title: Effect of coinfection with STDs and of STD treatment on HIV shedding in genital-tract secretions: systematic review and data synthesis.
abstract: OBJECTIVE
  To determine whether coinfection with sexually transmitted diseases (STD) increases HIV shedding in genital-tract secretions, and whether STD treatment reduces this shedding.
  
  
  METHODS
  Systematic review and data synthesis of cross-sectional and cohort studies meeting predefined quality criteria.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Epidemiological Research in South Africa, South African Medical Research Council, Hlabisa.
authors.forename: K
authors.initials: K
authors.lastname: Rotchford
authors.forename: A W
authors.initials: AW
authors.lastname: Strum
authors.forename: D
authors.initials: D
authors.lastname: Wilkinson
mesh_terms: D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005835:Genitalia / Q000821:virology*; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D012749:Sexually Transmitted Diseases / Q000150:complications* / Q000188:drug therapy; D017201:Virus Shedding