Semen HIV Concentration and Urethritis
Heterosexual contact is the primary method of transmission of HIV in some countries and the most rapidly expanding contact method in the United States. The presence of other sexually transmitted diseases (STDs) appears to enhance the likelihood of transmission. This study compared the semen HIV concentration in HIV seropositive men, with and without urethritis.
Participants (n = 206) were men selected from an STD clinic complaining of urethral discharge, dysuria, or both. Gonococcal urethritis was treated with a single dose of gentamicin 250 mg; non-gonococcal urethritis was treated with the same gentamicin plus 1 g azithromycin. Plasma and semen were analyzed for HIV-1 RNA (= viral load) among untreated urethritis patients, post-treatment, and among HIV seropositive men without urethritis (= controls).
There was a striking eight-fold higher semen viral load among patients with urethritis than those without urethritis. Viral load correlated with the WBC inflammatory response; hence, gonococcal urethritis was associated with greater viral load (and greater WBCs/hpf on gram stain) than non-gonococcal urethritis or control patients.
Treatment was associated with substantial decline in semen viral load, approximately three-fold. In antibiotic-treated patients, two weeks post-therapy, semen viral load had declined to levels not statistically different from controls. The authors encourage attention to treatment of STDs, especially gonorrhea, as a method to reduce likelihood of HIV transmission.
Cohen M, et al. Lancet 1997;349: 1868-1873.
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