Tattooing and risk of transmitting HIV in Quthing prison, Lesotho.

Sir: Rates of HIV in Africa appear to be greater in uncircumcised men compared with those circumcised. One explanation for this might be the role that poor male genital hygiene might play in increasing susceptibility to HIV in uncircumcised men. As part of a study to investigate whether subpreputial penile wetness was associated with HIV in uncircumcised male sexually transmitted infection (STI) clinic attenders we also undertook a study to determine whether a simple penile wipe was acceptable to clean both the prepuce and subpreputial space. A total of 650 consecutive men attending the Prince Cyril Zulu STI clinic in Durban for a new STI-related problem were enrolled into a study between January and March 2004 to investigate the relationship between male genital hygiene and HIV as reported elsewhere. All were asked to return 14 days later after treatment for their STI-related problem. Men who returned were asked to apply a nappy wipe (Johnsons) themselves to the glans penis in those circumcised or in uncircumcised men to the subpreputial space and prepuce by retracting the foreskin. Subjects were asked whether they found this single use of the wipe acceptable if they would use one again and whether they experienced any side-effects. The wipe was evaluated in 457/488 subjects that returned after 14 days. The majority of the men 414/454 (92%) were uncircumcised and 259/453 (57.2%) were HIV positive. Washing the genital area before sex was reported by 27/457 (5.9%) and after sex by 136/457 (29.8%). Patients perception of their own personal genital hygiene in 456 subjects was very good in 98 (21.5%) quite good in 249 (54.6%) average in 90 (19.7%) and worse than average in 19 (4.2%) The wipe was acceptable to 456 (99.8%) of the men. All but six subjects said they would use them again. Fifteen (3.3%) reported local irritation (7) bleeding (1) and other (7) side-effects. After use of the wipe the prepuce was invariably slightly moist. The wipe was acceptable to almost all subjects and there was a low incidence of side-effects. After the initial examination we did not examine subjects again to determine the duration of wipe-induced wetness. While the wipe undoubtedly has an antibacterial action our finding that penile wetness was associated with HIV2 would suggest that the use of this particular wipe cannot yet be advocated although the wipe-induced wetness is clearly different from that identified during routine clinical examination in these subjects. If a wipe were to be used it would seem logical to advise that it had the capacity to dry up the subpreputial space following its application. If good penile hygiene were accepted among communities as a social norm mens behaviour might be encouraged to change if good penile hygiene made them more acceptable as sexual partners. The penile wipe could be used as a tool to both promote male penile hygiene and raise awareness of its importance as a possible risk factor in facilitating HIV transmission. (full-text)