Abstract

Objectives: To determine infection patterns of STIs that facilitate HIV transmission among HIV-discordant couples.

Methods: 112 initial respondents were recruited in an impoverished neighborhood of Brooklyn, NY. Their sexual (and injection) partners were recruited in up to 4 additional network sampling waves for a final sample of 465 persons 18 years or older. After separate informed consent, blood and urine were collected and tested for HIV (EIA/WB); type-specific (FOCUS) anti-HSV-2; syphilis (RPR and TPPA); chlamydia (BDProbeTec Amplified DNA assay) and gonorrhea (BDProbeTec Amplified DNA assay).

Results: Of 30 HIV-discordant partnerships, 5 were same-sex male partnerships and 25 were opposite-sex partnerships. No subjects tested positive for syphilis or gonorrhea. Two couples were chlamydia-discordant. For HSV-2, 16 couples were double-positive, eight discordant, four double-negative, and two were comprised of a herpes-2-negative with a partner with missing herpes data.

Conclusions: HSV-2 was present in 83% of the HIV-discordant couples; CT in 7%; and syphilis and gonorrhea in none. HSV-2 is probably more important for HIV transmission than bacterial STDs since it is more widespread. Even given the limited generalizability of this community-based sample, there seems to be an important HIV-prevention role for herpes detection and prevention activities in places where HIV-infected people are likely to be encountered, including STD clinics, HIV counseling and testing programs, jails and prisons, needle exchanges, and drug abuse treatment programs. The effects of HSV-suppressive therapy in highly-impacted groups should also be investigated.