title: Ongoing sexually transmitted disease acquisition and risk-taking behavior among US HIV-infected patients in primary care: implications for prevention interventions.
abstract: BACKGROUND
  To better understand the factors associated with HIV- and sexually transmitted disease (STD)-transmitting behavior among HIV-infected persons, we estimated STD prevalence and incidence and associated risk factors among a diverse sample of HIV-infected patients in primary care.
  
  
  METHODS
  We analyzed data from 557 participants in the SUN Study, a prospective observational cohort of HIV-infected adults in primary care in 4 US cities. At enrollment and 6 months thereafter, participants completed an audio computer-assisted self-interview about their sexual behavior, and were screened for genitourinary, rectal, and pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis infections by nucleic acid amplification testing, and for serologic evidence of syphilis. Women provided cervicovaginal samples and men provided urine to screen for Trichomonas vaginalis by polymerase chain reaction.
  
  
  RESULTS
  Thirteen percent of participants had a prevalent STD at enrollment and 7% an incident STD 6 months later. The most commonly diagnosed infections were rectal chlamydia, oropharyngeal gonorrhea, and chlamydial urethritis among the men and trichomoniasis among the women. Other than trichomoniasis, 94% of incident STDs were identified in men who have sex with men. Polysubstance abuse other than marijuana, and having ≥4 sex partners in the 6 months before testing were associated with diagnosis of an incident STD.
  
  
  CONCLUSIONS
  STDs were commonly diagnosed among contemporary HIV-infected patients receiving routine outpatient care, particularly among sexually active men who have sex with men who used recreational drugs. These findings underscore the need for frequent STD screening, prevention counseling, and substance abuse treatment for HIV-infected persons in care.
authors.affiliation: Brown University and Miriam Hospital, Providence, RI, USA. Khmayer@gmail.com
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.forename: Timothy
authors.initials: T
authors.lastname: Bush
authors.forename: Keith
authors.initials: K
authors.lastname: Henry
authors.forename: Edgar T
authors.initials: ET
authors.lastname: Overton
authors.forename: John
authors.initials: J
authors.lastname: Hammer
authors.forename: Jean
authors.initials: J
authors.lastname: Richardson
authors.forename: Kathy
authors.initials: K
authors.lastname: Wood
authors.forename: Lois
authors.initials: L
authors.lastname: Conley
authors.forename: John
authors.initials: J
authors.lastname: Papp
authors.forename: Angela M
authors.initials: AM
authors.lastname: Caliendo
authors.forename: Pragna
authors.initials: P
authors.lastname: Patel
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D058070:Asymptomatic Diseases; D002487:Centers for Disease Control and Prevention, U.S.; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D011446:Prospective Studies; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D014481:United States / Q000453:epidemiology; D055815:Young Adult