Skip to main content
NCBI home page
Genitourinary Medicine logoLink to Genitourinary Medicine
. 1995 Jun;71(3):150–154. doi: 10.1136/sti.71.3.150

Rectal gonorrhoea as an independent risk factor for HIV infection in a cohort of homosexual men.

K J Craib 1, D R Meddings 1, S A Strathdee 1, R S Hogg 1, J S Montaner 1, M V O'Shaughnessy 1, M T Schechter 1
PMCID: PMC1195487  PMID: 7635489

Abstract

OBJECTIVE--To determine whether certain sexually transmitted diseases are independent risk factors for HIV transmission in a cohort of homosexual men. METHODS--Eligible cases were identified as those who had seroconverted between November 1982 and November 1990. Two persistently HIV-seronegative control participants were randomly selected for each case from all participants who remained seronegative in November 1990. For cases, risk factor data were taken from an index visit which was defined as the first seropositive visit, while for controls these data were obtained from a matched visit which occurred within two months of the index visit for the corresponding case. Mantel-Haenszel methods and logistic regression were used to compare differences in risk factors for seroconversion between cases and controls. RESULTS--A total of 125 cases and 250 controls were eligible for this study. Cases were significantly more likely to have had reported any gonorrhoea (17% versus 6%; OR = 2.94; 95% CI: 1.51-5.73) or syphilis (7% versus 2%; OR = 3.78; 95% CI: 1.33-10.79) than controls during the seroconversion period. Multivariate logistic regression revealed rectal gonorrhoea to be independently associated with risk of seroconversion (odds ratio = 3.18; p = 0.044), whereas urethral gonorrhoea (p = 0.479) and pharyngeal gonorrhoea (p = 0.434) were not after inclusion of rectal gonorrhoea. In addition, the following variables were also shown to exert an independent effect on seroconversion: frequency of anal intercourse, use of illicit drugs, number of male sexual partners, and lack of a post-secondary education. CONCLUSIONS--In this observational study, rectal gonorrhoea was found to be associated with HIV seroconversion after adjustment for a number of HIV risk factors. We cannot rule out that rectal gonorrhoea was not directly associated with HIV infection but rather with other residual lifestyle factors not fully adjusted for in the analysis. However, the relationship with gonococcal involvement of a specific anatomic site lends support to a biological association between gonorrhoea and HIV infection, rather than to alternative non-biologic explanations. Our findings are consistent with previous studies reporting an association between HIV infection and non-ulcerative sexually transmitted diseases. Such a direct association might be explained by postulating that gonorrhoea results in inflamed rectal mucosa and compromised epithelial integrity, thereby predisposing an individual to subsequent HIV infection.

