Biological and Behavioral Risk Factors Associated with STDs/HIV in Women: Implications for Behavioral Interventions

Women are disproportionately affected by the burden and consequences of STDs, including human immunodeficiency virus (HIV). Of the estimated 19 million cases of STDs that occur annually in the United States (1), about two-thirds are in women (2). Further, both bacterial and viral STDs are associated with negative sequelae in women. Untreated gonococcal and chlamydial infections can produce significant and disproportionate reproductive system morbidity in women, including pelvic inflammatory disease, infertility, ectopic pregnancy, and chronic pelvic pain (2,3). Additionally, about 70% of chlamydia infections and 50% of gonococcal infections are asymptomatic in women, causing a delay in seeking care and an increase in the risk for negative sequelae (3,4). Genital human papillomavirus (HPV) infection, the most common sexually transmitted viral infection worldwide, can also produce negative sequelae for women. Although most genital HPV infections are transient (i.e., are cleared by a healthy immune system), persistent infection with oncogenic or high-risk types are associated with cervical abnormalities and cervical cancer, while infection with other types can produce genital warts (5). Further, infection with herpes simplex virus, also common in women, can produce painful outbreaks, and in pregnant women, can result in perinatal transmission and serous neonatal infection (3).