Important note: Information in this article was accurate in March 2000. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; Monday, March 6, 2000
Prepared by AIDS Weekly editors from staff and other reports
While genital ulcers are a risk factor in HIV infection, the association of specific agents of genital ulcer disease (GUD) with HIV infection may vary.
In this study, C.Y. Chen and colleagues from the U.S. Centers for Disease Control and Prevention sought to determine the etiology of GUD in HIV infected and HIV uninfected men attending sexually transmitted disease (STD) clinics in Durban, Johannesburg, and Cape Town, South Africa, and the association of previous and current sexually transmitted infections with HIV infection in men with ulcerative and nonulcerative STDs ("Human immunodeficiency virus infection and genital ulcer disease in South Africa - The herpetic connection," Sex Transm Dis 2000 Jan;27(1):21-9.
A cross-sectional study of 558 men with genital ulcers and 602 men with urethritis was conducted.
Patients with GUD were more likely to be infected with HIV than patients with urethritis (39.4% versus 21.4%, Pless than or equal to0.001). Herpes simplex virus 2 (HSV-2) was the most common agent identified in ulcer specimens (35.9%), and was detected in a significantly higher proportion of ulcer specimens from HIV infected patients than in specimens from HIV uninfected patients (47.3% versus 28.2%, Pless than or equal to0.001).
Patients infected with HIV-1 were significantly more likely to have HSV-2 infection, as measured by the presence of the antibody to glycoprotein G-2, than patients not infected with HIV (63.1% versus 38.5%, Pless than or equal to0.001). Patients infected with HIV-1 were also significantly more likely to have initial HSV-2 infection than HIV uninfected patients with GUD (50.0% versus 31.6%, P=0.007).
Hemophilus ducreyi was detected in 31.7% of ulcer specimens; prevalence did not vary by HIV infection status. Treponema pallidum DNA was detected significantly less frequently in ulcer specimens from patients infected with HIV than in specimens from patients not infected with HIV (10.2% versus 26%, Pless than or equal to0.001); no association was found between HIV infection status and fluorescent treponemal antibody absorption test seroreactivity, even when men with PCR-positive syphilis lesions were excluded from the analyses.
The authors found that HSV-2 is a more common etiology of GUD than has been suggested by previous studies conducted in South Africa; serologic evidence of HSV-2 infection and current cases of genital herpes are strongly associated with HIV infection among men who present to STD clinics with GUD or urethritis.
The corresponding author for this study is S.A. Morse, U.S. Centers for Disease Control and Prevention, Div AIDS STD & TB Lab Res, MS-A12, 1600 Clifton Rd., Atlanta, GA 30333, USA.
Key points reported in this study are:
This article was prepared by AIDS Weekly editors from staff and other reports.
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