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Updated September 7, 2006

Case 4: STDs and HIV Transmission

Authors: Emily Darby, MD Jeanne Marrazzo, MD, MPH

A 23-year-old heterosexual HIV-infected woman presents to a sexually transmitted diseases (STD) clinic complaining of severe pain in her vulva. A sexual history reveals that she has had a steady HIV-negative sexual partner for 8 months, but occasionally exchanges sex for crack cocaine. She rarely uses condoms, explaining that she has heard it is difficult for women to transmit HIV to men. Her history and exam are consistent with primary genital herpes, and laboratory studies are sent to confirm this suspected diagnosis. She also undergoes complete testing for other common STDs.

Which of the following is TRUE regarding STDs and HIV transmission?

A The presence of genital lesions caused by HSV in an HIV-infected person confers a major increase (up to 4-fold) in the risk of HIV transmission to a HIV-negative partner.
B If this patient’s HIV-negative sexual partner has a history of genital herpes, her current HSV infection would not place him at increased risk of acquiring HIV.
C Among sexually transmitted pathogens, only those organisms that cause genital ulcer disease are associated with an increased risk of HIV transmission.
D Treatment of common sexually transmitted infections that cause cervicitis, including chlamydia and trichomoniasis, in HIV-infected women has not been shown to decrease genital shedding of HIV.