Adolescent sexually transmitted infections and risk for subsequent HIV.
OBJECTIVE
We estimated the risk of HIV associated with sexually transmitted infection (STI) history during adolescence.


METHODS
We retrospectively studied a cohort of adolescents (n = 75 273, born in 1985-1993) who participated in the Philadelphia High School STD Screening Program between 2003 and 2010. We matched the cohort to STI and HIV surveillance data sets and death certificates and performed Poisson regression to estimate the association between adolescent STI exposures and subsequent HIV diagnosis.


RESULTS
Compared with individuals reporting no STIs during adolescence, adolescents with STIs had an increased risk for subsequent HIV infection (incidence rate ratio [IRR] for adolescent girls = 2.6; 95% confidence interval [CI] = 1.5, 4.7; IRR for adolescent boys = 2.3; 95% CI = 1.7, 3.1). Risk increased with number of STIs. The risk of subsequent HIV infection was more than 3 times as high among those with multiple gonococcal infections during adolescence as among those with none.


CONCLUSIONS
Effective interventions that reduce adolescent STIs are needed to avert future STI and HIV acquisition. Focusing on adolescents with gonococcal infections or multiple STIs might have the greatest impact on future HIV risk.
The authors are with the Philadelphia Department of Public Health, Philadelphia, PA. At the time of the study, Melinda E. Salmon and Andrew De Los Reyes were also with Centers for Disease Control and Prevention, Atlanta, GA.
E Claire
EC
Newbern
Greta L
GL
Anschuetz
Michael G
MG
Eberhart
Melinda E
ME
Salmon
Kathleen A
KA
Brady
Andrew
A
De Los Reyes
Jane M
JM
Baker
Lenore E
LE
Asbel
Caroline C
CC
Johnson
Donald F
DF
Schwarz
D000293:Adolescent; D002648:Child; D003644:Death Certificates; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D015143:Philadelphia / Q000453:epidemiology; D016012:Poisson Distribution; D011159:Population Surveillance; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D015231:Sexually Transmitted Diseases, Bacterial / Q000453:epidemiology* / Q000652:urine; D047568:Unsafe Sex; D055815:Young Adult