Effect of coinfection with STDs and of STD treatment on HIV shedding in genital-tract secretions: systematic review and data synthesis

Sex Transm Dis. 2000 May;27(5):243-8. doi: 10.1097/00007435-200005000-00001.


Objective: To determine whether coinfection with sexually transmitted diseases (STD) increases HIV shedding in genital-tract secretions, and whether STD treatment reduces this shedding.

Design: Systematic review and data synthesis of cross-sectional and cohort studies meeting predefined quality criteria.

Main outcome measures: Proportion of patients with and without a STD who had detectable HIV in genital secretions, HIV load in genital secretions, or change following STD treatment.

Results: Of 48 identified studies, three cross-sectional and three cohort studies were included. HIV was detected significantly more frequently in participants infected with Neisseria gonorrhoeae (125 of 309 participants, 41%) than in those without N gonorrhoeae infection (311 of 988 participants, 32%; P = 0.004). HIV was not significantly more frequently detected in persons infected with Chlamydia trachomatis (28 of 67 participants, 42%) than in those without C trachomatis infection (375 of 1149 participants, 33%; P = 0.13). Median HIV load reported in only one study was greater in men with urethritis (12.4 x 104 versus 1.51 x 104 copies/ml; P = 0.04). In the only cohort study in which this could be fully assessed, treatment of women with any STD reduced the proportion of those with detectable HIV from 39% to 29% (P = 0.05), whereas this proportion remained stable among controls (15-17%). A second cohort study reported fully on HIV load; among men with urethritis, viral load fell from 12.4 to 4.12 x 104 copies/ml 2 weeks posttreatment, whereas viral load remained stable in those without urethritis.

Conclusion: Few high-quality studies were found. HIV is detected moderately more frequently in genital secretions of men and women with a STD, and HIV load is substantially increased among men with urethritis. Successful STD treatment reduces both of these parameters, but not to control levels. More high-quality studies are needed to explore this important relationship further.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Genitalia / virology*
  • HIV Infections / complications*
  • HIV Infections / virology
  • HIV-1 / isolation & purification*
  • Humans
  • Male
  • Sexually Transmitted Diseases / complications*
  • Sexually Transmitted Diseases / drug therapy
  • Virus Shedding*