Sexually transmissible infections among people with HIV infection

Templeton DJ1,2,3, Wong AK1, Balasubramanian S1, Fargie FM1.

  1. Department of Sexual Health Medicine, Sydney Local Health District, Sydney, Australia
  2. Kirby Institute, UNSW Sydney, Sydney, Australia
  3. Sydney Medical School, The University of Sydney, Sydney, Australia

Last reviewed: October 2019

 Introduction

The epidemiology of sexually transmissible infections (STIs) among Australian people with HIV infection varies widely, in keeping with the diverse demographic and behavioural characteristics of people with HIV infection in Australia (1). Community-based cohort studies from the last decade found a higher incidence of most STIs among the group who bear a disproportionate burden of STIs in Australia: HIV-positive men who have sex with men (MSM) (2), and this finding remains consistent with recent Australian surveillance reports (3). To our knowledge, there are no comparable data regarding STIs among non-MSM people with HIV infection in Australia.

Australian guidelines recommend STI testing (and, initially, vaccination for vaccine-preventable STIs) four times per year in asymptomatic MSM, and testing according to risk behaviour in other people with HIV infection (4).The presence of some STIs is known to enhance transmission of HIV infection (5), however in the setting of HIV viral suppression, concurrent STIs do not appear to affect risk of HIV acquisition via condomless anal sex between serodiscordant gay male couples (6, 7).

This chapter will discuss most STIs but focus on those where there are recognised differences in clinical presentation and management among HIV-positive individuals, namely lymphogranuloma venereum (LGV), syphilis and herpes simplex virus (HSV). Details of clinical presentation and guidelines for management of other STIs can be found online in the Australian STI Management Guidelines (4). Human papillomavirus infection (Chapter X) and Hepatitis B and C virus infections (Chapter Y) are covered in detail in other chapters of these guidelines.