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Updated August 29, 2006

Case 3: Sexually Transmitted Diseases Screening in HIV-infected Individuals

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A 31-year-old woman with HIV infection (CDC category A2) presents to establish care with a new primary care provider. She has known of her HIV infection for one year, and her CD4 counts have been stable between 370 to 450 cells/mm3. She acquired HIV through sexual contact with an HIV-infected male injection-drug user with whom she continues to have a relationship. Although he is her only current sexual partner, she doubts he is monogamous, saying it is likely that he "sleeps around" when using drugs. She thinks his other partners are only women, but she’s not completely sure. She explains that since she is HIV-infected and on oral contraceptives, she does not routinely use condoms. She primarily has oral and vaginal sex, but also intermittently engages in anal sex. She has no current symptoms of dysuria, vaginal discharge, or genital sores. She has a history of genital chlamydia. She does not use injection drugs.

Which of the following is TRUE regarding screening for sexually transmitted diseases (STDs) in this HIV-infected patient?

A She is asymptomatic, so STD screening is not indicated.
B Genital chlamydia screening is not necessary because she is older than 25.
C Women with HIV are at low risk for asymptomatic trichomonas infection, so screening for this infection is not recommended.
D Men and women who report receptive anal intercourse should receive screening for rectal chlamydia.
E Only HIV-infected men who have sex with men (MSM) should be routinely screened for syphilis.