High Cumulative Incidence of Genital Herpes Amongst HIV-1 Seropositive Heterosexuals in South London

The cumulative incidence of sexually transmitted diseases (STD) in a cohort of 51 (35 female, 16 male) HIV-1 seropositive STD clinic attenders who had acquired HIV-1 infection via heterosexual transmission was investigated through a retrospective review of the case notes. The women were followed up for a mean 11.6 months and the men for 18 months. Thirty-one (88%) of the women and 13 (81%) of the men were of sub-Saharan African origin. Approximately half of the subjects were first diagnosed as HIV-1 positive with CD4 counts <200×10⁶/1 and a quarter with CD4 counts <50×10⁶/1. STDs detected in women were: genital herpes 15 (43%), Candida 12 (34%), bacterial vaginosis 9 (25%), and in men: genital herpes 6 (38%), non-gonococcal urethritis 4 (25%). No cases of gonorrhoea were detected. At the time of first diagnosis of genital herpes at the clinic, the mean CD4 count in women was 275×10⁶/1 and in men 285×10⁶/1. Genital herpes was the AIDS defining diagnosis in 3 of the women.

The recognized risk of HIV transmission via genital lesions should be stressed in HIV-1 positive subjects with genital herpes. The incidence of other STD was low—both knowledge of HIV status and safer sex counselling may limit unsafe sexual behaviour and should be evaluated further as a strategy for limiting the spread of HIV-1 infection.