Cited by 2,271HIV/AIDS Research and InterventionsReproductive tract infections researchCervical Cancer and HPV Research

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From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection.

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Fleming, D. T., Wasserheit, J. N.·1999·Sexually Transmitted Infections

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Abstract

OBJECTIVES: To review the scientific data on the role of sexually transmitted diseases (STDs) in sexual transmission of HIV infection and discuss the implications of these findings for HIV and STD prevention policy and practice. METHODS: Articles were selected from a review of Medline, accessed with the OVID search engine. The search covered articles from January 1987 to September 1998 and yielded 2101 articles. Methods used to uncover articles which might have been missed included searching for related articles by author, and combing literature reviews. In addition, all abstracts under the category "sexually transmitted diseases" from the XI and XII International Conferences on AIDS (Vancouver 1996 and Geneva 1998) and other relevant scientific meetings were reviewed. Efforts were made to locate journal articles which resulted from the research reported in the identified abstracts. All original journal articles and abstracts which met one of the following criteria were included: (1) studies of the biological plausibility or mechanism of facilitation of HIV infectiousness or susceptibility by STDs, (2) prospective cohort studies (longitudinal or nested case-control) which estimate the risk of HIV infection associated with specific STDs or STD syndromes, or (3) intervention studies which quantitate the effect which STD treatment can have on HIV incidence. RESULTS: Strong evidence indicates that both ulcerative and non-ulcerative STDs promote HIV transmission by augmenting HIV infectiousness and HIV susceptibility via a variety of biological mechanisms. These effects are reflected in the risk estimates found in numerous prospective studies from four continents which range from 2.0 to 23.5, with most clustering between 2 and 5. The relative importance of ulcerative and non-ulcerative STDs appears to be complex. Owing to the greater frequency of non-ulcerative STDs in many populations, these infections may be responsible for more HIV transmission than genital ulcers. However, the limited reciprocal impact of HIV infection on non-ulcerative STDs and the evidence that non-ulcerative STDs may increase risk primarily for the receptive partner (rather than bidirectionally) may modulate the impact of these diseases. The results of two community level randomised, controlled intervention trials conducted in Africa suggest that timely provision of STD services can substantially reduce HIV incidence, but raise additional questions about the optimal way to target and implement these services to achieve the greatest effect on HIV transmission. CONCLUSIONS: Available data leave little doubt that other STDs facilitate HIV transmission through direct, biological mechanisms and that early STD treatment should be part of a high quality, comprehensive HIV prevention strategy. Policy makers, HIV prevention programme managers, and providers should focus initial implementation efforts on three key areas: (i) improving access to and quality of STD clinical services; (ii) promoting early and effective STD related healthcare behaviours; and (iii) establishing surveillance systems to monitor STD and HIV trends and their interrelations.

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Authors: Fleming, D. T., & Wasserheit, J. N.
Affiliations: Centers for Disease Control and Prevention (US)
ORCID: Wasserheit, J. N.
Venue: Sexually Transmitted Infections
Publisher: BMJ
Published: 1999-02-01
Volume: 75
Issue: 1
Pages: 3-17
ISSN: 0007-134X (ISSN-L)
1368-4973
DOI: 10.1136/sti.75.1.3
PMC: PMC1758168
OpenAlex: W2054233015
Cited by: 2,271
References: 81
Citations by year: 2026: 9 · 2025: 21 · 2024: 24 · 2023: 43 · 2022: 46 · 2021: 61 · 2020: 52 · 2019: 82 · 2018: 78 · 2017: 75 · 2016: 70 · 2015: 105 · 2014: 107 · 2013: 110 · 2012: 119
FWCI: 13.74
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Sexually Transmitted Infections (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
Keywords: sexually transmitted infections, HIV transmission, HIV susceptibility, genital ulcers, STD treatment, HIV prevention policy, HIV incidence reduction, bidirectional transmission, Africa
MeSH terms: Disease Susceptibility, Female, Health Policy, HIV, Humans, Male, Public Health, Sex Factors, Sexually Transmitted Diseases, Global Health, HIV Infections

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From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection.

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