Background. Minimal data exist that describe the epidemiology of sexually transmitted infections (STI) in human immunodeficiency virus (HIV) positive populations across the pre- and post-diagnosis periods for HIV. Purpose. The purpose of this study was to identify and describe the epidemiology of gonorrhea, chlamydia, syphilis, herpes simplex virus, and human papillomavirus in an HIV-positive population. Methods. All 1,961 HIV seropositive United States active duty military personnel from 2000–2010 were identified. STI diagnoses relative to HIV diagnosis from 1995, which was the earliest electronic medical record available, to 2010 were examined. Results. The incidence diagnosis rates of STI generally increased during the period leading up to eventual HIV diagnosis. The rates of STI during the post-HIV diagnosis period fluctuated, but remained elevated compared to pre-HIV diagnosis period. Approximately 45%–69% with an STI in the HIV seropositive military population were diagnosed with their first STI greater than one year after their HIV diagnosis. Of those who were diagnosed with an STI in the post-HIV diagnosis period, 70.6% had one STI diagnosis, 23.5% had two STI diagnoses, and 5.8% had three or more STI diagnoses. Conclusions. Despite aggressive counseling, high-risk sexual behavior continues to occur in the HIV-positive military population. 1. Introduction In the United States (US), an estimated 56,300 new human immunodeficiency virus (HIV) infections were diagnosed in 2006, with an incidence rate of 22.8 infections per 100,000 people [1]. During that same year, there were 196 new HIV-1 diagnoses in the active duty US military with an incidence rate of 18.3 per 100,000 tested [2]. Increasing numbers of lifetime sexual partners, decreased condom usage, and prior sexually transmitted infections (STI) have all been reported to increase the risk of HIV transmission [3–5]. With the advent of effective antiretroviral medications, there has been a reduced risk of HIV transmission to HIV-negative partners in some situations (i.e., preexposure prophylaxis) [6]. Increased unsafe behavioral risk factors have been noted in some HIV-positive populations, with approximately 32–39% of HIV-positive people engaging in unprotected intercourse [7]. This not only increases the risk of transmitting HIV to an HIV-negative sexual partner, but also places the HIV-positive partner at risk of acquiring an STI. In 1985, the US military began conducting mandatory routine screening for HIV-1 antibodies and at least biennially (once every 2 years) since 2004. The epidemiology
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