Can sexually transmitted infections (STIs) cause weight loss in men?

Sexually Transmitted Infections Can Cause Weight Loss in Men

Yes, sexually transmitted infections (STIs) can lead to weight loss in men, particularly in the case of HIV infection where weight loss is a common manifestation at various stages of the disease. 1

HIV and Weight Loss

• HIV infection can cause weight loss at all stages of disease progression, from seroconversion to advanced AIDS 1
• During seroconversion, HIV often manifests as severe systemic disease with weight loss followed by spontaneous recovery 1
• Approximately one-third of patients experience weight loss during the asymptomatic latent phase of HIV infection 1
• Weight loss becomes invariable in the symptomatic and end-stage phases of HIV disease 1
• HIV Wasting Syndrome is defined as weight loss of ≥10% with fever and/or diarrhea of unknown origin, although wasting can occur without these symptoms 1
• Rapid wasting is typically a manifestation of opportunistic infection or malignancy in late AIDS with advanced immunodeficiency 1
• Even weight changes less dramatic than the 10% specified in the CDC definition can adversely impact health 1

Mechanisms and Risk Factors for Weight Loss in STIs

• Weight loss in HIV can be caused by multiple factors:
  • Opportunistic infections or malignancies 1
  • Depression 1
  • Anorexia 1
  • Self-neglect (e.g., in drug abusers) 1
  • Dry mouth and lack of saliva caused by medication (e.g., antiviral therapy) 1
• In men with HIV, hypogonadism (low testosterone) is common and can contribute to weight loss 1
• Providers should consider obtaining morning serum total testosterone measurements in male patients who complain of fatigue, weight loss, loss of libido, erectile dysfunction, or depressive symptoms 1

Clinical Implications and Monitoring

• Decreased nutritional status in HIV-infected patients is associated with increased mortality, independently of immunodeficiency and viral load 1
• Weight loss should prompt a search for opportunistic infections or other complications of disease or therapy 1
• Nutritional status in HIV is best reflected by muscle mass representing the structural protein pool 1
• Untreated HIV infection is characterized by early loss of structural protein, loss of lean body mass, and more precisely by loss of body cell mass 1

Other STIs and Weight Loss

• While HIV is the primary STI associated with weight loss, other chronic STIs can potentially contribute to weight changes through systemic effects 1
• Men with multiple or untreated STIs may experience systemic symptoms that could include weight loss 2
• The presence of other STIs increases the risk of HIV acquisition and transmission, potentially leading to HIV-related weight loss 2

Management Considerations

• Nutritional intervention is a key component of managing weight loss in HIV-infected patients 1
• Nutritional counseling with or without oral nutritional supplements is effective for preserving nutritional status 1
• Protein intake should achieve 1.2 g/kg body weight/day in stable phases of disease and may be increased to 1.5 g/kg body weight/day during acute illness 1
• For significant weight loss despite appropriate treatment, consider:
  • Evaluating for depression 1
  • Assessing for anorexia 1
  • Testing testosterone levels in men 1
  • Screening for opportunistic infections 1

Screening Recommendations

• Regular screening for STIs is essential, particularly for high-risk individuals 2
• The CDC recommends annual screening for sexually active MSM and more frequent screening (every 3-6 months) for those with multiple or anonymous partners 2
• Early detection and treatment of STIs can prevent progression to systemic illness that might lead to weight loss 2

Weight loss in men with STIs, particularly HIV, should be taken seriously as it correlates with increased mortality despite recent advances in treatment. Prompt diagnosis and appropriate management of the underlying infection and nutritional status are essential for improving outcomes.