Sexually transmitted diseases are epidemiologically associated with HIV infection. Diseases that cause genital ulcers, such as herpes, chancroid, and syphilis, are believed to provide vascular portals of entry for HlV. Prevalence studies demonstrate a three- to fivefold increased odds ratio of HIV seropositivity in patients with genital ulcers.24 A similarly increased risk of HIV infection has recently been found among patients with gonorrhea and chlamydial infections. These studies, along with recent emergency-department-based prevalence surveys, have led to a recommendation for increased surveillance of sexually transmitted diseases as a means of controlling HIV transmission.2526 All patients with symptoms suggestive of sexually transmitted disease should be tested for gonorrhea, chlamydia, and syphilis. Primary (chancre) and secondary (rash, mucocutaneous lesions, and adenopathy) syphilis should be treated with a single intramuscular dose of benzathine penicillin, 2.4 million units. For latent syphilis or unknown duration of secondary syphilis, three weekly injections are recommended. Any patient with known or suspected syphilis should be evaluated for the possibility of neurosyphilis, which is known to have an increased incidence in the HIV-infected population. Therapy for other sexually transmitted diseases is based on current CDC guidelines (see Chap 137, "Sexually Transmitted Diseases").
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