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Increased risk for acute HIV infection from non-ulcerative STI's in MSM: aggressive STI eradication programs needed for reduction in HIV incidence

  • 1,
  • 1,
  • 1,
  • 2,
  • 2,
  • 2 and
  • 3
Journal of the International AIDS Society200811 (Suppl 1) :P303

  • Published:


  • Syphilis
  • Pharyngitis
  • Gonorrhea
  • Eradication Program
  • Population Attributable Risk

Purpose of the study

Clinical presentation of acute HIV infection is non-specific and may mimic sexually transmitted infections (STIs). Non-ulcerative STIs are prevalent among MSM. We examined the clinical presentation of acute HIV and sexually transmitted co-infections, and the role of non-ulcerative STIs in sexual acquisition of HIV infection.


9,058 persons testing HIV antibody negative were screened using a pooled HIV NAAT test (pool sizes varied from 24 to 90). STI testing of all at-risk anatomical sites was encouraged.

Summary of results

33 acute HIV infections were detected (positivity rate 0.36%). Of 31 patients concurrently tested, 19 (61.3%) were co-infected with STIs: 13 (41.9%) gonorrhea (2 urethral/7 rectal/7 pharyngeal); seven (22.6%) chlamydia (2 urethral/7 rectal); two (6.5%) syphilis; one (3.2%) herpes, and eight (25.8%) had two or more STI's. 24 saw a medical provider; only 46% reported symptoms and 21% had signs likely caused by HIV; 63% of symptoms and 67% of signs could be attributed to the STI. In 25% of cases there was significant overlap. Unexplained was the high rate of symptomatic oropharyngeal gonorrhea (4/7, or 57.1%) as compared to 4/17 (23.5%) with pharyngitis but no gonococcus. Analysis was adjusted for age, sex, sexual orientation, sexual behavior, and the number of sexual partners in the last 3 months and in the last 30 days. There was a strong association between acute HIV infection and the presence of gonorrhea (OR (95% CI): 3.79, 1.79 – 7.97); chlamydia (OR: 3.28, 1.34 – 7.98), and chlamydia and/or gonorrhea (OR: 4.43, 2.13 – 9.22). The population attributable risk (PAR) for HIV infection associated with gonorrhea was 32.4%, chlamydia 16.8% and chlamydia and/or gonorrhea 44.2%.


When acute HIV and an STI are co-infections, presenting signs/symptoms are more likely due to the STI than HIV, although non-specific symptoms consistent with Acute HIV Infection Syndrome can occur. Pharyngeal gonorrhea was often symptomatic in the setting of acute HIV. All at-risk anatomical sites should be tested for STIs. A high proportion of acute HIV infections in this MSM population are attributable to non-ulcerative STIs. Pooled NAATs for HIV and STI testing provide an opportunity for early HIV detection and STI treatment. For the HIV-negative individual, screening and treatment of STIs is crucial for HIV prevention. For the HIV-infected individual, the screening and treatment strategy will reduce further spread of HIV and STIs.

Authors’ Affiliations

L.A. Gay & Lesbian Center, Sexual Health Program, Los Angeles, USA
Los Angeles County Department of Public Health, Sexually Transmitted Disease Program, Los Angeles, USA
Western University of Health Sciences College of Pharmacy, Pomona, CA, USA


  1. 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 (1): 3-17.PubMedPubMed CentralView ArticleGoogle Scholar


© Bolan et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.