RISK-FACTORS FOR POSTCOITAL BLEEDING AMONG WOMEN WITH OR AT RISK FOR INFECTION WITH HUMAN-IMMUNODEFICIENCY-VIRUS

Risk factors for postcoital bleeding were examined in 475 women who we re enrolled in a study of heterosexual transmission of human immunodef iciency virus (HIV). In bivariate analyses, history of sexually transm itted diseases (STDs; P = .03), HIV infection (P = .008), and dyspareu nia or pain during intercourse (P = .0001) were significant risk facto rs, In multivariate analysis, the two latter factors remained signific ant (for HIV, odds ratio [OR] = 2.1, P = .02, 95% confidence interval [CI] = 1.1-4.0; for dyspareunia, OR = 3.5, P < .001, 95% CI = 1.8-6.6) , as did the interaction term of STD history and heavy smoking (OR = 2 .4, P = .02, 95% CI = 1.2-5.0). Pain during intercourse was the strong est predictor of postcoital bleeding but may be part of the same pheno menon. Similarly, because this study relied on cross-sectional data, t he direction of the causal pathway linking HIV to postcoital bleeding cannot be established. However, these data suggest that smoking, a mod ifiable risk factor, may increase risk of postcoital bleeding and cont ribute to susceptibility for HIV and other STDs.