STD After HIV Diagnosis

Background:  The Pennsylvania Department of Health collects data on HIV and STDs through an integrated surveillance system known as the Pennsylvania National Electronic Diseases Surveillance System (PA-NEDSS).  This integrated  system provides an opportunity to examine co-infections with these diagnoses. 

Objectives:  The objective was to examine characteristics of people with episodes of STD after diagnosed HIV infection.

Methods:  Data from PA-NEDSS were examined to identify Pennsylvanians (excluding Philadelphia) reported with HIV infection diagnosed between 2003 and December 2010 who also were reported to have  confirmed gonorrhea, syphilis and Chlamydia occurring >30   days after their initial HIV diagnosis. To identify STD events, the database was examined through September 2011.  Frequencies were used to assess demographic and risk factor distributions. 

Results:  A total of 1,204 STDs occurring >30 days after initial HIV diagnosis were found among 872 individuals with HIV.  The median number of STD episodes per co-infected person was 1 (range 1 to 7 episodes).  This included 214 (18%) episodes of syphilis, 564 (47%) episodes of gonorrhea, and 426 (35%) episodes of Chlamydia.   Males accounted for 659 (75.5%) of these patients.  Men having sex with men (MSM) as primary risk factor accounted for 516 (59.1%) of the co-infected individuals.  Among those with co-infection, 359 (41.1%) where White, 346 (39.6%) were African Americans and 93 (10.7%) were Hispanic.  The majority (71.6%) of co-infected persons were over age 30 at time of STD diagnosis.

Conclusions:  A substantial number of HIV infected individuals continue to engage in unprotected sexual activity that places them at high risk of STDs.  This has significant implications for control and prevention of STDs as well as HIV. 

Implications for Programs, Policy, and Research:  This finding demonstrates a need for strengthening and intensifying HIV prevention with positive strategies.