Rising HIV-1 prevalence among sexually transmitted disease clinic attenders in Jamaica: traumatic sex and genital ulcers as risk factors.
Figueroa JpA R BrathwaiteJ MorrisElizabeth WardArmando PerugaWilliam A. BlattnerSten H. VermundRichard Hayes
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Abstract:
Between November 1990 and January 1991, status of human immunodeficiency virus (HIV) infection was assessed for 522 men and 484 women attending the Comprehensive Health Centre in Kingston, Jamaica, for a new sexually transmitted disease (STD) complaint. Prevalence of HIV type 1 (HIV-1) infection was 3.1% (31 of 1,006), a tenfold rise in seroprevalence in 4.5 years. Nineteen of 517 (3.7%) heterosexual men, 3 of 5 (60%) homosexual/bisexual men, and 9 of 484 (1.9%) women were infected with HIV. In heterosexual men, factors associated with HIV infection after age adjustment included present complaint of genital ulcer [odds ratio (OR) 7.3; 95% confidence interval (CI) 1.4-72], past history of genital ulcer (OR, 4.3; CI, 1.4-12), positive MHATP syphilis serology (OR, 3.4; CI, 1.1-10), sex with a prostitute in the past month (OR, 3.8; CI, 1.1-11). Three or more sex partners in the month prior to complaint (OR, 3.6; CI, 1.0-12), and bruising during sex (OR, 4.0; CI, 1.4-13). On multiple logistic regression analysis, independent associations with HIV infection were shown for bruising during sex (OR, 3.0; CI, 1.1-8.3), positive MHATP syphilis serology (OR, 3.2; CI, 1.1-9.5), and history of genital ulcer (OR, 2.9; CI, 1.0-8.0).(ABSTRACT TRUNCATED AT 250 WORDS)Keywords:
Genital ulcer
Sex organ
Seroprevalence
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The syndromic management of genital ulcer disease (GUD) misses asymptomatic syphilis cases but is widely utilized in resource-limited settings without diagnostic capabilities to ensure treatment for the most common etiologies of GUD. We used rapid serology tests for syphilis screening at a Malawian sexually transmitted infections clinic. The estimated seroprevalence was 9% and was highest among patients with genital ulcers (26%) and newly diagnosed HIV infection (19%). Rapid syphilis screening has the potential to increase syphilis detection, but accurate patient histories regarding syphilis diagnosis and prior treatment are needed.
Genital ulcer
Seroprevalence
Sex organ
Treponematosis
Etiology
Syphilis Serodiagnosis
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Objective To investigate the etiology of genital ulcer diseases(GUD) in sexually transmitted disease(STD) clinics,and to examine its relationship to HIV infection.Methods Between September 9,1997 and December 30,2004,322 patients with GUD was based on physical appearance and microbiologic evaluations which included dark field microscopy and serology test for syphilis for diagnosis the etiology of GUD.Results 234 men and 88 women were evaluated.The etiology of GUD was TP 26.40%(85/322),HSV 26.09%(84/322),and multiple infection 3.11%(10/322).No chancroid case was found.No etiology was identified in 47.52%(153/322).The seroprevalence of HIV was 1.86%(6/322).HIV seroprevalence positive rate in patients with syphilis,genital herpes and other GUD was 4.70%(4/85),1.19%(1/84) and 0.65%(1/153),respectively.HIV seroprevalence positive rate in patients with syphilis was significantly higher than that in patients with genital herpes and other GUD,but there was no significant difference in statistic 4.70%(4.70% vs 1.19%,χ~2=0.24,P0.05,OR=3.04,95% CI=0.31-29.93;4.70% vs 0.65%,χ~2=1.29,P0.05,OR=5.63,95% CI=0.58-55.06;1.19% vs 0.65%,χ~2=0.00,P0.05,OR=1.85,95% CI=0.11-30.00).Conclusions The study showed that syphilis and genital herpes predoinate in patients with GUD.The seropositive HIV infection in GUD was very low,and syphilis,genital herpes and its relationship to HIV infection need to proceeding a thorough research.
