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Sexual Transmission of AIDS
Sexual Transmission of AIDS
Sexual Transmission of AIDS
Of the various ways in which HIV can lumnar cells, is richly vascularized, and
be transmitted, sexual contact is respon- contains abundant unencapsulated
sible for the greatest proportion of infec- lymphoid tissue. The epithelium is often
tions. It was initially believed that homo- damaged during rectal penetration, per-
sexual males were the only group at risk, mitting contact between HIV and the
but cases of AIDS were soon described in cells that have specific receptors on their
men and women who had become in- membranes (CD4 surface marker).
fected via heterosexual contact.
Sexual transmission of HIV is associ- Vaginal intercourse. HIV transmission
ated with transfer of bodily products; ac- appears to be less efficient via vaginal coi-
cording to the type of sexual contact, vag- tus owing to the anatomic and physio-
inal secretions, saliva, urine, semen, logic characteristics of the vaginal mu-
rectal mucus, feces, and blood may be cosa, which consists of a flat, stratified,
transferred. Although HIV has been iso- unkeratinized epithelium that provides
lated from all these substances, the mere more resistance to solutions in contact
presence of the v@s-for example, in with it.
saliva-does not necessarily imply that a Although HIV may be present in the
substance is an important vehicle for female genital tract throughout the entire
transmission; up to now only blood and menstrual cycle, the risk of infection for
semen are known for certain to play that both the woman and her male partner
role. Vaginal secretions have been impli- probably increases during the menstrual
cated in sexual transmission of HIV but period. Hormonal changes that affect the
confirmation is still lacking (2). vaginal mucosa permit easier access of
the virus to the bloodstream, increasing
PORTALS OF ENTRY the possibility of infection for the
woman, and contact with blood would
Several studies have sought to deter- pose a potential threat to the male (3).
mine the differences in transmission effi- Some studies indicate a higher risk of
ciency of different sexual practices and transmission from an infected male to a
the portals of entry of the virus. Trans- female rather than the reverse (I), which
mission has been found to occur from could be due to the higher concentration
male to male, male to female, and female of virus in semen as opposed to vaginal
to male, with the frequency of transmis- secretions. Also, it is likely that sexual
sion varying for each combination. relations in which there is contact with
the oral mucosa (oral-penile, oral-
Anal intercourse. Sexual contact in- vaginal, and oral-anal) favor transmis-
volving penetration of the penis into the sion of HIV, although the importance of
rectum carries the greatest risk of trans- this route has not been confirmed.
mission of HIV (2). This fact is explained
primarily by the nature of the rectal epi- CONTRIBUTING FACTORS
thelium, which is a layer of simple co-
An association has been observed be-
tween transmission of HIV and some
Source: Dire&k General de Epidemiologia, Se-
cretaria de Salud, Mexico. Transmisih sexual. Bol other microorganisms, among which are
Mens SlDA 2(1-2):231-241,1988. cytomegalovirus, herpesvirus, Epstein-