Current Infectious Disease Reports

, Volume 7, Issue 1, pp 79–84 | Cite as

Efforts to control sexually transmitted infections as a means to limit HIV transmission: What is the evidence?

  • Gina Dallabetta
  • Graham Neilsen


There is overwhelming and compelling evidence that control efforts for sexually transmitted infection (STI) have a major role to play in the prevention of HIV transmission. Community-based randomized controlled trials are set as the highest standard of evidence for showing the efficacy of STI interventions to prevent HIV transmission. The negative results of recent randomized controlled trials have cast doubt on the positive findings of the Mwanza study. Deeper analysis of the result of these trials has improved understanding of the role of STI interventions and augmented the wealth of evidence provided by numerous epidemiologic and biomedical studies. Apart from the biologic impact of effective treatment of curable STIs on HIV transmission, clinical services also support the reduction of HIV risk behaviors. STI interventions should limit the scale of the impending epidemics in Asia and Eastern Europe, depending on the priority that they are given by governments and major donor agencies.


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References and Recommended Reading

  1. 1.
    UNAIDS report: most deaths and new infections ever; some good news. AIDS Treat News 2003, (396)3.Google Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    Baeten JM, Mostad SB, Hughes MP, et al.: Selenium deficiency is associated with shedding of HIV-1 infected cells in the female genital tract. J Acquir Immune Defic Syn 2001, 26:360–364.Google Scholar
  4. 4.
    Mostad SB, Overbaugh J, De Vange DM, et al.: Hormonal contraception, vitamin A deficiency, and other risk factors for shedding of HIV-1 infection cells from the cervix and vagina. Lancet 1997, 350:922–927.PubMedCrossRefGoogle Scholar
  5. 5.
    Koopman JS, Jacquez JA, Welch GW, et al.: The role of early HIV infection in the spread of HIV through populations. J Acquir Immune Defic Syn 1997, 14:56–62.Google Scholar
  6. 6.
    Gray RH, Wawer MJ, Serwadda D, et al.: Determinants of HIV-1 viral load in subjects with early and later HIV infection, in a general-population cohort of Rakai, Uganda. J Infect Dis 2004, 189:1209–1215.PubMedCrossRefGoogle Scholar
  7. 7.
    Lehner T: The role of CCR5 chemokine ligands and antibodies to CCR5 coreceptors in preventing HIV infection. Trends Immunol 2002, 23:347–351.PubMedCrossRefGoogle Scholar
  8. 8.
    Siegfried N, Muller M, Volmink J, et al.: Male circumcision for prevention of heterosexual acquisition of HIV in men. Cochrane Database Syst Rev 2003, (3):CD003362.PubMedGoogle Scholar
  9. 9.
    Sangani P, Rutherford G, Wilkinson D: Population-based interventions for reducing sexually transmitted infections, including HIV infection. Cochrane Database Syst Rev 2004, (2):CD001220.PubMedGoogle Scholar
  10. 10.
    Galvin SR, Cohen MS: The role of sexually transmitted disease in HIV transmission. Nat Rev Microbiol 2004, 2:33–42.PubMedCrossRefGoogle Scholar
  11. 11.
    Rottingen JA, Cameron DW, Garnett GP: A systematic review of the epidemiologic interactions between classic sexually transmitted disease and HIV: How much really is known? Sex Transm Dis 2001, 28:579–597.PubMedCrossRefGoogle Scholar
  12. 12.
    UNAIDS/WHO: Consultation on STD Interventions for Preventing HIV: What is the evidence? UNAIDS, Geneva, Switzerland, May 2000.Google Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    Hobbs M, Kazemba P, Reed A, et al.: Trichomonas vaginalis as a cause of urethritis in Malawian men. Sex Transm Dis 1999, 26:381–387.PubMedCrossRefGoogle Scholar
  15. 15.
    Price MA, Zimba D, Hoffman IF, et al.: Addition of treatment for trichomoniasis to syndromic management of urethritis in Malawi: a randomized clinical trial. Sex Transm Dis 2003, 30:516–522.PubMedCrossRefGoogle Scholar
  16. 16.
    Mbopi-Keou FX, Gresenguet G, Mayaud P, et al.: Interactions between herpes simplex virus type 2 and human immunodeficiency virus type 1 infection in African women: opportunities for interventions. J Infect Dis 2000, 182:1090–1096.PubMedCrossRefGoogle Scholar
  17. 17.
