HIV and other sexually transmitted infections share common transmission routes. When an individual has both HIV and another STI at the same time, this is referred to as coinfection. Understanding the relationship between these infections is important because certain STIs can biologically influence HIV acquisition and transmission risk.
Coinfection can occur simultaneously or sequentially, and it does not always produce noticeable symptoms. Some STIs cause inflammation or ulcerative lesions that may affect the body’s protective barriers, potentially increasing susceptibility to HIV. Others may influence viral shedding in individuals already living with HIV.
This article explains the biological mechanisms behind STI and HIV coinfection, which infections are most relevant, and why comprehensive laboratory screening provides the clearest picture of sexual health status.
Quick Answer: What Is STI and HIV Coinfection?
STI and HIV coinfection refers to having HIV alongside another sexually transmitted infection. Certain STIs, particularly those that cause inflammation or sores, can increase the likelihood of HIV transmission or acquisition. This occurs because infections may affect mucosal barriers and immune cell activity. Laboratory testing is required to confirm any infection.
Key Points:
- •Some STIs increase HIV susceptibility
- •Ulcerative infections raise transmission risk
- •Inflammation can increase viral exposure
- •Coinfection does not always produce symptoms
- •Testing confirms infection status
Laboratory testing is required to confirm any infection.
What Does Coinfection Mean?
Coinfection refers to the presence of two or more infections in the same individual at the same time. In the context of sexual health, STI and HIV coinfection means that a person has HIV alongside one or more other sexually transmitted infections.
Coinfection may involve HIV alongside bacterial infections such as chlamydia, gonorrhoea or syphilis, or viral infections such as herpes (HSV-2) or hepatitis B. The infections may be diagnosed simultaneously during a screening visit, or they may be identified at different times.
Each infection requires separate laboratory confirmation. The presence of one STI does not automatically mean that another is present, but shared transmission routes mean that comprehensive screening is a practical consideration when any single infection is identified.
How Do STIs Increase HIV Risk?
The biological relationship between certain STIs and HIV risk is well-documented in clinical literature. Several mechanisms may contribute to increased susceptibility:
- •Inflammation: STIs that cause genital inflammation attract immune cells (including CD4 cells, which HIV targets) to the affected area. This concentration of target cells may increase the likelihood of HIV acquisition if exposure occurs
- •Ulcerative lesions: Infections such as syphilis and herpes produce sores or ulcers that disrupt the skin and mucosal barriers. These breaks in protective tissue may create entry points for HIV
- •Increased viral shedding: In individuals already living with HIV, the presence of another STI may increase the amount of HIV present in genital secretions, potentially increasing the likelihood of transmission to partners
- •Compromised mucosal integrity: Even non-ulcerative STIs may affect the integrity of mucosal surfaces, reducing the body’s natural protective barriers
It is important to note that increased biological susceptibility does not guarantee transmission. Exposure to HIV is still required for infection to occur. These mechanisms describe how certain STIs may increase risk under specific circumstances, not that coinfection is inevitable.
The Syphilis and HIV Link
The relationship between syphilis and HIV is one of the most well-documented examples of how STIs can influence HIV risk. Syphilis produces ulcerative sores known as chancres, which can create direct entry points for HIV through the disrupted skin or mucosa.
The inflammation associated with syphilis also concentrates immune cells at the site of infection, potentially increasing the number of target cells available for HIV. Additionally, syphilis and HIV share common transmission routes and overlapping risk behaviours, making co-exposure a realistic possibility.
For these reasons, dual testing for syphilis and HIV is a practical consideration. A syphilis test uses validated laboratory methods to confirm infection status. When syphilis is identified, concurrent HIV screening may provide additional clarity about overall sexual health.
We provide laboratory-based STI screening. Treatment arrangements are managed separately if required.
Gonorrhoea, Chlamydia and HIV Risk
While gonorrhoea and chlamydia are non-ulcerative infections — meaning they do not typically produce open sores — they can still influence HIV risk through inflammatory mechanisms.
Both infections can cause inflammation of the cervix, urethra or rectum, depending on the site of infection. This inflammation attracts immune cells to the affected area, which may increase the concentration of HIV target cells if exposure occurs. Rectal inflammation from gonorrhoea or chlamydia may be particularly relevant in this context.
A notable characteristic of both gonorrhoea and chlamydia is that they are frequently asymptomatic. An individual may carry one or both infections without any noticeable signs, meaning that the inflammatory changes and associated increased susceptibility may be present without the person being aware.
This underscores the importance of laboratory screening, particularly when there has been a potential exposure event. Coinfection with these bacterial STIs and HIV is possible without producing obvious symptoms in either infection.
Herpes and HIV Coinfection
Herpes simplex virus type 2 (HSV-2) is another infection closely linked to HIV risk in clinical literature. HSV-2 causes recurrent genital sores that disrupt mucosal barriers, and the chronic nature of herpes means that these disruptions may recur periodically.