Full text

PDF
150

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander N. J. Sexual transmission of human immunodeficiency virus: virus entry into the male and female genital tract. World Health Organization, Global Programme on Acquired Immune Deficiency Syndrome. Fertil Steril. 1990 Jul;54(1):1–18. doi: 10.1016/s0015-0282(16)53628-0. [DOI] [PubMed] [Google Scholar]
  2. Coates R. A., Soskolne C. L., Calzavara L., Read S. E., Fanning M. M., Shepherd F. A., Klein M. M., Johnson J. K. The reliability of sexual histories in AIDS-related research: evaluation of an interview-administered questionnaire. Can J Public Health. 1986 Sep-Oct;77(5):343–348. [PubMed] [Google Scholar]
  3. Darrow W. W., Echenberg D. F., Jaffe H. W., O'Malley P. M., Byers R. H., Getchell J. P., Curran J. W. Risk factors for human immunodeficiency virus (HIV) infections in homosexual men. Am J Public Health. 1987 Apr;77(4):479–483. doi: 10.2105/ajph.77.4.479. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Hogg R. S., Craib K. J., Willoughby B., Sestak P., Montaner J. S., Schechter M. T. Sociodemographic correlates for risk-taking behaviour among HIV seronegative homosexual men. Can J Public Health. 1993 Nov-Dec;84(6):423–426. [PubMed] [Google Scholar]
  5. Hogg R. S., Strathdee S. A., Craib K. J., O'Shaughnessy M. V., Montaner J. S., Schechter M. T. Lower socioeconomic status and shorter survival following HIV infection. Lancet. 1994 Oct 22;344(8930):1120–1124. doi: 10.1016/s0140-6736(94)90631-9. [DOI] [PubMed] [Google Scholar]
  6. Holmberg S. D., Stewart J. A., Gerber A. R., Byers R. H., Lee F. K., O'Malley P. M., Nahmias A. J. Prior herpes simplex virus type 2 infection as a risk factor for HIV infection. JAMA. 1988 Feb 19;259(7):1048–1050. [PubMed] [Google Scholar]
  7. Kingsley L. A., Detels R., Kaslow R., Polk B. F., Rinaldo C. R., Jr, Chmiel J., Detre K., Kelsey S. F., Odaka N., Ostrow D. Risk factors for seroconversion to human immunodeficiency virus among male homosexuals. Results from the Multicenter AIDS Cohort Study. Lancet. 1987 Feb 14;1(8529):345–349. doi: 10.1016/s0140-6736(87)91725-9. [DOI] [PubMed] [Google Scholar]
  8. Kreiss J. K., Coombs R., Plummer F., Holmes K. K., Nikora B., Cameron W., Ngugi E., Ndinya Achola J. O., Corey L. Isolation of human immunodeficiency virus from genital ulcers in Nairobi prostitutes. J Infect Dis. 1989 Sep;160(3):380–384. doi: 10.1093/infdis/160.3.380. [DOI] [PubMed] [Google Scholar]
  9. Kreiss J., Caraël M., Meheus A. Role of sexually transmitted diseases in transmitting human immunodeficiency virus. Genitourin Med. 1988 Feb;64(1):1–2. doi: 10.1136/sti.64.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Laga M., Manoka A., Kivuvu M., Malele B., Tuliza M., Nzila N., Goeman J., Behets F., Batter V., Alary M. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS. 1993 Jan;7(1):95–102. doi: 10.1097/00002030-199301000-00015. [DOI] [PubMed] [Google Scholar]
  11. Latif A. S., Katzenstein D. A., Bassett M. T., Houston S., Emmanuel J. C., Marowa E. Genital ulcers and transmission of HIV among couples in Zimbabwe. AIDS. 1989 Aug;3(8):519–523. doi: 10.1097/00002030-198908000-00006. [DOI] [PubMed] [Google Scholar]
  12. Mertens T. E., Hayes R. J., Smith P. G. Epidemiological methods to study the interaction between HIV infection and other sexually transmitted diseases. AIDS. 1990 Jan;4(1):57–65. doi: 10.1097/00002030-199001000-00008. [DOI] [PubMed] [Google Scholar]
  13. Miettinen O. Estimability and estimation in case-referent studies. Am J Epidemiol. 1976 Feb;103(2):226–235. doi: 10.1093/oxfordjournals.aje.a112220. [DOI] [PubMed] [Google Scholar]
  14. Nsubuga P., Mugerwa R., Nsibambi J., Sewankambo N., Katabira E., Berkley S. The association of genital ulcer disease and HIV infection at a dermatology-STD clinic in Uganda. J Acquir Immune Defic Syndr. 1990;3(10):1002–1005. [PubMed] [Google Scholar]
