Table 1

Summary of findings from studies of sexually transmitted co-infections in people living with HIV/AIDS

Study authors, dateSample—all HIV+% Receiving ARTSTI diagnosis/detectionSTI point prevalenceSTI time interval prevalence
Africa and Middle East
Machekano et al, 200027666 Men factory workers, ZimbabweNRPresentation with urethral discharge, genital ulcer, genital warts, or other
  • 11% Genital ulcers

  • 5% Urethral discharge

Aboud et al, 200852292 Pregnant women enrolled in an HIV prevention trial, Malawi, Tanzania, ZambiaNRExternal examination, serology, Gram stain
  • 47.8% Bacterial vaginosis

  • 2.6% Chlamydia

  • 2.2% Genital ulcer

  • 1.7% Gonorrhoea

  • 18.8% Trichomoniasis

Agmon-Levin et al, 2010281060 Patients receiving HIV-related care, IsraelNRClinical records and serology14% Syphilis
Asia
Zhang et al, 20072916 Men, VCT centre, ChinaNone, initial testSerology
  • 31% Chlamydia

  • 50% Syphilis

Park et al, 200830539 Patients at HIV clinics, Republic of Korea100% Taking HAARTSerology
  • 10% Early syphilis

  • 3% Primary syphilis

  • 7% Secondary syphilis

Lee et al, 200931116 Men and 7 women attending HIV clinic, ChinaNRSelf-reported history, medical records, serology and urine screening8.9% Had active STD at enrolment19.5% New STI since HIV diagnosis
Sirivongrangson et al, in press131 MSM STI clinic patients, Thailand16%Clinical examination, PCR, serology
  • 10% Chlamydia

  • 13% Gonorrhoea

  • 9% Syphilis reactive

  • 10% Genital ulcers

Australia
Jin et al, 200732235 Men in the Positive Health Cohort AustraliaNRSerology, urine and anal screening
  • 5.9% Anal chlamydia

  • 2.2% Urethral chlamydia

  • 3.2% Anal gonorrhoea

  • 18.6% Syphilis reactive

Europe
Stolte et al, 200633222 Men, STD clinic patients, The NetherlandsNoneSerology and culture
  • 15.8% Rectal gonorrhoea

  • 9.9% Infectious syphilis

Kofoed et al, 2006242200 Infectious disease patients, Denmark83% of Syphilis patients taking ARTSerology2% Syphilis cases diagnosed in 1 year
Dodds et al, 200734
  • 257 Men, venue surveys, 3 cities in UK

  • London n=176

  • Brighton n=51

  • Manchester n=30

NRSelf-report STI diagnosis in past year
  • STI in the past year

  • London 38%

  • Brighton 43%

  • Manchester 35%

Landes et al 2007351050 Pregnant women, seven countries in Europe80% Antenatal ARTClinical and laboratory
  • Diagnosed during pregnancy

  • 1% Gonorrhoea/chlamydia

  • 2% Syphilis

  • 12% Trichomoniasis

Diaz et al, 2009361462 MSM diagnosed with HIV between 2003 and 2007 in SpainNAClinical diagnosis31% Diagnosed with chlamydia, gonorrhoea or syphilis at time of testing HIV positive
Branger et al, 2009371105 HIV clinic patients with history of syphilis testing, The NetherlandsNRSerology6.2% Syphilis (33% asymptomatic)
Dang et al, 200938147 Men, Swiss HIV Cohort Study, Switzerland71% Combination ARTAnal swab specimens screened for Chlamydia trachomatis by PCR; self-reported STI history
  • 10.9% C trachomatis

  • 2.7% Gonorrhoea

  • 43% Syphilis reactive

North America
Niccolai et al, 2000391407 Women at public HIV outpatient clinic, USANRClinical diagnosis trichomoniasis, gonorrhoea, chlamydia and primary or secondary syphilis
  • 27% A concurrent STI

  • 29% Trichomoniasis

  • 36% Re-infected with trichomoniasis

Kalichman et al, 200040223 Men, 112 women, 5 transgender recruited from community services, USANRSelf-reported
  • 3-Month retrospective

  • Men

  • 3% Chlamydia

  • 4% Gonorrhoea

  • 3% Incident HSV

  • 3% Syphilis

  • 1% Trichomoniasis

  • Women

  • 4% Chlamydia

  • 6% Gonorrhoea

  • 6% Incident HSV

  • 4% Syphilis

  • 9% Trichomoniasis

Cu-Uvin et al, 200122108 Women, research site, USA
  • 30% Untreated

  • 25% Non-HAART

  • 45% HAART

Clinical diagnosis and culture
  • 11% Bacterial vaginosis

  • 4% Trichomoniasis

Scheer et al, 20014111 516 People living with AIDS in San Francisco data extracted from central STI registry, USA79% Received HIV therapyClinical reports to central registry of chlamydia, gonorhrhea, non-gonococcal urethritis, syphilis
  • 2% Diagnosed with STI after AIDS diagnosis

  • Of those with STI

  • 5% Chlamydia

  • 84% Gonorhrhea

  • 7% Non-gonococcal urethritis

  • 3% Syphilis

Do et al, 20014236 102 Patients attending over 100 health clinics, USA between 1991 and 199862% Received HIV therapyCulture, Gram-stain1.6% Urogenital gonorrhoea infection
Cu-Uvin et al, 200243871 Women in HERS Cohort – patients in health clinics in 4 cities, USANRMicroscopic evaluation, culture
  • 47% Bacterial vaginosis

