Treating Other STDs May Reduce HIV Levels in the Semen

CHAPEL HILL, NC—Men infected with HIV who also have another sexually transmitted disease (STD) have approximately an eightfold increase in the amount of HIV in their semen, compared with men who do not have a second sexually transmitted disease, a study conducted in Africa has shown.

The study, headed by Dr. Myron S. Cohen, of the University of North Carolina School of Medicine, has important public health and economic implications worldwide. The results suggest a relatively inexpensive, indirect means of potentially preventing HIV infection, namely, treating the co-infection with antibiotics to reduce the amount of HIV in the semen and thus lower the risk of HIV transmission to sexual partners.

The study was conducted in Malawi, a country in southern Africa with a high rate of HIV infection, allowing for faster results than could be obtained in the United States. Approximately 15% of sexually active adults in Malawi are infected with HIV, primarily due to heterosexual activity.

The trial was sponsored by the World Health Organization and several US agencies, including the National Institute of Allergy and Infectious Diseases.

The study involved 135 HIV-positive men who were being treated for other symptoms (Lancet, June 28, 1997). Of this group, 86 men had pain on urination due to another sexually transmitted disease, including gonorrhea, syphilis, and genital ulcers presumed to be due to an STD.

The remaining 49 men did not have a second sexually transmitted disease but were being treated for skin conditions. The men with a sexually transmitted disease had semen HIV levels eight times higher than the other group.

Within one week of antibiotic treatment, HIV levels in the semen fell significantly in the men treated for other sexually transmitted diseases, and within two weeks of treatment, these levels were the same as those in the men being treated for skin conditions.