Sexually transmissible infections (STIs) like chlamydia, gonorrhoea, herpes or syphilis can affect any woman but they can have a more significant effect on women with HIV. HIV can cause more severe symptoms and can make an STI more difficult to treat. STIs can also place an additional burden on your immune system.
If your partner is HIV-negative and either you or your partner has an STI, the risk of HIV transmission is increased. You or your partner could have an STI even if you have no symptoms.
Using condoms for sex is a practical preventative measure although it won’t completely remove all risk of infection with some STIs. Many STIs do not have obvious symptoms so a regular check-up is recommended. Basically, the more sex you have with different people, the more regularly you should be tested for STIs. Many STIs can be quickly and easily dealt with if they are picked up early. NAPWHA’s treatment page Women & STIs also offers some useful information.
Herpes and HIV The frequency and severity of outbreaks of genital herpes may increase if your immune system is weakened by HIV. It is also possible for undiagnosed herpes infection (which has not caused symptoms in the past) to be ‘reactivated’ and cause symptomatic illness.
Herpes may increase the replication of HIV and therefore raise viral load. Symptomatic herpes in an HIV-negative person increases their risk of HIV infection.
Treatment Medical educators urge the aggressive treatment of herpes infections in people with HIV. Recurrent outbreaks may be treated with the antiviral drugs acyclovir (Zovirax), famiciclovir (Famvir) or valaciclovir (Valtrex). Reducing stress, having a healthy diet and taking care of yourself can all help reduce the recurrence of herpes.
Prevention Male or female condoms for vaginal or anal sex, and the use of barrier protection like dams, can help prevent infection but herpes can still be transmitted if condoms do not completely cover the infected area. Antiviral treatment may help prevent spread to sexual partners. Talk to your doctor.
Chlamydia and HIV Chlamydia greatly increases the viral load in semen, which makes it is easier to pass HIV on to other people.
Treatment Testing for chlamydia is easy — done by your doctor checking a urine sample. Chlamydia responds effectively and quickly to a short course of antibiotics. All sexual partners from the last six months should be tested and if they test positive, should be treated. It is important that you return to your doctor for a check-up once the treatment is completed to make sure you have no recurring infection. You should not have penetrative sex until you have received a negative test result following the check-up. If chlamydia is left untreated, it can cause serious health problems.
Prevention Chlamydia is prevented by using barrier protection like male or female condoms or dams every time you have sex. A chlamydia test is recommended whenever you change sexual partners and at least once a year if you are under 25 and sexually active.
Syphilis and HIV Genital sores caused by syphilis make it easier to transmit and acquire HIV. Syphilis can also progress to severe symptoms more quickly in people with HIV. There can be rapid progression from early syphilis to nervous system involvement in a matter of months, rather than the years or decades it takes in HIV-negative people. Complications to the nervous system may also occur in the early stage of infection, not just in the later stages.
Co-infection with HIV and syphilis may also result in more rapid onset of HIV disease and AIDS. It can decrease CD4 count (thereby damaging the immune system) and increase HIV viral load.
Syphilis can be more difficult to treat in people with HIV. There have also been cases of treatment failure in patients with secondary syphilis, all of whom were HIV positive. People with HIV can also progress to neurosyphilis despite standard treatment. If you have syphilis (early or latent), careful monitoring is advised so that any abnormality is treated immediately.
Treatment If treated early and appropriately, syphilis can easily be cured by penicillin injections or tablets. If you are allergic to penicillin there are alternative treatments. The duration and intensity of treatment depends on the stage of infection. Although the treatment is straightforward, it is important to have repeat blood tests to check that the treatment has worked. After treatment with penicillin some people (particularly those who have early syphilis) have a flu-like illness for 24 hours. This includes fevers, aches and pains and generally feeling unwell. It will go away and doesn’t require any specific treatment except plenty of rest and fluids.
Prevention Always use male or female condoms for vaginal, anal and oral sex. Condoms are not 100 per cent effective because they will only stop infection from the skin covered by the condom – they may not cover all sores or rashes in the affected area. Use dams for oral sex. Avoid contact with any sores. Avoid sex if either partner has infectious syphilis. You should not have sex until your rash or sore clears up. Regular testing is important as it is the only way to truly diagnose syphilis. Once tested, you and/or your partner can be treated. Wait at least a week after treatment before having sex.
Gonorrhoea and HIV HIV infection may exacerbate some of the symptoms and complications of gonorrhoea. Also, some research has shown a link between gonorrhoea and faster HIV disease progression. Cases of severe arthritis related to gonorrhoea have been reported in people with HIV. There are also reports of keratoconjunctivitis, a severe inflammation of the membrane which covers the eye.
Treatment Women are tested using a urine test or a swab from the cervix, anus or throat. Gonorrhoea is treated with antibiotics. A follow-up swab is taken to make sure the infection is gone. Men are tested by urine test or swab from the penis or a swab from the anus or throat.
Prevention Always use male or female condoms for vaginal, anal and oral sex. Use dams for oral sex to cover the vagina or anus. Make sure your current partners have been tested. You should not have any sexual contact for one week after completion of treatment (not even sex with a condom).