  • 29% Trichomoniasis estimated

Whittington et al, 200244337 Men receiving public health clinic services and recruited from other sites, USANRSerology and urine screening
  • STD clinics

  • 15% Gonorrhoea or chlamydia

  • Other recruitment sites

  • 8% Gonorrhoea or chlamydia

  • 2% Syphilis

Erbelding et al, 200345796 Men and 354 women public STI clinic patients, USANAClinical records from routine testing services
  • Co-infection at time of testing

  • Men

  • 14% Gonorrhoea

  • 19% Non-gonococcal urethritis

  • 21% Syphilis

  • Women

  • 9% Gonorrhoea

  • 18% Syphilis

  • 20% Trichomoniasis

Bachmann et al, 200546338 Men, HIV clinic, USA76% HAARTPharynx and rectal swabs; urine samples, cultures and PCR
  • 3% Chlamydia

  • 1.5% Gonorrhoea

Phipps et al, 200547814 Primary care HIV patients, USANRSerology, urine screening, pharyngeal and anal swabs
  • 10% Gonorrhoea/chlamydia

  • 1.8% Syphilis

Kahle et al, 2007484711 Patients at HIV clinics and hospitals, USA74% History of HIV treatmentSerology, Gram stain, culture, self-report and referral
  • 1 Year interval

  • 2% Chlamydia

  • 4% Gonorrhoea

  • 1% Syphilis

Manning et al, 200749632 264 People living with HIV/AIDS in New York City data extracted from central STI registry, USANRClinical reports to central registry
  • People living with HIV

  • 5% of Men

  • 2.5% Women

  • People living with AIDS

  • 1.8% Men

  • 1.4% Women

  • Frequency of diagnoses among people living with HIV/AIDS

  • With 2-year cumulative STI

  • 20% Chlamydia

  • 42% Gonorrhoea

  • 31% Syphilis

  • 5% Multiple STI

  • 16% Repeated STI

Sena et al, 2008501460 Newly diagnosed men and 2142 newly diagnosed women from public testing sites, USANASerology and clinical records
  • 7% Syphilis, men

  • 13% Syphilis, women

Rieg et al, 200851212 Men receiving medical care at 2 HIV clinics, USANRSerology, urine screening, self-report
  • 6% Gonorrhoea

  • 5% Chlamydia

Mayer et al, 200952398 Men screened at a community research site, USA66% ARTMedical records of clinical examination, serology, PCR,
  • STI in past year

  • >1% Chlamydia

  • 3.1% Gonorrhoea

  • 6.4% Syphilis

Horberg et al, 200953622 Patients in an integrated healthcare system, USA51% TreatedLaboratory database searched for serological test results12.4% Syphilis
Kalichman et al, 200954320 Men, 137 women, 33 transgender recruited from community services, USA71% TreatedSelf-reported STI
  • STI diagnosis in past 6 month

  • 14% New chlamydia, gonorrhoea, HSV, or syphilis

  • STI diagnosis since testing HIV+

  • 20% Chlamydia

  • 13% Gonorrhoea

  • 37% HSV

  • 36% Syphilis

Romanowski et al, 200955455 Men, 174 women infectious disease clinic patients, Canada77% Men, 60% women HAARTHSV-1 and HSV-2 serology
  • 78% HSV-1 positive

  • 54% HSV-2 positive

  • 58% of HSV-2 positive without genital herpes symptoms

McCoy et al, 2009656 Men and 19 women with acute HIV infection, USANAClinical confirmed diagnosis
  • 30.6% Co-infected with STI

  • Men

  • >1% Chlamydia

  • 12% Gonorrhoea

  • 7% Syphilis

  • Women

  • 15% Bacterial vaginosis

  • 10% Chlamydia

  • 10% Gonorrhoea

  • 26% Trichomoniasis

South America
Griemberg et al, 20065687 HIV-positive patients detected in clinics/hospitals, ArgentinaNAClinical diagnosis58% Syphilis reactive at time of testing
Grinsztejn et al, 200657458 Women receiving care, Brazil67%Clinical diagnosis
  • 7.0% Trichomoniasis

  • 0.9% Neisseria gonorrhoeae

  • 3.0% C trachomatis

  • 3.1% HSV

  • 13.8% Syphilis

  • 22.8% Bacterial vaginosis

Caribbean
Hutton-Rose et al, 200858138 Men and 132 women referral clinic, JamaicaNRHistory, clinical examination, and lab diagnosis
  • Men

  • 4% Chancroid

  • 19% Gonorrhoea

  • 19% Non-gonococcal urethritis

  • 8% Syphilis

  • 9% Trichomoniasis

  • 14% Genital ulcer

  • Women

  • 10% Bacterial vaginosis

  • 2% Chancroid

  • 15% Gonorrhoea

  • 19% Non-gonococcal urethritis

  • 6% Syphilis

  • 15% Trichomoniasis

  • 7% Genital ulcer

  • ART, antiretroviral therapy; HAART, highly active antiretroviral therapy; HSV, herpes simplex virus; MSM, men who have sex with men; STD, sexually transmitted disease; STI, sexually transmitted infection; VCT, voluntary counselling and testing.