STDs and HIV – CDC Detailed Fact Sheet

People who have a sexually transmitted disease (STD) are more likely to get HIV, when compared to people who do not have STDs.

STDs and HIV.

People who have an STD may be at an increased risk of getting HIV.^1-3 One reason is the behaviors that put someone at risk for one infection (not using condoms, multiple partners, anonymous partners) often put them at risk for other infections. Also, because STDs and HIV tend to be linked, when someone gets an STD it suggests they got it from someone who may be at risk for other STDs and HIV. Finally, a sore or inflammation from an STD may allow infection with HIV that would have been stopped by intact skin.

STDs can increase the risk of spreading HIV.

People with HIV are more likely to shed HIV when they have urethritis or a genital ulcer.^{4, 5} When a person with HIV gets another STD, such as gonorrhea or syphilis, it suggests that they were having sex without using condoms. If so, they may have spread HIV to their partners. Antiretroviral treatment for HIV can prevent the transmission of HIV even from persons who have other STDs.⁶

Some STDs are more closely linked to HIV than others.

In the United States, both syphilis and HIV are highly concentrated epidemics among gay, bisexual, and other men who have sex with men (MSM).^{7, 8} In 2021, MSM only and men who have sex with both men and women (MSMW) accounted for 63% of all primary and secondary syphilis cases among males in which sex of sex partner was known.⁹  In Florida, in 2010, among all persons diagnosed with infectious syphilis 42% were also HIV infected.¹⁰ Men who get syphilis are at very high risk of being diagnosed with HIV in the future; among HIV-uninfected men who got syphilis in Florida in 2003, 22% were newly diagnosed with HIV by 2011.²  HIV is more closely linked to gonorrhea than chlamydia (which is particularly common among young women).¹¹  Herpes is also commonly associated with HIV; a meta-analysis found persons infected with HSV-2 are at 3-fold increased risk for acquiring HIV infection.^12-14

Some activities can put people at increased risk for both STDs and HIV.

• Having anal, vaginal, or oral sex without a condom;
• Having multiple sex partners;
• Having anonymous sex partners;
• Having sex while under the influence of drugs or alcohol can lower inhibitions and result in greater sexual risk taking.

Does treating STDs prevent HIV?

Not by itself. Given the close link between STDs and HIV in many studies, it seems obvious that treating STDs should reduce the risk of HIV. However, most studies that have treated STDs to prevent HIV have not lowered the risk of HIV.^{6, 15-23}

Screening for STDs can help assess a person’s risk for getting HIV. Treatment of STDs is important to prevent the complications of those infections, and to prevent transmission to partners, but it should not be expected to prevent spread of HIV.

What can people do to reduce their risk of getting STDs and HIV?

The only 100% effective way to avoid STDs is to not have vaginal, anal, or oral sex. If people are sexually active, they can do the following things to lower their chances of getting STDs and HIV:

• Choose less risky sexual behaviors;
• Use a new condom, consistently and correctly, for every act of vaginal, anal, and oral sex throughout the entire sex act (from start to finish);
• Reduce the number of people with whom they have sex;
• Limit or eliminate drug and alcohol use before and during sex;
• Have an honest and open talk with their healthcare provider and ask whether they should be tested for STDs and HIV.
• Talk with their healthcare provider and find out if either pre-exposure prophylaxis, or PrEP, or post-exposure prophylaxis, or PEP, is a good option for them to prevent HIV infection.

If someone already has HIV, and subsequently gets an STD, does that put their sex partner(s) at an increased risk for getting HIV?

If the person living with HIV gets and maintains an undetectable viral load by taking antiretroviral treatment, then an STD does not increase the risk of transmitting HIV.⁶ However, HIV-infected persons who are not taking antiretroviral treatment may be more likely to transmit HIV when they have another STD.

HIV-negative sex partners of people with HIV can prevent HIV if:

• HIV-positive people use antiretroviral therapy (ART) as prescribed. ART reduces the amount of virus (viral load) in blood and body fluids. People with HIV who take ART, as prescribed, to achieve and maintain an undetectable viral load can stay healthy for many years, and have effectively no risk of transmitting HIV to sexual partners.
• Sex partners take PrEP medications, as prescribed, after discussing this option with their healthcare provider and determining whether it is appropriate.
• Partners choose less risky sex activities.
• Partners use a new condom for every act of vaginal, anal, and oral sex throughout the entire sex act (from start to finish).

Will treating someone for STDs prevent them from getting HIV?

No. It’s not enough. Screening for STDs can help assess a person’s risk for getting HIV.  Treatment of STDs is important to prevent the complications of those infections, and to prevent transmission to partners, but it should not be expected to prevent spread of HIV.

If someone is HIV-positive and is diagnosed with an STD, they should receive counseling about risk reduction and how to protect their sex partner(s) from getting re-infected with the same STD or getting HIV.