Genital ulcer
Chancroid
Seroprevalence
Etiology
Sex organ
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To assess the relative importance of ulcerative and non-ulcerative sexually transmitted disease in the transmission of HIV, a seroprevalence study was conducted on 2210 patients at the sexually transmitted diseases (STD) clinic of the S. Maria e S. Gallicano Hospital in Rome, between 1989 and 1994. Among male patients, by univariate analysis, strong predictors of HIV infection were homosexuality, sexual exposure to a HIV-positive partner, hepatitis B virus infection, and positive syphilis serology. An increased risk was estimated for patients with past genital herpes (odds ratio (OR) 3·86, 95% confidence intervals (CI) 0·40–18·2), and primary syphilis (OR 5·79, 95% CI 0·59–28·6). By multivariate analysis, a positive association was found with homosexuality (OR 6·9, 95% CI 2·9–16·5), and positive syphilis serology (OR 3·5, 95% CI 1·3–9·2). An adjusted OR of 2·41 was calculated for current and/or past genital herpes. These results, although not conclusive, suggest a role of ulcerative diseases as risk factors for prevalent HIV infection, and indicate that positive syphilis serology is an unbiased criterion for identifying individuals at increased risk of HIV infection.
Genital ulcer
Treponematosis
Seroprevalence
Sexual transmission
Univariate analysis
Syphilis Serodiagnosis
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To determine if infection with herpes simplex virus (HSV) type 2 is associated with human immunodeficiency virus (HIV) type 1 infection among patients attending sexually transmitted diseases clinics, a case-control study was done on coded sera from 179 HIV-1-infected patients and 367 age-, race-, and gender-matched HIV-1-seronegative patients. Although only 13 (2.3%) of 546 patients had a history of genital herpes treatment, 72% and 56.6%, respectively, had serologic evidence of prior infection with HSV-1 and -2. HSV-1 antibody prevalence was similar among both patient groups; however, HSV-2 antibodies were more common among those infected with HIV-1. Among heterosexual men, 62.7% of those infected with HIV-1 had HSV-2 antibodies compared with 46.7% of those not infected (P less than .01). The HSV-2 seroprevalence among women with or without HIV infection was 78.1% and 57.7%, respectively (P less than .02). A history of intravenous drug use and a reactive serologic test for syphilis were each independently associated with HIV-1 infection in heterosexuals. These data suggest that the two most common causes of genital ulcerative disease in the United States, genital herpes and syphilis, may contribute to increased risk for HIV-1 infection among heterosexuals.
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Objective: To investigate the etiology of genital ulcer disease (GUD) and the relationship between GUD and human immunodeficiency virus (HIV) infection. Methods: Dark field microscopy, serology test were used to detect Treponema pallidum (TP) , Herpes simplex virus (HSV) was detected by enzyme immunoassay, Haemophilus ducreyi (HD) was detected by culture method, and serum HIV antibody was tested in 285 patients with GUD. Results:285 patients with GUD were studied. TP and HSV were detected in 75(26. 3%) and 74(26. 0 %) patients, respectively, both the two pathogens were detected in 9(3. 2%) patients, no HD was found. No pathogen was identified in 136(47. 7%) patients. The seroprevalence of HIV was 1.8% (5/285). HIV seroprevalence positive rates in patients with syphilis, genital herpes and remaining patients with GUD were 4. 0%(3/75) , 1. 4%(l/74) and 0. 7%(l/136) , respectively. HIV seroprevalence positive rate in patients with syphilis was higher than the patients with genital herpes and the remaining GUD patients, however, there were no statistically significant difference. Conclusions:The major pathogens of GUD are syphilis and genital herpes. The seropositive HIV infection in GUD is very low, further studies are needed to elucidate the relationship between syphilis, genital herpes and HIV infection.
Genital ulcer
Haemophilus ducreyi
Seroprevalence
Etiology
Sex organ
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Background Genital herpes has been emerging as one of the leading cause of sexually transmitted infections. Serology has an important role in the diagnosis of genital herpes. Our objective was to know the hospital based prevalence, other epidemiological parameters, co-infections and serological utility in genital herpes. Methods This was a cross-sectional, descriptive study of patients attending sexually transmitted diseases clinic of our hospital. A total of 820 consecutive patients of both the sexes attending the clinic over a period of 18 months, were screened for the features of genital ulcer disease. Among 128 patients with genital ulcer disease, 76 clinically suspected with genital herpes were subjected to serology. Results The hospital based prevalence of genital herpes among sexually transmitted diseases patients and genital ulcer disease was 9.3% and 59.4% respectively. Males were predominantly affected. Maximum prevalence, 30 (39.5%) patients was seen in the age group of 30-39 years. Sixty (78.9%) were married, 58 (76.3%) belonged to lower class. Among women, majority of them were housewives. Among patients with genital herpes, 22 (28.9%) had primary disease, while 54 (71.1%) had recurrent disease. Common clinical features were only erosions in 24 (31.6%), erosions with crusting, 24 (31.6 percent). Herpes simplex virus (HSV) 1 and 2 coexistence was seen in 34 (44.7%), followed by HSV 2 alone 26 (34.2%) and HSV 1 in 10 (13.2%) of patients. Serological reactivity for HIV I and II in 24 (31.6%), syphilis in 10 (13.2%) and HbsAg in 4 (5.3%) were seen. Polymerase chain reaction for HSV was positive in 38 (50%), of patients. Conclusion The hospital based prevalence of genital herpes among STD patients was 9.3 percent. Lower socioeconomic status, illiteracy and number of sexual partners may contribute to the higher incidence of genital herpes. Serology can be used in adjunct to clinical examination and the diagnosis can be confirmed by specific polymerase chain reaction.
