Sexually Transmitted Disease in HIV

Aka: Sexually Transmitted Disease in HIV, Sexually Transmitted Infection in HIV, HIV-Related Sexually Transmitted Disease

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II. Causes: Syphilis (common in men and women)

  1. Cofactor in the acquisition of HIV Infection
  2. Atypical presentations in HIV
    1. Condyloma Lata (Secondary Syphilis) is most common presentation in HIV
    2. Lues Maligna (Skin Ulcers due to necrotizing Vasculitis)
    3. Fever
    4. Nephrotic Syndrome
  3. Neurosyphilis (increased risk in HIV Infection)
    1. Syphilitic Meningitis
    2. Cranial neuritis
    3. Neuroretinitis
    4. May be complicated by Deafness, CVA
    5. Positive CSF Syphilis Serology
  4. Labs
    1. Serology may be prolonged positive despite treatment
    2. VDRL False Positive
    3. Fluorescent Treponemal Antibody (FTA) False Negative (due to Immunodeficiency)

III. Causes: Other Sexually Transmitted Infections

  1. See Trichomoniasis
  2. See Genital Herpes
  3. Chancroid (common)
    1. HIV may alter the natural history of this infection
  4. Herpes Simplex Virus 2 (Genital Herpes)
    1. Chronic recurrent infections are common
    2. Frequency and severity rises as CD4 Count drops
    3. May require chronic suppression with Acyclovir
  5. Mucopurulent Cervicitis
    1. Neisseria gonorrhoeae
    2. Chlamydia trachomatis
    3. Anaerobes
    4. Enteric flora

IV. Causes: Non-STD Genitourinary Infections

  1. Vulvovaginal Candidiasis
    1. Vulvar and vaginal erythema, Plaques and discharge
    2. Pruritic, Morbilliform infection may spread to thighs

V. References

  1. Baloor (2018) Exam Preparatory Manual for Undergraduates Medicine, Jaypee Brothers, India, p. 240
  2. Mayer (2018) J Int AIDS Soc 21(7):e25164 +PMID: 29989338 [PubMed]
  3. Cohen (2019) J Int AIDS Soc 22(Suppl 6):e25355 +PMID: 31468737 [PubMed]

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