    McClelland RS, Wang CC, Overbaugh J, et al.: Association between cervical shedding of herpes simplex virus and HIV1. AIDS 2002, 16:2425–2437.PubMedCrossRefGoogle Scholar
  18. 18.
    Pilcher CD, Price MA, Hoffman IF, et al.: Frequent detection of acute primary HIV infection in men in Malawi. AIDS 2004, 18:517–524.PubMedCrossRefGoogle Scholar
  19. 19.
    Rotchford K, Sturm AW, Wilkinson D: Effect of coinfection with STDs and of STD treatment on HIV shedding in genitaltract secretions: systematic review and data synthesis. Sex Transm Dis 2000, 27:243–248.PubMedCrossRefGoogle Scholar
  20. 20.
    McClelland RS, Wang CC, Mandaliya K, et al.: Treatment of cervicitis is associated with decreased cervical shedding of HIV-1. AIDS 2001, 15:105–110.PubMedCrossRefGoogle Scholar
  21. 21.
    Anzala AO, Simonsen JN, Kimani J, et al.: Acute sexually transmitted infection increase human immunodeficiency virus type 1 plasma viremia, increase plasma type 2 cytokines and decrease CD4 cell counts. J Infect Dis 2000, 182:459–466.PubMedCrossRefGoogle Scholar
  22. 22.
    Nkengasong JN, Kestens L, Ghys PD, et al.: Human immunodeficiency virus type-1 (HIV1) plasma virus load and markers of immune activation among HIV-infected female sex workers with sexually transmitted diseases in Abidjan, Cote d’Ivoire. J Infect Dis 2001, 183:1405–1408.PubMedCrossRefGoogle Scholar
  23. 23.
    Cohen MS, Hoffman IF, Royce RA, et al.: Reduction of concentration of HIV1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV1. Lancet 1997, 349:1868–1873.PubMedCrossRefGoogle Scholar
  24. 24.
    Schacker T, Zeh J, Huilin H, et al.: Changes in plasma human immunodeficiency virus type 1 RNA associated with herpes simplex virus reactivation and suppression. J Infect Dis 2002, 186:1718–1725.PubMedCrossRefGoogle Scholar
  25. 25.
    Buchacz K, Patel P, Taylor M, et al.: Syphilis infection increases HIV viral load in HIV-infected men. Paper presented at the National HIV Prevention Conference. Atlanta, Georgia, July 27–30, 2003.Google Scholar
  26. 26.
    Miller CJ, Shattock RJ: Target cells in vaginal HIV transmission. Microbes Infect 2003, 5:59–67.PubMedCrossRefGoogle Scholar
  27. 27.
    Levine WC, Pope V, Bhoomkar A, et al.: Increase in endocervical CD4 lymphocytes among women with nonulcerative sexually transmitted diseases. J Infect Dis 1998, 177:167–174.PubMedCrossRefGoogle Scholar
  28. 28.
    Coombs RW, Reichelderfer PS, Landay AL: Recent observations on HIV type-1 infection in the genital tract of men and women. AIDS 2003, 17:455–480. Comprehensive review of virologic, microbiologic, and immunologic parameters that affect HIV-1 pathogenesis and sexual transmission.PubMedCrossRefGoogle Scholar
  29. 29.
    Wald A, Link K: Risk of human immunodeficiency virus infection in herpes simplex virus type 2-seropositive persons: a meta-analysis. J Infect Dis 2002, 185:45–52.PubMedCrossRefGoogle Scholar
  30. 30.
    Del Mar Pujades Rodrfguez M, Obasi A, Mosha F, et al.: Herpes simplex virus type 2 infection increases HIV incidence: a prospective study in rural Tanzania. AIDS 2002, 16:451–462.CrossRefGoogle Scholar
  31. 31.
    Reynolds SJ, Risbud AR, Shepherd ME, et al.: Recent herpes simplex virus type 2 infection and the risk of human immunodeficiency virus type 1 acquisition in India. J Infect Dis 2003, 187:1513–1521. Large retrospective cohort study in India correlating timing of HSV-2 seroconversion to HIV-1 acquisition.PubMedCrossRefGoogle Scholar
  32. 32.
    Renzi C, Douglas JM, Foster M, et al.: Herpes simplex virus type 2 infection as a risk factor for human immunodeficiency virus acquisition in men who have sex with men. J Infect Dis 2003, 187:19–25.PubMedCrossRefGoogle Scholar
  33. 33.
    The HIV Trials Prevention Network: HPTN 039 A Phase III, randomized, double-blind, placebo-controlled trial of acyclovir for the reduction of HIV acquisition among high risk HSV-2 seropositive, HIV-seronegative individuals. http:// January 8,2004.Google Scholar
  34. 34.
    The Bill & Melinda Gates Foundation: Gates Foundation provides $30 million grant for first-ever study of Herpes treatment to reduce HIV transmission. http://www.gatesfoundation. org/GlobalHealth/HIVAIDSTB/HIVAIDS/Announcements/ Announce-030724.htm.Accessed April 18, 2004.Google Scholar
