Sexually-Transmitted Infections for HIV-Positive People

STD s (sexually transmitted disease) that cause ulcerations (sores on the skin, including on or inside the genitals, mouth, or rectum) can dramatically increase the risk of picking up HIV, due to the fact that ulcers and open sores provide an easy entry for the virus. Infections that cause irritation of the urethra, vagina, or rectum can increase the risk of HIV infection two- to five-fold. Some studies show that these infections may also increase an HIV-positive person's viral load, leading to higher concentrations of HIV in body fluids and a heavier attack on the immune system. It's important for everyone to be aware of signs and symptoms of these infections in order to avoid discomfort, possible health risks, and transmission of infections to sex partners, but the additional health concerns for HIV-positive people makes it even more important that STD screening and treatment be a regular part of healthcare.

Bacterial Infections

Gonorrhea (Nerissa gonorrhea) and chlamydia (chlamydia achromatic) are relatively simple bacterial infections that occur in the urethra, vagina, rectum or throat, and generally cause discharge and/or pain in the infection site. Rarely, a gonorrhea infection can spread throughout the body (disseminated gonorrheal infection), causing joint pain and other symptoms that appear unrelated to sexual transmission. The symptoms of chlamydia tend to be less severe than those caused by gonorrhea, and therefore may be overlooked until they've spread further into the reproductive tract. Both are easily cured with the appropriate antibiotics, but a growing number of strains are resistant to one or more of the antibiotics commonly used to treat gonorrhea.

Gonorrhea and chlamydia are the most common causes of Pelvic Inflammatory Disease (PID), a serious women reproductive tract infection that can include the uterus, Fallopian tubes, and/or ovaries in addition to the cervix and vagina. If left untreated, PID can result in scarring, infertility, and severe illness. Epidermis (infection of the epidermal tubes in men) and proctors (rectal inflammation in both women and men) can also result from untreated gonorrhea or chlamydia infection in the penis or rectum. Since both gonorrhea and chlamydia are curable with the appropriate antibiotics, don't leave symptoms go -- unusual discharges or pain should be checked out right away.

Syphilis

Caused by the pretty little Treponema Pallidium spirochete, syphilis is probably the most well-documented STD in human history. Prior to the availability of penicillin, syphilis was largely regarded with the same fear and loathing as HIV/AIDS is today -- it was a complicated, virtually incurable "sinful disease" that too often led to debilitating illness, blindness, heart and brain damage, stillborn babies, and other terrible tragedies that are now largely avoidable if syphilis is caught and treated in the early stages. Sometimes referred to as "The Great Pretender," syphilis can cause confusing symptoms. It's primarily transmitted through contact with bacteria-containing sores and rashes on the surface of the skin. The first sign of syphilis is a painless sore called a chancre, which shows up at the place where the bacteria entered into the body -- most often the genitals, anal area, or mouth.

Because the chancre is painless and heals by itself without treatment, many people miss it and don't seek treatment. During the second stage, the symptoms of syphilis include diverse symptoms like rashes (often on the palms and soles of the feet), patchy hair loss, and general feeling of illness. If not treated during the first or second stages, the infection enters the asymptomatic "latent" stage, where it begins to cause the internal damage that characterizes "tertiary syphilis," or third stage. Fortunately, syphilis is detectable by blood testing and curable with penicillin at any point in the infection, though damage caused by long-term untreated syphilis may be permanent.

Chancroid (Haemophilius ducreyi) Granuloma Inguinale (Calymmatobacterium granulomatis), and Lymphogranuloma (chlamydia trachomatis L1, L2, L3) are bacterial infections that cause large and painful skin ulcerations on the genitals, rectal area, and lymph nodes of the groin. While currently uncommon throughout most of North America, the fact that these infections cause ulcerations makes them a matter of concern from an HIV prevention perspective even if the chance of acquiring the infection is low. While curable with antibiotics, HIV-positive people with these infections may experience slower healing and require a more lengthy course of antibacterial therapy than those who are HIV-negative.

Viral Infections

Herpes simplex (herpes simplex virus I and II) is an incredibly common viral infection that's transmitted by skin-to-skin contact when the virus is active on the surface of a mucous membrane, like those on the lips, genitals, and anal area. Once it sets up shop in the body, HSV will spend most of it's time lying dormant along a nerve pathway ... but when the immune system is occupied with other matters, it'll follow the nerve ending up to the surface of the skin, causing the tingling, pain, and blistering ulcers associated with a herpes outbreak. Over time, most people's immune systems develop the ability to keep HSV in check much of the time, but recurrent and/or severe outbreaks can be a problem for those whose immune systems are compromised by HIV. Acyclovir and acyclovir derivatives (valcyclovir, famcyclovir) are available both to help speed the healing of an outbreak and for use as suppressive therapy for those who experience frequent outbreaks -- they work better in some people's bodies than in others, but at least they're an option if persistent herpes outbreaks are a problem for you.

