Objectives: To investigate the prevalence and incidence of sexually transmitted infections (STI) in HIV-infected women in relation to time from infection and sexual behaviour.
Design: The European study on the natural history of HIV infection in women is a prospective cohort study of 487 HIV-infected women with a known interval of seroconversion from 12 European countries.
Methods: Incidence was measured with person–time methods. Generalized estimating equations analysis was used to determine risk factors for STI.
Results: At entry, 15% of the women were diagnosed with at least one acute STI (chlamydial infection, trichomoniasis or gonorrhoea), 10% with at least one other STI (genital warts or genital ulcerations) and 13% with vaginal candidiasis. Although frequently diagnosed during follow-up, the occurrence of acute STI and vaginal candidiasis decreased, whereas the occurrence of other STI increased with ongoing time from HIV infection. Furthermore, women with a history of prostitution [relative risk (RR), 2.00; 95% confidence interval (95% CI), 1.20–3.33] and women with irregular condom use (RR, 7.74; 95% CI, 3.52–17.0) were at higher risk for an acute STI.
Conclusions: Although STI diagnoses were frequent, the occurrence of acute STI declined with time from infection which might be explained by changed sexual behaviour over time. The occurrence of other STI increased with time from HIV infection, presumably due to reactivation as a result of immunosuppression.
From the aMunicipal Health Service, Division of Public Health and Environment, Amsterdam, The Netherlands and the bCentre for the epidemiological monitoring of AIDS, Saint-Maurice, France. *See Appendix.
Sponsorship: This study was supported by the DG XII of the European Commission, the French National Agency for AIDS research (ANRS) and the Dutch AIDS Foundation (Stichting AIDS Fonds, project 2171).
Correspondence to Birgit van Benthem, Municipal Health Service, Division of Public Health and Environment, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands. Tel: +31 20 5555 514; Fax: +31 20 5555 533; Email: bvbenthem@gggd. amsterdam.nl
Received: 2 March 1999;
revised: 14 September 1999; accepted: 17 September 1999.