  35. 35.
    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.PubMedCrossRefGoogle Scholar
  36. 36.
    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.PubMedCrossRefGoogle Scholar
  37. 37.
    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.PubMedCrossRefGoogle Scholar
  38. 38.
    Wawer MJ, Sewankambo NK, Serwadda D, et al.: Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomized community trial. Lancet 1999, 353:525–535.PubMedCrossRefGoogle Scholar
  39. 39.
    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.PubMedCrossRefGoogle Scholar
  40. 40.
    Kamali A, Quigley M, Nakiyingi J, et al.: Syndromic management of sexually-transmitted infections and behavior change interventions on transmission of HIV-1 in rural Uganda: a community randomized trial. Lancet 2003, 361:645–652. Report of a three-arm community randomized trial of HIV education, HIV education and syndromic STI management, and community development to assess impact on HIV-1 transmission.PubMedCrossRefGoogle Scholar
  41. 41.
    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.CrossRefGoogle Scholar
  42. 42.
    Boily MC, Lowndes CM, Alary M: Complementary hypothesis concerning the community sexually transmitted disease mass treatment puzzle in Rakai, Uganda. AIDS 2000, 14:2583–2592.PubMedCrossRefGoogle Scholar
  43. 43.
    Orroth KK, Korenromp EL, White RG, et al.: Comparison of STD prevalences in the Mwanza, Rakai, and Masaka trial populations: the role of selection bias and diagnostic errors. Sex Transm Infect 2003, 79:98–105.PubMedCrossRefGoogle Scholar
  44. 44.
    Orroth KK, Korenromp EL, White RG, et al.: Higher risk behaviour and rates of sexually transmitted diseases in Mwanza compared to Uganda may help explain HIV prevention trial outcomes. AIDS 2003, 17:2653–2660. In-depth reanalysis of baseline data from three trial populations comparing sexual demography, sexual risk behavior, and HIV/STI epidemiology adjusting for underlying performance characteristics of STIdiagnostic tests.PubMedCrossRefGoogle Scholar
  45. 45.
    Orroth K, White RG, Bakker R, et al.: Proportion of HIV infection attributable to sexually transmitted disease in Mwanza and Rakai -results of a simulation model. Paper presented at the 2003 International Society for Sexually Transmitted Disease Research Congress. Ottawa, Canada, July 27–30, 2003.Google Scholar
  46. 46.
    Korenromp EL, Bakker R, deVlas SJ, et al.: HIV dynamics and behavior change as determinants of the impact of sexually transmitted disease treatment on HIV transmission in the context of the Rakai trial. AIDS 2002, 16:2209–2218.PubMedCrossRefGoogle Scholar
  47. 47.
    Kaul R, Kimani J, Nagelkerke NJ, et al.: Monthly antibiotic chemoprophylaxis and incidence of sexually transmitted infection and HIV1 infection in Kenyan sex workers: a randomized controlled trial. JAMA 2004, 291:2555–2562. Report of a double-blind, placebo-controlled trial of STI treatment in sex workers in Kenya assessing the impact on STI and HIV incidence.PubMedCrossRefGoogle Scholar
  48. 48.
    Kaul R, Kimani J, Nagelkerke MJ, et al.: Reduced HIV risk-taking and low HIV incidence after enrollment and risk-reduction counseling in a sexually transmitted disease prevention trial in Nairobi, Kenya. J Acquir Immune Defic Syndr 2002, 30:69–72.PubMedCrossRefGoogle Scholar
  49. 49.
    Steen R, Dallabetta G: Sexually transmitted infection control in sex workers: regular screening and presumptive treatment augment efforts to reduce risk and vulnerability. Reprod Health Matters 2003, 11:74–90.PubMedCrossRefGoogle Scholar
  50. 50.
    Monitoring the AIDS Pandemic report: AIDS in Asia: face the facts - a comprehensive analysis of the AIDS epidemics in Asia. Monitoring the AIDS Pandemic report. 2004. http:// Accessed April 18, 2004.Google Scholar
  51. 51.
    Moses S, Ngugi EN, Costigan A, et al.: Response of a sexually transmitted infection epidemic to a treatment and prevention programmed in Nairobi. Sex Transm Infect 2002, 78(Suppl 1):i114-i120.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • Gina Dallabetta
    • 1
  • Graham Neilsen
  1. 1.Institute for HIV/AIDSFamily Health InternationalArlingtonUSA

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