Objectives: To determine the incidence of sexually transmitted diseases (STD; gonorrhoea, early syphilis, Chlamydia trachomatis infection, trichomoniasis and primary genital herpes) and gynaecologic disorders (vaginal candidiasis, anaerobic vaginosis, genital ulcerations of unknown cause, pelvic inflammatory disease, recurrent genital herpes, recurrent genital warts) in a cohort of HIV-infected and non-infected drug-using prostitutes in Amsterdam between 1986 and 1992. Design: A subgroup of 212 female drug users with a history of prostitution, who made at least one visit to a special STD clinic for drug-using prostitutes was selected from an ongoing cohort study of drug users in Amsterdam. Methods: Using Poisson regression, the relative risk (RR) for each outcome was calculated for HIV-positive women compared with HIV-negative women. To determine potential causal relations with immune suppression, associations between disease incidence and immunologic markers (CD4 cell count and anti-CD3 response) were assessed in HIV-positive women. Results: Adjusted for number of clients and frequency of condom use, HIV-positive women were at strong and significantly increased risk for primary genital herpes (RR, 7.64), recurrent herpes (RR, 8.33) and recurrent genital warts (RR, 15.93); moderately (significantly) increased risks were found for gonorrhoea (RR, 1.43), trichomoniasis (RR, 1.39), vaginal candidiasis (RR, 2.11) and genital ulcers of unknown aetiology (RR, 2.60). Of these HIV-related outcomes, the risk for recurrent genital herpes and genital warts were strongly associated with decreased CD4 cell counts. Conclusions: HIV-infected women experience an excess morbidity of STD and gynaecologic disorders. The strongly increased risk for genital herpes and warts in HIV-seropositive women indicates a causal relation with HIV. This study emphasizes the need for accessible medical care for drug-using prostitutes.
