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Epidemic increases in active syphilis have been reported in the geographic areas hit hard by acquired immunodeficiency syndrome. Although both epidemics have been associated with illicit substance abuse, the extent to which recent increases in syphilis are linked to the human immunodeficiency virus (HIV-1) epidemic is uncertain. In order to define the frequency of syphilis and HIV-1 coinfection in the pregnant patients seen at City Hospital Center at Elmhurst, we saved syphilis-positive serologic specimens from obstetrical patients for anonymous HIV-1 antibody testing. Of 120 women who tested positive for syphilis, 7/120 (5.8%) had antibodies to HIV-1; of the 44 women with VDRL titers greater than or equal to 1:16 (suggestive of a recent infection), 1/44 (2.3%) had antibodies to HIV-1.

To assess the association of the human immunodeficiency virus (HIV) with other sexually transmitted diseases we undertook an anonymous HIV antibody serosurvey of all women admitted to the hospital with pelvic inflammatory disease. All the patients were given HIV risk reduction information and offered voluntary antibody testing. Thirty-one consecutive patients were evaluated; 30 specimens were suitable for anonymous testing. Five of the 30 (16.7%) were seropositive on both an enzyme-linked immunosorbent assay and Western blot test. The majority of the patients expressed concern about their HIV risk; 23 (74%) requested confidential testing. Of those tested, five (21.7%) were seropositive; three had traditional risk factors (intravenous drug abuse and/or sexual contacts at risk), and two denied traditional risk factors but reported nonintravenous cocaine use and multiple sexual partners. Of the seronegative women, 33% reported nonintravenous cocaine use (many with multiple sexual partners). Preventing the heterosexual spread of HIV into this vulnerable population is a formidable public health challenge.

The potential spread of the human immunodeficiency virus (HIV) to childbearing women in areas of high acquired immunodeficiency syndrome (AIDS) endemicity is a major public health concern. As a private institution providing obstetric care to such a population of women, we undertook an anonymous HIV cord blood serosurvey to estimate the number of childbearing women at our institution at risk for perinatal transmission of the virus and to assess the success of our voluntary screening program to identify seropositive women. Between November 1987 and January 1988, cord blood samples from all clinic deliveries were analyzed for the presence of HIV antibody. For each sample obtained, the mother's age and site of prenatal care were known. Overall, 2.7% (six of 224) of the samples tested were seropositive; two of the 34 samples (5.9%) from teenage mothers were seropositive. All positive samples were from women who received prenatal care; none were identified through a voluntary screening program based on patient self-acknowledged risk-behavior assessment. This confirms that risk factor history elicited by personal interview is not a reliable screening tool for initiating HIV antibody counseling and testing. The high seropositive rate in teenagers is disturbing and needs further assessment.