Human immunodeficiency virus infection and genital ulcer disease in South Africa: the herpetic connection.

This cross-sectional study of 558 men with genital ulcer disease (GUD) and 602 men with urethritis aimed to determine the etiology of GUD in HIV-infected and noninfected men attending sexually transmitted disease (STD) clinics in Durban Johannesburg and Cape Town South Africa. Statistical analysis shows that patients with GUD were more likely to be infected with HIV than patients with urethritis (39.4% vs. 21.4%). Most importantly it was found that herpes simplex virus 2 (HSV-2) is a more common cause of GUD than has been suggested by previous studies conducted in South Africa. In addition serologic evidence of HSV-2 infection and current initial or recurrent genital herpes are strongly associated with HIV infection among men who attended STD clinics with GUD or urethritis. In view of these findings it is suggested that future approaches for reducing HIV transmission by STD control should include efforts to address HSV-2 infection.