Sexually transmitted diseases in 1161 HIV-positive patients: a 38-month prospective study in southern Spain

Background HIV infection is primarily a sexually transmitted disease (STD), but intravenous drug use (IDU) is the main risk factor for HIV infection i n certain areas, including southern Europe. A number of prospective studies of dermatological findings in HIV-1 infected patients have been published, almost all from countries where homosexuality is the main risk factor of H IV infection and without correlation with CD4 cell counts. No STD data is i ncluded in those studies. Objective To determine the incidence of STDs in a cohort of 1161 HIV-1-posi tive patients from Spain, in the previous medical history and during the pr ospective study. Methods We prospectively examined 1161 HIV-1-positive patients for 38 month s, 986 men and 175 women. IDU was the risk factor in 74%, while homosexuali ty was a risk factor in only 9%. CDC stage II was predominant (51%), while stage IV was less frequent (39%). The mean CD4 cell count was 353/mm(3). Pa tients' past and present medical history of STDs was obtained. CD4 cells/mm (3) counts were measured at each visit. Results Six hundred and eighty-four patients had a past history of STD, whi lst new infections were diagnosed in 258 individuals (22%) during the 38-mo nth study. Pediculosis pubis (26%), gonorrhoea (22%), syphilis (13%), genit al candida infection (11%) and condyloma acuminatum (10%) were the commones t previous STDs, followed by non-gonococcal urethritis (NGU) (5%), genital herpes (4%) and trichomoniasis (2%). During the 38-month study period and w ith strong recommendation of condom use for sexual intercourse, condyloma a cuminatum (7%), scabies (6%), syphilis (4%) and genital herpes (3%) were co mmonly diagnosed, followed by gonorrhoea (1.8%), NGU (1.6%), genital candid a infection (1,5%), pediculosis pubis (0.6%) and trichomoniasis (0.3%). Onl y genital herpes had a statistically significant association with advanced stage (P = 5.12 x 10(-6)) and low CD4 cell counts (180 +/- 166 cells/mm(3)) . Conclusion Despite the predominance of the IDU factor among our patients, t he incidence of STDs in the past medical history was surprisingly high. The incidence of STD during the study was also high, despite the advice of usi ng condoms after the diagnosis of HIV infection. STDs may accelerate the co urse of HIV infection and be a poor prognostic indicator in these patients. If an HIV-1-positive patient can acquire an STD, he/she can also transmit HIV infection. This indicates that new publicity campaigns are still needed to stop HIV and STDs infection among HIV-positive patients as well as in t he general population. (C) 1998 Elsevier Science B.V. All rights reserved.