in men: association with gonococcal urethritis and CD4 cell depletion. J Infect Dis 1995, 172:1469–1474.

    PubMed  CAS  Google Scholar 

  12. Gupta P, Leroux C, Patterson BK, et al.: Human immunodeficiency virus type 1 shedding pattern in semen correlates with the compartmentalization of viral quasi species between blood and semen. J Infect Dis 2000, 192:79–87.

    Article  Google Scholar 

  13. Chen CY, Ballard RC, Beck-Sague CM, et al.: Human immunodeficiency virus infection and genital ulcer disease in South Africa. Sex Transm Dis 2000, 27:21–29.

    Article  PubMed  CAS  Google Scholar 

  14. Risbud A, Chan-Tack K, Gadkari D, et al.: The etiology of genital ulcer disease by multiple polymerase chain reaction and relationship to HIV infection among patients attending sexually transmitted disease clinics in Pune, India. Sex Transm Infect 1999, 26:55–62.

    CAS  Google Scholar 

  15. Mostad SB, Kreiss JK, Ryncarz AJ, et al.: Cervical shedding of herpes simplex virus in human immunodeficiency virusinfected women: effects of hormonal contraception, pregnancy and vitamin A deficiency. J Infect Dis 2000, 18:158–163.

    Google Scholar 

  16. Vernazza PL, Troiana L, Flepp MJ, et al.: Potent antiretroviral treatment of HIV-infection results in suppression of the seminal shedding of HIV. AIDS 2000, 14:117–121.

    Article  PubMed  CAS  Google Scholar 

  17. Zhang H, Bornadula G, Beumont M, et al.: Human immunodeficiency virus type 1 in the semen of men receiving highly active antiretroviral therapy. N Engl J Med 1998, 339:1803–1809.

    Article  PubMed  CAS  Google Scholar 

  18. Torian LV, Makki HA, Menzies IB, et al.: High HIV seroprevalence associated with gonorrhea: New York City Department of Health, sexually transmitted disease clinics, 1990–1997. AIDS 2000, 14:189–195.

    Article  PubMed  CAS  Google Scholar 

  19. Machekano RN, Bassett, Zhou PS, et al.: Report of sexually transmitted diseases by HIV infected men during follow up: time to target the HIV infected? Sex Transm Infect 2000, 76:188–192.

    Article  PubMed  CAS  Google Scholar 

  20. Chesson HW, Pinkerton SD, Irwin KL, et al.: New HIV cases attributable to syphilis in the USA: estimates from a simplified transmission model. AIDS 1999, 13:1387–1396.

    Article  PubMed  CAS  Google Scholar 

  21. Korenromp EL, Van Vliet C, Grosskurth H, et al.: Model-based evaluation of single-round mass treatment of sexually transmitted diseases for HIV control in a rural African population. AIDS 2000, 14:573–593. This study used the STDSIM model and existing data from the Mwanza clinical trial to estimate the impact on HIV transmission of different combinations of STD interventions implemented over the long or short term. Sustained syndromic management with mass treatment was estimated to quickly reduce HIV incidence due to STDs in Mwanza, by up to 70% over 10 years.

    Article  PubMed  CAS  Google Scholar 

  22. Grosskurth H, Mosha F, Todd J, et al.: A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results. AIDS 1995, 9:927–934.

    Article  PubMed  CAS  Google Scholar 

  23. Gray RH, Wawer MJ, Sewankambo NK, et al.: Relative risks and population attributable fraction of incident HIV associated with symptoms of sexually transmitted diseases and treatable symptomatic sexually transmitted diseases in Rakai District, Uganda. AIDS 1999, 13:2113–2123.

    Article  PubMed  CAS  Google Scholar 

  24. Orroth KK, Gavyole A, Todd J, et al.: Syndromic treatment of sexually transmitted disease reduces the proportion of incident HIV infections attributable to these diseases in rural Tanzania. AIDS 2000, 14:1429–1437.

    Article  PubMed  CAS  Google Scholar 

  25. Hayes R, Mosha F, Nicoll A, et al.: A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 1. Design. AIDS 1995, 9:919–926.

    Article  PubMed  CAS  Google Scholar 

  26. Mayaud P, Mosha F, Todd J, et al.: Improved treatment services significantly reduce the prevalence of sexually transmitted diseases in rural Tanzania: results of a randomized controlled trial. AIDS 1997, 11:1873–1880.

    Article  PubMed  CAS  Google Scholar 

  27. Grosskurth H, Gray R, Hayes R, et al.: Control of sexually transmitted diseases for HIV-1 prevention: understanding the implications of the Mwanza and Rakai trials. Lancet 2000, 355:WA8-WA14. Overview of the design and results of two community-level clinical trials to reduce HIV transmission by providing syndromic management or mass treatment of STDs. This paper argues that the outcomes from both studies are complementary, not contradictory, and it gives implications for policy and questions for future research.

    Article  Google Scholar 

  28. Quinn TC, Wawer MJ, Sewankambo N, et al.: Viral load and heterosexual transmission of human immunodeficiency virus type 1. N Engl J Med 2000, 342:921–929.

    Article  PubMed  CAS  Google Scholar 

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Dallabetta, G., Feinberg, M. Efforts to control sexually transmitted diseases as a means to limit HIV transmission: Pros and cons. Curr Infect Dis Rep 3, 162–168 (2001). https://doi.org/10.1007/s11908-996-0053-1

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  • DOI: https://doi.org/10.1007/s11908-996-0053-1

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