The association between gonorrhea and the acquisition of HIV has been demonstrated in several well-controlled studies, mainly in Kenya and Zaire. The nonulcerative STIs enhance the transmission of HIV by three- to fivefold, possibly because of increased viral shedding by persons with urethritis or cervicitis (Chap. 182). HIV has been detected by polymerase chain reaction (PCR) more commonly in ejaculates from HIV-positive men with gonococcal urethritis than in those from HIV-positive men with nongonococcal urethritis. PCR positivity diminishes twofold after appropriate therapy for urethritis. Not only does gonorrhea enhance the transmission of HIV; it may also increase the individual's risk for acquisition of HIV. A proposed mechanism is the significantly greater number of CD4+ T lymphocytes and dendritic cells that can be infected by HIV in endocervical secretions of women with nonulcerative STIs than in those of women with ulcerative STIs.
Harrison's Internal Medicine > Chapter 137. Gonococcal Infections
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