title: Contribution of HIV-1 infection to acquisition of sexually transmitted disease: a 10-year prospective study.
abstract: BACKGROUND
  Sexually transmitted diseases (STDs) enhance human immunodeficiency virus (HIV)-1 susceptibility, but few studies have examined the reciprocal effect of HIV-1 on STD acquisition.
  
  
  METHODS
  Data from a prospective cohort study conducted among female sex workers in Mombasa, Kenya between 1993 and 2003 were used to determine the effect of HIV-1 infection on STD susceptibility. The cohort included 1215 HIV-1-seronegative women who underwent monthly HIV-1 and STD screening, of whom 238 experienced seroconversion to HIV-1 during follow-up. Andersen-Gill proportional-hazards models were used to compare the incidence rates for genital-tract infections (syphilis, genital ulcer disease [GUD], Neisseria gonorrhoeae infection, Chlamydia trachomatis infection, Trichomonas vaginalis infection, vulvovaginal candidiasis, and bacterial vaginosis) in HIV-1-seropositive versus HIV-1-seronegative women, after controlling for sexual behavior and other potential confounding factors.
  
  
  RESULTS
  HIV-1 infection was associated with a significantly higher incidence of GUD (hazard ratio [HR], 2.8; 95% confidence interval [CI], 2.0-3.9), gonorrhea (HR, 1.6; 95% CI, 1.1-2.2), and vulvovaginal candidiasis (HR, 1.5; 95% CI, 1.3-1.8). The risks of GUD and vulvovaginal candidiasis increased with progressive levels of immunosuppression.
  
  
  CONCLUSIONS
  The increased incidence of genital-tract infections among HIV-1-seropositive women could promote the spread of both HIV-1 and other STDs, particularly in areas where these conditions are highly prevalent.
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington 98104, USA. mcclell@u.washington.edu
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.forename: Ludo
authors.initials: L
authors.lastname: Lavreys
authors.forename: Christine
authors.initials: C
authors.lastname: Katingima
authors.forename: Julie
authors.initials: J
authors.lastname: Overbaugh
authors.forename: Vrasha
authors.initials: V
authors.lastname: Chohan
authors.forename: Kishorchandra
authors.initials: K
authors.lastname: Mandaliya
authors.forename: Jeckoniah
authors.initials: J
authors.lastname: Ndinya-Achola
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology / Q000209:etiology; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000635:transmission; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000209:etiology / Q000635:transmission*