HIV This Week

Grijsen ML, Graham SM, Mwangome M, Githua P, Mutimba S, Wamuyu L, Okuku HS, Price MA, McClelland SR, Smith AD, Sanders EJ. Screening for genital and anorectal sexually transmitted infections in HIV prevention trials in Africa. Sex Transm Infect. 2008 Mar 28 [Epub ahead of print]

Grijsen and co-authors’ objectives were (1) to demonstrate the value of routine, basic sexually transmitted infections screening at enrolment into an HIV-1 vaccine feasibility cohort study; and (2) to highlight the importance of soliciting a history of receptive anal intercourse  in adults identified as being at higher risk for HIV exposure. Routine sexually transmitted infections screening was offered to adults at higher risk for HIV-1 upon enrolment into a cohort study in preparation for HIV-1 vaccine trials. Risk behaviours and sexually transmitted infections prevalence were summarized, and the value of microscopy assessed. Associations between prevalent HIV-1 infection and receptive anal intercourse or prevalent sexually transmitted infections were evaluated with multiple logistic regression. Participants had a high burden of untreated sexually transmitted infections. Symptom-directed management would have missed 67% of urethritis cases in men and 59% of cervicitis cases in women. Receptive anal intercourse was reported by 36% of male and 18% of female participants. Receptive anal intercourse was strongly associated with HIV-1 in men (adjusted odds ratio [aOR] = 3.8, 95% CI 2.0-V 6.9), and independently associated with syphilis in women (aOR 12.9, 95% CI 3.4-V 48.7). Grijsen and colleagues conclude that high-risk adults recruited for HIV-1 prevention trials carry a high sexually transmitted infections burden.  Symptom-directed treatment may miss many cases, and simple laboratory-based screening can be done with little cost. Risk assessment should include questions about anal intercourse and whether condoms were used. Sexually transmitted infections screening, including specific assessment for anorectal disease, should be offered in African research settings recruiting participants at high risk for HIV-1 acquisition.

Editors´note: This article is about the importance of screening potential vaccine trial participants for sexually transmitted infections. But it is also about unprotected receptive anal intercourse, considered to be the most efficient mode of secual transmission of HIV, whether among men who have sex with men or heterosexual couples. If questions that are carefully worded are not asked, no answers will be given and the opportunity for intensified risk reduction counselling will be missed.