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STD cofactors in transmission: how much?

Sep 18, 1997

I have read that having an STD other than HIV (such as herpes) greatly increases the risk of actual infection if you are exposed to HIV-infected body fluids. I have also seen claims that if you do NOT have another STD, it's quite difficult to get HIV even through high risk exposure. I don't remember the source, but I recall at least one researcher who believes that almost all cases of HIV infection have happened in the presence of STDs as a cofactor. Does the presence of STDs actually facilitate the process of actual infection by the HIV virus at the cellular level, in the context of a high risk exposure? And is the latter claim, that it's hard to get HIV unless you have an STD, at all true?

Response from Mr. Sowadsky

Hi. Thank you for your question. In regards to it being difficult to get HIV if you do not have another STD, this is simply NOT true! The fact is, the majority of persons who became infected with HIV through sexual contact, did NOT have another STD at the time of infection. The presence of STD's is NOT required for HIV transmission to occur during unprotected sex!

HIV must enter the bloodstream in order for infection to occur. During vaginal and anal intercourse, HIV can enter the bloodstream through microscopic cuts/abrasions that normally occur in both partners, during intercourse. Also, when giving oral sex, if the person has any open sores in their mouth (like canker sores), if they have gum disease, or if they have any cuts/abrasions in the mouth (even microscopic ones), HIV can enter the bloodstream. In other words, during intercourse and giving oral sex, HIV can still gain a direct access to the bloodstream, even when the person does NOT have another STD.

However, if a person were to have certain STD's while engaging in high risk sex, this can increase the high risk of infection even more. If a person were to have an STD that causes open lesions (for example, active Herpes infection, Primary Syphilis, or Chancroid), these open lesions can give HIV an easier access to the bloodstream. Even without these lesions, unprotected intercourse and giving oral sex are high risk for HIV. But when open lesions from an STD are present, it makes the high risk of transmission, even higher. Unprotected intercourse and giving oral sex are still high risk for HIV, even if another STD is not present. But having STD's that cause open lesions, simply increases the risk even more.

If you have any further questions, please feel free to e-mail me at or call me at 1-800-842-AIDS (Nationwide). I'm glad to help!

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