How the evolving epidemics of opioid misuse and HIV infection may be changing the risk of oral sexually transmitted infection risk through microbiome modulation

Abstract

The epidemiology of sexually transmitted infections (STI) is constantly evolving, and the mechanisms of infection risk in the oral cavity (OC) are poorly characterized. Evidence indicates that microbial community (microbiota) compositions vary widely between the OC, genitalia and the intestinal and rectal mucosa, and microbiome-associated STI susceptibility may also similarly vary. The opioid misuse epidemic is at an epidemic scale, with >11 million US residents misusing in the past 30 days. Opioids can substantially influence HIV progression, microbiota composition and immune function, and these three factors are all mutually influential via direct and indirect pathways. While many of these pathways have been explored independently, the supporting data are mostly derived from studies of gut and vaginal microbiotas and non-STI infectious agents. Our purpose is to describe what is known about the combination of these pathways, how they may influence microbiome composition, and how resultant oral STI susceptibility may change. A better understanding of how opioid misuse influences oral microbiomes and STI risk may inform better mechanisms for oral STI screening and intervention. Further, the principles of interaction described may well be applied to other aspects of disease risk of other health conditions which may be impacted by the opioid epidemic.

Keywords:

• Oral microbiome
• sexually transmitted infection
• opioid
• HIV
• immune function

Acknowledgements

WDJ acknowledges funding by the National Institutes of Health (1UG3DA044829-01) though this funding is not associated with this specific work. LBB acknowledges funding by the National Institutes of Health (K12HL143959-02) though this funding is not associated with this specific work. Wiley D. Jenkins confirms that he has access to all data associated with this study.

Author contributions

WDJ is responsible for the manuscript conception, development, research, writing and revision. LBB is responsible for manuscript development, research, figure design and revision. CR is responsible for manuscript figure design, research and revision. LC is responsible for manuscript research and revision.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

LC is employed by Illinois Department of Public Health and acknowledges funding by CDC under the PCHD grant to perform STD prevention and surveillance activities.