  15. Ostrow D. G., VanRaden M. J., Fox R., Kingsley L. A., Dudley J., Kaslow R. A. Recreational drug use and sexual behavior change in a cohort of homosexual men. The Multicenter AIDS Cohort Study (MACS). AIDS. 1990 Aug;4(8):759–765. doi: 10.1097/00002030-199008000-00007. [DOI] [PubMed] [Google Scholar]
  16. Plummer F. A., Simonsen J. N., Cameron D. W., Ndinya-Achola J. O., Kreiss J. K., Gakinya M. N., Waiyaki P., Cheang M., Piot P., Ronald A. R. Cofactors in male-female sexual transmission of human immunodeficiency virus type 1. J Infect Dis. 1991 Feb;163(2):233–239. doi: 10.1093/infdis/163.2.233. [DOI] [PubMed] [Google Scholar]
  17. Saltzman S. P., Stoddard A. M., McCusker J., Moon M. W., Mayer K. H. Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men. Public Health Rep. 1987 Nov-Dec;102(6):692–697. [PMC free article] [PubMed] [Google Scholar]
  18. Schechter M. T., Boyko W. J., Douglas B., Willoughby B., McLeod A., Maynard M., Craib K. J., O'Shaughnessy M. The Vancouver Lymphadenopathy-AIDS Study: 6. HIV seroconversion in a cohort of homosexual men. CMAJ. 1986 Dec 15;135(12):1355–1360. [PMC free article] [PubMed] [Google Scholar]
  19. Schechter M. T., Craib K. J., Le T. N., Willoughby B., Douglas B., Sestak P., Montaner J. S., Weaver M. S., Elmslie K. D., O'Shaughnessy M. V. Progression to AIDS and predictors of AIDS in seroprevalent and seroincident cohorts of homosexual men. AIDS. 1989 Jun;3(6):347–353. doi: 10.1097/00002030-198906000-00002. [DOI] [PubMed] [Google Scholar]
  20. Simonsen J. N., Cameron D. W., Gakinya M. N., Ndinya-Achola J. O., D'Costa L. J., Karasira P., Cheang M., Ronald A. R., Piot P., Plummer F. A. Human immunodeficiency virus infection among men with sexually transmitted diseases. Experience from a center in Africa. N Engl J Med. 1988 Aug 4;319(5):274–278. doi: 10.1056/NEJM198808043190504. [DOI] [PubMed] [Google Scholar]
  21. Spanier G. B. Use of recall data in survey research on human sexual behavior. Soc Biol. 1976 Fall;23(3):244–253. doi: 10.1080/19485565.1976.9988235. [DOI] [PubMed] [Google Scholar]
  22. Stall R., McKusick L., Wiley J., Coates T. J., Ostrow D. G. Alcohol and drug use during sexual activity and compliance with safe sex guidelines for AIDS: the AIDS Behavioral Research Project. Health Educ Q. 1986 Winter;13(4):359–371. doi: 10.1177/109019818601300407. [DOI] [PubMed] [Google Scholar]
  23. Stamm W. E., Handsfield H. H., Rompalo A. M., Ashley R. L., Roberts P. L., Corey L. The association between genital ulcer disease and acquisition of HIV infection in homosexual men. JAMA. 1988 Sep 9;260(10):1429–1433. [PubMed] [Google Scholar]
  24. Van de Perre P., De Clercq A., Cogniaux-Leclerc J., Nzaramba D., Butzler J. P., Sprecher-Goldberger S. Detection of HIV p17 antigen in lymphocytes but not epithelial cells from cervicovaginal secretions of women seropositive for HIV: implications for heterosexual transmission of the virus. Genitourin Med. 1988 Feb;64(1):30–33. doi: 10.1136/sti.64.1.30. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Winkelstein W., Jr, Lyman D. M., Padian N., Grant R., Samuel M., Wiley J. A., Anderson R. E., Lang W., Riggs J., Levy J. A. Sexual practices and risk of infection by the human immunodeficiency virus. The San Francisco Men's Health Study. JAMA. 1987 Jan 16;257(3):321–325. [PubMed] [Google Scholar]
  26. Wolff H., Anderson D. J. Male genital tract inflammation associated with increased numbers of potential human immunodeficiency virus host cells in semen. Andrologia. 1988 Sep-Oct;20(5):404–410. [PubMed] [Google Scholar]

Articles from Genitourinary Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES