21% in 2000 to 0.78% in 2009 [17]. A high prevalence of genital infections in women of Afro-Caribbean origin has been reported [18]. The diagnosis and treatment of genital infections in any individual have clear benefits in terms of both individual morbidity and possible infectivity to any sexual partner. In pregnancy, the welfare of the baby is an additional

issue. However, apart from the recommendation that all pregnant women should be screened for HIV, hepatitis B virus (HBV) and syphilis, asymptomatic HIV-uninfected pregnant women in the UK are not routinely screened for genital infections. In HIV-positive pregnant women additional considerations are the potential effects of the presence of a genital infection on MTCT of HIV-1. This could occur through an increase in the HIV-1 viral PD-166866 concentration load in the genital tract and/or the presence of chorioamnionitis. In addition, certain infections may be linked to premature birth, an event that occurs more frequently in HIV-positive women when compared to HIV-uninfected women. Viral load in cervicovaginal specimens has been shown to

correlate with HIV-1 MTCT [19]. Genital tract viral load will usually mirror the plasma viral load [20], but there is increasing evidence of compartmentalization of HIV-1 between the plasma and genital tract. Genital tract HIV-1 has been detected in women with an undetectable plasma viral load [21, 22] and genetic diversity of virus from the two compartments has been reported [23]. A number of factors may be responsible for this, including buy Pirfenidone differential drug penetration into body compartments and the presence of genital tract infections. With increasing numbers of women in the UK aiming Org 27569 for and achieving a vaginal delivery an increasing number of fetuses are exposed to the cervicovaginal secretions of HIV-positive women. The clinical significance of this is not clear. Data from the UK and Ireland [4] and France [24] showing no difference in MTCT associated with mode of delivery in women with an undetectable viral load provide some reassurance

that the potential discordance may not be clinically relevant but further research is warranted. It has long been recognized that genital infections, in particular ulcerative diseases, are associated with an increased risk of sexual transmission of HIV [25, 26]. This may be a consequence of an increase in local HIV replication resulting in a higher viral load in genital secretions, secondary to the presence of specific microorganisms, and/or ulceration and inflammation [27, 28]. Organisms associated with bacterial vaginosis (BV) have been shown to stimulate HIV expression in vitro [29, 30]. A study from Kenya demonstrated a reduction in cervical mucosal shedding of HIV-1 RNA following treatment of both gonococcal and chlamydial cervicitis [31].