Skip to Main Content

  • • Because new sexually transmitted diseases (STDs) are common in HIV-infected patients, regular screening and timely treatment are essential.
  • • Counseling of HIV-positive patients should include discussion of HIV-STD interactions and risks.
  • • Both genital ulcer–causing diseases and non–ulcer-causing STDs increase HIV transmission.
  • • Clinical and laboratory findings of syphilis in HIV-infected patients can be challenging to interpret, and these patients require close follow up.
  • • Prevention of human papillomavirus (HPV)– associated malignancies requires active surveillance in HIV-infected persons.
  • • Genital herpes and syphilis may increase HIV viral load, lower CD4 count, and hasten HIV disease progression.

Symptomatic Assessment

At the initial evaluation of a patient with HIV infection, the clinician should actively screen for typical symptoms and signs of STDs. These include the presence of genital, oral, or anal lesions; pain or burning with urination; new or unusual skin rash; lymphadenopathy and rectal symptoms of discharge, burning, or itching. In addition, men should be screened for urethral discharge or groin pain and women for bloody or foul-smelling vaginal discharge, itching, lower abdominal pain, missed menses, and pregnancy status. Any patient reporting symptoms and signs of STDs should have appropriate diagnostic testing regardless of reported sexual behavior or other risk factors.

Routine Laboratory Assessment

All HIV-infected patients should undergo serologic testing for syphilis, herpes simplex virus type 2 (HSV-2), and hepatitis as well as gonorrhea and chlamydia testing at all exposed anatomic sites (urogenital, anal, oral) at the initial visit. HSV-2 serologic testing should utilize newer, glycoprotein G–specific tests (see Table 21–1). HIV-infected women should undergo speculum-guided pelvic examination with microscopic evaluation of vaginal fluid (wet mount) and Papanicolaou (Pap) smear. Pap smears should be repeated at 6 months and then annually thereafter. Although no national guidelines exist, some experts recommend that HIV-infected men should also undergo regular anal cancer screening (anal Pap smear). Newly diagnosed HIV-infected patients should also receive a broad medical evaluation, which is beyond the scope of discussion in this chapter.

Table 21–1. Initial STD Screenings in HIV-Infected Patients.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.