While most people with HSV become proficient at recognizing the symptoms of an outbreak and working around them to reduce transmitting the virus to a partner, it's important to realize that HSV can be active with very mild symptoms that are easy to overlook, or be active with no symptoms at all ("asymptomatic shedding").

HSV I is commonly associated with cold sores on the mouth and HSV II with genital and anal sores; the two strains should be considered interchangeable for all practical purposes -- they don't care where the mucous membrane is, as long as they can get into the body and cause their mischief. For this reason, it's important for all of us who experience the occasional cold sore to avoid performing oral sex or having oral-anal contact while a cold sore is present, in order to avoid passing the virus to a partner's genitals or anal area.

Warts, whether on your feet, hands, or genitals, are all caused by one of the many strains of human papillomavirus (HPV). There are about 30 known strains of HPV that are specialized for life on mucous membranes -- these are the ones responsible for genital and anal warts, both visible and invisible. Probably the most common STD in swing today in all communities, HPV is transmitted through direct mucous-membrane contact with active virus on the surface of the skin.

Unfortunately, since several strains of HPV produce invisible cell changes instead of visible (and therefore more avoidable) wart growth, HPV is not the easiest infection to work around or detect. Visible warts, most often caused by HPV types 6 and 11, can be removed through a number of different therapies (freezing, topical applications, and surgical removal for advanced or complicated wart growth). But "subclinical" cell changes may go unnoticed for long periods of time, and certain HPV types (16, 18, 31, 33, and 35) are now known to be associated with an increased risk of cancerous or pre-cancerous cell changes on the cervix and in the rectum. There currently exists no easy and widespread test for HPV infection, nor is HPV infection considered curable. Since people with both HIV and HPV infections may be at increased risk for developing cervical or anal cancer if they're infected with HPV types 6, 18, 31, 33, or 35, regular cervical and anal Pap smears are recommended in order to monitor any cell changes that are indicative of pre-cancer or cancerous conditions. For more information, check the HPV Resource Center at

Neither HSV nor HPV can pass through latex, so use of latex barriers (condoms and dental dams) are recommended to help reduce the risk of picking up or passing these skin-to-skin transmitted viral infections. However, latex barriers can't provide as much protection against these viruses as they do for bacterial infections like gonorrhea and chlamydia, because they only cover a specific amount of surface skin. Given the widespread nature of both HSV and HPV, as well as the fact that people can't always tell when these viruses are active (or even if they have them at all), the sad reality is that these are not easy infections for sexually active people to avoid.

Viral Hepatitis: A, B, and C (HAV, HBV, HCV)

"Hepatitis" means "liver inflammation" -- viral hepatitis is liver inflammation caused by one of several hepatitis viruses, some of which are known to be sexually transmissible. Hepatitis A (HAV) is generally acquired by ingesting food or water contaminated with feces, but can be passed during sexual activity involving oral-anal contact or contact with feces. Hepatitis B (HBV) is definitely considered a sexually-transmitted infection, due to the virus's presence in semen and vaginal secretions as well as blood. Hepatitis C (HCV) is primarily a blood-borne virus, but appears able to be passed sexually when inflammation or blood is present. Of the three, HCV is the strain most likely to cause liver damage and least likely to be cleared by the body, but HBV is the strain most efficiently passed during sexual activity. Fortunately, preventive vaccines are available to protect against both HAV and HBV (though none exists for HCV). All sexually active people, regardless of age, are now encouraged to take advantage of the HAV and HBV vaccinations in order to reduce their risk for chronic hepatitis, cirrhosis (scarring of the liver), and liver cancer. There is a combination vaccine for both viruses.

Parasites, Protozoans and Bugs

Most commonly acquired through ingesting contaminated food or water, infections such as Giardia (Giardia Lamblia), Shigella, and Amoebiasis (Entamoeba histolytica) can be passed during oral-anal contact and other sexual activities that bring partners into contact with each others' feces. Common symptoms include diarrhea, gas, and cramping. While these infections are curable with the appropriate medications, they can be stubborn in people whose immune systems are compromised by HIV -- it's a good idea for everyone to avoid ingesting fecal matter, but especially important for HIV-positive people. Use of latex or plastic barriers during sexual activities such as rimming goes a long way towards preventing these infections, as does regular hand-washing and other basic hygiene before and after sexual activity involving anal or fecal play.