During active outbreaks, the ulcerative lesions caused by herpes may increase susceptibility to HIV acquisition if exposure occurs. Even during periods between outbreaks, subclinical viral shedding and persistent low-level inflammation may influence HIV risk to some degree.
Many individuals with HSV-2 are unaware of their infection, as outbreaks may be mild, infrequent or entirely absent. This lack of awareness means that the potential influence on HIV susceptibility may go unrecognised without laboratory testing.
Can You Have Coinfection Without Symptoms?
Yes. Coinfection with HIV and another STI can occur without producing any noticeable symptoms. Many STIs are asymptomatic by nature, and HIV itself may remain silent for an extended period, particularly during the early stages of infection.
An individual may carry both HIV and an STI such as chlamydia, gonorrhoea or syphilis without experiencing any outward signs. When symptoms do occur, they may be mild, non-specific or attributed to other causes.
The absence of symptoms does not indicate the absence of infection. This is why laboratory screening — rather than symptom monitoring — is considered the reliable method for identifying both HIV and other STIs. Comprehensive testing provides objective confirmation that symptom observation alone cannot.
How Is STI and HIV Coinfection Diagnosed?
Diagnosing coinfection requires testing for each infection individually using validated laboratory methods. No single test can detect all STIs simultaneously, but multiple infections can be screened for within a single clinic visit through appropriate sample collection.
- •Blood testing: Used for HIV, syphilis, and hepatitis B and C screening
- •Urine testing: Commonly used for chlamydia and gonorrhoea detection
- •Swab testing: May be used for site-specific screening depending on symptoms and exposure history
- •Multi-site testing: Testing from multiple sample types within a single appointment for comprehensive coverage
- •Confidential laboratory processing: All samples analysed by accredited laboratories using validated methods
A comprehensive STI screening panel can test for multiple infections from a single visit, providing broad insight into overall sexual health status.
We provide laboratory-based STI screening. Treatment arrangements are managed separately if required.
Managing Multiple Infections
When coinfection is identified, each infection is assessed individually. The presence of multiple infections does not change the testing process for any single infection, but it does mean that a comprehensive approach to screening and follow-up is appropriate.
Follow-up testing protocols may be recommended to monitor infection status over time. This is particularly relevant when infections are identified during or near the window period, as confirmatory testing may be necessary to verify initial results.
For HIV-specific care, referral pathways exist for ongoing medical management and monitoring. Coordination of monitoring for multiple infections is an important consideration, and individuals are supported with appropriate information about next steps following diagnosis.
Each infection is managed according to its own clinical pathway. Laboratory testing provides the foundation for understanding which infections are present and informing appropriate next steps.
Prevention and Risk Reduction
Understanding the relationship between STIs and HIV risk supports informed decision-making about sexual health. While no prevention method eliminates risk entirely, several approaches may reduce the likelihood of both STI and HIV acquisition:
- •Barrier protection: Consistent use of condoms reduces the risk of transmission for many STIs, including HIV
- •Regular testing: Routine screening identifies infections early, including those that are asymptomatic, and supports timely awareness of infection status
- •Communication with partners: Open discussion about sexual health history and testing supports informed decisions for all parties
- •Comprehensive screening: Testing for multiple infections simultaneously provides a complete picture of sexual health status and identifies any coinfection
Awareness of the biological relationship between STIs and HIV supports informed health choices. Laboratory testing provides the objective foundation for understanding individual infection status.
People Also Ask
Does having an STI make HIV more likely?
Certain STIs can increase biological susceptibility to HIV by causing inflammation, disrupting mucosal barriers, or concentrating immune target cells at the site of infection. However, increased susceptibility does not guarantee transmission — exposure to HIV is still required. Laboratory testing confirms whether either infection is present.
What is the link between syphilis and HIV?
Syphilis produces ulcerative sores that can create entry points for HIV through disrupted tissue. The inflammation associated with syphilis also concentrates immune cells at the infection site. These two infections share transmission routes and risk behaviours, making dual testing a practical consideration when either is suspected.
Can you have HIV and not know it?
Yes. HIV can remain asymptomatic for an extended period, especially during the early stages. Many individuals experience no symptoms or only mild, non-specific signs that are easily attributed to other causes. The only way to confirm HIV status is through laboratory testing, regardless of whether symptoms are present.
Should I test for both HIV and STIs together?
Comprehensive screening that includes both HIV and other STIs may provide a clearer picture of overall sexual health status. Because these infections share transmission routes, testing for multiple infections within a single visit is a practical and efficient approach to sexual health screening.
Are coinfections common?
Coinfections can occur because HIV and other STIs share the same transmission routes. An individual who has been exposed to one sexually transmitted infection may also have been exposed to others, including HIV. Comprehensive screening helps identify whether multiple infections are present, supporting informed health management.
This article is for general information. Laboratory testing is required to confirm any infection.
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For general information only — not a substitute for professional advice. In an emergency call 999, visit A&E, or call NHS 111.