The Link Between HIV and STDs

It is generally accepted that having a sexually transmitted disease (STD) increases in a person's risk of getting HIV, both for biological and behavioral reasons.

According to research, STDs like syphilis and gonorrhea not only provide HIV easier access to vulnerable cells and tissues of the body, STD co-infection actually increases the infectivity of the person with HIV—making them more likely to transmit the virus to others.

STDs can increase HIV susceptibility in a number of ways:

• Some STDs cause open wounds or ulcers to form in the genital area (such as syphilis, which frequently presents with ulcerative chancres). These wounds, sometimes seen and sometimes not, provide HIV a direct route into the bloodstream.
• While some STDs don't cause open wounds, the presence of the infection can cause the body to increase the concentration of CD4 T-cells in the genital area. It has been well established that increased concentrations these cells can provide HIV with a favorable target for infection.
• People infected with an STD also have increased concentrations of HIV in their seminal and vaginal fluids, increasing the possibility of HIV transmission. One study showed that men infected with HIV and gonorrhea have 10 times more HIV in their semen than men infected only with HIV.

Prime among the concerns are STDs like infective syphilis, gonorrhea, and herpes (HSV), with evidence that chlamydia can also increase HIV risk in women.

According to the Centers for Disease Control and Prevention (CDC), nearly 20 million new STD infections occur every year, accounting for almost $16 billion in health care costs. In 2016, the bulk of infections were primarily constrained to three diseases:

• Chlamydia: 1,598,354 infections at a rate of 497 per 100,000
• Gonorrhea: 468,514 infections at a rate of 146 per 100,000
• Syphilis (primary and secondary): 27,814 infections at a rate of 9 per 100,000
• Syphilis (congenital): 628 at a rate of 16 per 100,000 live births

The rate of STD infections is particularly high among gay and bisexual men who, not surprisingly, account for the highest rate of HIV infections in the U.S. 

Gay and bisexual men account for almost 90 percent of all primary and secondary syphilis cases. They accounted for 80 percent of all male STD infection where the sex partner is known.

To this end, If you are a sexually active gay or bisexual man, you should be tested for syphilis, chlamydia, gonorrhea, and HIV at least once a year. More frequent STD testing, between every three to six months, is recommended for gay or bisexual men at high risk, especially those who have multiple sex partners, use recreational drugs, or practice condomless sex. 

In the presence of an STD diagnosis, people should receive treatment as soon as possible—not only to treat the infection but to potentially decrease the risk of onward transmission should you have HIV.

According to the latest research, HIV-positive people on STD therapy tend to shed far less HIV and to shed the virus less frequently than those not on treatment. (Shedding is the state where the HIV is present in semen, vaginal secretions, blood, or breast milk even when a person has an undetectable HIV viral load).

Additionally, safer sex counseling hand-in-hand with STD therapy can help a person uninfected with HIV to identify their personal risk factors and find ways to better reduce their risk of HIV.

Oftentimes, we tend to focus on HIV in isolation, particularly when it comes to issues of prevention and treatment. But the fact is this: even if a person is on the HIV prevention pill (PrEP) or is taking full-time antiretroviral therapy, STDs can increase the risk of HIV transmission, putting yourself or others at risk.

It is, therefore, important to remember the following take-home points:

• You have a greater chance of HIV if you have an STD.
• Having an STD and HIV can increase your risk of spreading HIV.
• STD treatment may help slow the spread of HIV.
• HIV therapy does prevent you from getting another type of STD.
• Condoms are still the single best way to reduce your risk of getting an STD, including HIV.