Trichomoniasis (Trichomonas vaginalis)

Scabies (Sarcoptes scabiei) and pubic lice (Pediculosis Pubis) are parasitic insects that are passed from person to person through close physical contact. Both cause intense itching, but scabies, skin-burrowing mites, leave a distinctive "track"-like rash on the skin, while pubic lice party in your pubic hair. Both can be killed with medicated creams (shampoo for the lice, too), and infestations controlled by washing all bedding and clothing while treating the body. HIV-positive people who pick up scabies are at increased risk for a particularly aggressive scabies infestation (referred to as "crusted scabies"), and therefore may need to work with a specialist in order to properly rid themselves of an infestation.

Laura Jones is a sexual health activist who writes frequently on topics related to sex, drugs, and pregnancy/childbirth. Since moving to Chicago in 1995, she has worked with a wide range of projects promoting healthy sexual decision-making and harm reduction for folks of all gender expressions and sexual orientations. In her spare time, she assists at births, reads socially-unacceptable comics and graphic novels (usually about lesbians), and occasionally eats dinner with her long-suffering husband, Randy.

Non-HIV Viral Sexually Transmitted Diseases

In the AIDS era, most guys are so worried about HIV that they forget about all the other viral sexually transmitted diseases. Although the list is long, the most common viral STDs include herpes, condyloma, and molluscum. (No, it's not something you'd order at a raw bar.) I have included hepatitis in this chapter because within the gay community, this disease is often spread through sexual contact.... [M]ost STDs are far more prevalent than AIDS and don't require ejaculation or even penetration to spread. Viral STDs are no exception, but it gets worse; the condom you so faithfully wear for penetration may not protect you. If your partner has been rubbing his penis against your butt or groin, he can easily pass a virus. You say it couldn't happen because you make him wear a condom even during foreplay. Don't forget about his scrotum, pubic hair, and base of his shaft, areas not covered by the condom. He can carry viruses there and give them to you. And once you catch one of these nasty viruses, you can have it for life.

This doesn't mean you are doomed to a life of pain and unsightly blisters. On the contrary, viral STDs are typified by recurring outbreaks between quiet periods. These viruses hide within your cells, safe from marauding antibodies, white blood cells, and medications.A virus is the simplest biological form -- a segment of genetic material tightly wrapped inside a protein coat. Unable to reproduce on its own, a virus must invade a living cell to multiply. Once safe inside, the virus commandeers the cell's reproductive machinery and new viruses are made.

When a virus is dormant in a cell, its genetic material is still present but idle until it receives some unknown biological stimulus to reproduce again. Then the cells are turned into factories making copies of the virus. New viruses break out of the cells (sometimes but not always destroying the cell in the process) and move to infect other cells -- in your body or in an unsuspecting partner!

Each viral outbreak sends your immune system into overdrive, churning out antibodies and T-cells that attack viruses. Men with AIDS may not have immune systems capable of producing enough T-cells to kill the virus. Fortunately, various medications such as acyclovir (Zovirax) help immune systems by preventing viral reproduction and are available by prescription.

Since there is no simple way to rid yourself of many of the viral STDs, what's a sexually active gay man to do? The answer is simple: Prevent infection in the first place. But prevention is a two-sided responsibility. You must recognize signs of infection in your partner (see below), and you also must recognize your own symptoms. It is much harder to transmit dormant virus, so the quicker you get treated, the less chance there is for you to pass the virus on to an unsuspecting partner.

Currently, condoms are the only widely available, proven method for reducing transmission of HIV and other sexually transmitted infections (STIs) during intercourse. Organizations around the world recommend condom use for the prevention of pregnancy and HIV/STIs. The American Social Health Association (ASHA) supports the promotion and use of male latex condoms to limit the spread of sexually transmitted infections and their harmful consequences. Condoms are effective when people use them correctly and consistently. The surest way to avoid transmission of STIs is to abstain from sexual intercourse or to be in a long-term mutually monogamous relationship with a partner who has been tested and is not infected with any sexually transmitted infections.

People who choose to be sexually active must have access to information and options to reduce their risk and for the millions of people who have previously acquired a viral sexually transmitted infection, effective measures must be taken to protect any future partners from infection: In the United States, there are more than 50 million people estimated to have genital herpes, 20 million people with HPV, and over 1 million people estimated to have HIV, the virus that causes AIDS. The male latex condom effectively reduces the risk of STD transmission when used correctly and consistently.