Genital ulcer
Sex organ
Herpes Genitalis
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In Brief Background The proportion of cases of genital ulcer disease attributable to herpes simplex virus type 2 (HSV-2) appears to be increasing in sub-Saharan Africa. Goal To assess the contributions of HIV disease and behavioral response to the HIV epidemic to the increasing proportion of genital ulcer disease (GUD) attributable to HSV-2 in sub-Saharan Africa. Study Design Simulations of the transmission dynamics of ulcerative sexually transmitted diseases (STDs) and HIV with use of the model STDSIM. Results In simulations, 28% of GUD was caused by HSV-2 before a severe HIV epidemic. If HIV disease was assumed to double the duration and frequency of HSV-2 recurrences, this proportion rose to 35% by year 2000. If stronger effects of HIV were assumed, this proportion rose further, but because of increased HSV-2 transmission this would shift the peak in HSV-2 seroprevalence to an unrealistically young age. A simulated 25% reduction in partner-change rates increased the proportion of GUD caused by HSV-2 to 56%, following relatively large decreases in chancroid and syphilis. Conclusion Behavioral change may make an important contribution to relative increases in genital herpes. Modeling scenarios suggest that behavioral responses to the HIV epidemic may have contributed markedly to observed increases in the proportion of genital ulcer disease due to herpes simplex virus type 2 in sub-Saharan Africa.
Genital ulcer
Chancroid
Herpes Genitalis
Seroprevalence
Sex organ
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To investigate the etiology of genital ulcer disease (GUD) among patients attending sexually transmitted disease(STD)clinics in Guangzhou,China.Between September 8,1998,and August 9,assessed.Clinical etiology of GUD was dependent on including the following:dark field microscopy and serology for Treponema pallidum(TP),swabs of genital ulcer for simultaneous detection of HSV,TP,Haemophius ducreyi (HD),Human papillomavirus(HPV),and serology for HIV infection.Two hundred thirty men and thirty-seven women with a median age of 33.4(range 16-74 years)were analyzed.The etiology of GUD was syphilis(26.59%)(71/267),genital herpes(17.60%)(47/267),condylomata acuminata(4.87%)(13/267),candidiasis(3.37%)(10/267),and multipe infection(6.74%)(18/267).The seroprevalence of HIV was 0.07%(2/267).No etiology was identified in 50.56%(135/267).The etiology of GUD among STD patients in our area was multifactorial with a predominance of syphilis and genital herpes.Based on this limited data obtained at STD clinics,HIV infection was not common.
Genital ulcer
Etiology
Haemophilus ducreyi
Sex organ
Chancroid
Seroprevalence
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SUMMARY A 45‐year‐old heterosexual man presented with phimosis three weeks after arriving in this country from India. Examination under anaesthesia and circumcision revealed a large ulcer on the ventral aspect of the penis around the fraenum. Histopathological examination of a biopsy taken from the ulcer revealed granulation tissue with inflammatory cell infiltrate. Specific and non‐specific serological tests for syphilis carried out four weeks after the initial presentation showed high titres. The importance of serological tests for syphilis in genital ulcer disease, especially in atypical presentations, is discussed.
Genital ulcer
Syphilis Serodiagnosis
Sex organ
Presentation (obstetrics)
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Sera from 500 (496 male and 4 female) consecutive patients with sexually transmitted diseases (STD) were examined for the presence of HIV1 antibodies. The serological tests were done using the ELISA (Wellcozyme) and confirmed by the western blot (Biorad). Sixty (12%) of the 500 patients were HIV-1 antibody positive. Seropositivity varied with the type of STD. A positivity rate of 16% seen with genital ulcer disease is significantly higher than the 7% prevalence rate seen in STD patients with urethral discharge. Infection with more than one kind of STD increases seropositivity significantly. Of the potential risk factors identified during the interview it seems that only shaving at barbers' shop is positively associated with seroprevalence. This study suggests that the presence of STDs is associated with an increased HIV-1 seroprevalence. Therefore, any effort to reduce HIV-1 infection should aim at the control of STDs.
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Prevalence
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