References

1. Hayes R, Watson-Jones D, Celum C, van de Wijgert J, Wasserheit J.  Treatment of sexually transmitted infections for HIV prevention:  end of the road or new beginning?  AIDS 2010;24(suppl 4):S15-S26

2.  Peterman TA, Newman, DR, Maddox L, Schmitt K, Shiver S.  Extremely High Risk for HIV following a diagnosis of syphilis, men living in Florida, 2000-2011  Pub Health Rep 2014;129:164-169.

3.  Pathela P, Braunstein SL, Blank S, Schillinger JA.  HIV incidence among men with and those without sexually transmitted rectal infections: estimates from matching against an HIV case registry.  Clin Infect Dis 2013;57:1203-1209.

4.  Cohen MS, Hoffman IF, Royce RA, et al.  Reduction of concentration of HIV-1 in semen after treatment of urethritis:  implications for prevention of sexual transmission of HIV-1.  Lancet 1997;349:1868-1873.

5.  Schacker T, Ryncarz AJ, Goddard J, Diem K, Shaughnessy M, Corey L.  Frequent recovery of HIV-1 from genital herpes simplex virus lesions in HIV-1—infected men.  JAMA 1998;280:61-66.

6. Cohen MS, Council OD, Chen JS.  Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention:  the biologic basis for epidemiologic synergy.  Journal of the International AIDS Society 2019, 22(s6)e25355.

7.  Pathela P, Braunstein SL, Schillinger JA, Shepard C, Sweeney M, Blank S.  Men who have sex with men have a 140-fold higher risk for newly diagnosed HIV and syphilis compared with heterosexual men in New York City.  J Acquir Immune Defic Syndr 2011;58:408-416.

8.  Purcell DW, Johnson CH, Lansky A, et al.  Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates.  Open AIDS J 2012;6(Suppl 1:M6)98-107.

9.  Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2021. Atlanta, GA: Department of Health and Human Services; April 2023.

10.  Florida trends and statistics. Available at:  http://www.doh.state.fl.us/disease_ctrl/std/trends/florida.html accessed 9/2/13

11. Newman DR, Rahman MM, Brantley A, Peterman TA. Rates of new human immunodeficiency virus (HIV) diagnoses after Reported sexually transmitted infection in women in Louisiana, 2000—2015: Implications for HIV Prevention.  CID.  2020;70:1115-1120.

12.  Wald A, Link K.  Risk of human immunodeficiency virus infection in herpes simplex virus type 2-seropositive persons: a meta-analysis.  J Infect Dis 2002 185:45-52.

13.  Freeman EE, Weiss HA, Glynn JR, Cross PL, Whitworth JA, Hayes RJ.  Herpes simplex virus 2 infection increases HIV acquisition in men and women: systematic review and meta-analysis of longitudinal studies.  AIDS 2006;20:73-83.

14. Looker JK, Elmes JAR, Gottlieb SL, et al.  Effect of HSV-2 infection on subsequent HIV acquisition: an updated systematic review and meta-analysis.  Lancet Infect Dis 2017;17:1303-1316.

15.  Grosskurth H, Mosha F, Todd J, et al.  Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania:  randomized controlled trial.  Lancet 1995;346:530-536.

16.  Wawer MJ, Sewankambo NK, Serwadda D, et al.  Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomized community trial.  Lancet 1999;353:525-535.

17.  Kamali A, Quigley M, Nakiyingi J, et al. Syndromic management of sexually-transmitted infections and behavior change interventions on transmission of HIV-1 in rural Uganda: a community randomized trial.  Lancet 2003;361:645-652.

18.  Gregson S, Adamson S, Papaya S, et al.  Impact and process evaluation of integrated community and clinic-based HIV-1 control: a cluster-randomised trial in eastern Zimbabwe.  PLoS Medicine 2007;4:e102.

19.  Ghys PD, Diallo MO, Ettiegne-Traore V, et al.  Effect of interventions to control sexually transmitted disease on the incidence of HIV infection in female sex workers.  AIDS 2001;15:1421-1431.

20.  Kaul R, Kimani J, Nagelkerke NJ, et al.  Monthly antibiotic chemoprophylaxis and incidence of sexually transmitted infections and HIV-1 infection in Kenyan sex workers: a randomized controlled trial.  JAMA 2004;291:2555-2562.

21.  Watson-Jones D, Weiss HA, Rusizoka M, et al.  Effect of herpes simplex suppression on incidence of HIV among women in Tanzania.  N Engl J Med 2008;358:1560-1571.

22.  Celum C, Wald A, Hughes J, et al.  Effect of acyclovir on HIV-1 acquisition in herpes simplex virus 2 seropositive women and men who have sex with men: a randomized, double-blind, placebo-controlled trial.  Lancet 2008;371:2109-2119.

23.  Celum C, Wald A, Lingappa JR, et al.  Acyclovir and transmission of HIV-1 from persons infected with HIV-1 and HSV-2.  N Engl J Med 2010;362:427-439.