June 23, 1997

Postcoital Vaginal Bleeding as a Risk Factor for Transmission of the Human Immunodeficiency Virus in a Heterosexual Partner Study in Brazil

Author Affiliations

the Rio de Janeiro Heterosexual Study Group

From the Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil (Dr Guimarães), the Oswaldo Cruz Foundation, Ministry of Health, Rio de Janeiro, Brazil (Dr Castilho), and the Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, Md (Drs Guimarães and Vlahov).

Arch Intern Med. 1997;157(12):1362-1368. doi:10.1001/archinte.1997.00440330102012

Background:  Several risk factors for male-to-female human immunodeficiency virus (HIV) transmission are well established, but few studies have examined the role of postcoital vaginal bleeding.

Methods:  Couples recruited from AIDS centers in Rio de Janeiro, Brazil, were interviewed for risk factors and had blood collected for examinations. Eligibility criteria included confirmed HIV positivity for the male partner, aged 18 years or older, heterosexual contact in the past year, and no other risk factor for female partners except sexual contact with the HIV-infected male partner. Logistic regression was used to assess the association between HIV serostatus and risk factors in the female partners.

Results:  The prevalence of HIV infection was 47.6% among the 418 women available for analysis. The following factors were independently associated with HIV infection: anal sex (odds ratio [OR], 3.06), condom use during vaginal sex sometimes (OR, 1.42) and rarely to never (OR, 2.00) compared with always, frequency of sexual contacts (>100 in the previous year) (OR, 1.71), HIV-infected male partners with symptoms of acquired immunodeficiency syndrome (OR, 1.70), and postcoital vaginal bleeding (OR, 1.89). The association of postcoital bleeding and HIV infection was more pronounced among women who did not engage in anal sex.

Conclusions:  The results support previous studies showing that advanced HIV infection in the male partner, anal sex, inconsistent condom use, and frequent sex are associated with HIV infection among the female partners of HIV-infected men. Postcoital vaginal bleeding was also identified as a risk factor for infection. In addition to other established preventive measures, a recommendation for seeking diagnosis and treatment of sexually transmitted diseases that are associated with postcoital bleeding and using water-soluble lubricants during sex to minimize trauma seems prudent.Arch Intern Med. 1997;157:1362-1368