title: Genital ulcer disease among STD clinic attenders in Nairobi: association with HIV-1 and circumcision status.
abstract: In previous studies, genital ulcers in men have been found to be associated with increased risk of HIV-1 seroconversion. To further explore this association male patients attending a sexually transmitted disease (STD) clinic in Nairobi for either urethritis (controls, n = 276) or a genital ulcer (cases, n = 607) were compared with respect to sexual behaviour, presence of HIV-1 antibody and circumcision status. Patients were followed to study risk factors for incident genital ulcers and HIV-1 seroconversion. At entry, being married was associated with higher prevalence of HIV-1 (OR = 1.76) and genital ulcers (OR = 1.42). Lack of circumcision was associated with both HIV-1 infection (OR = 4.67) and the presence of a genital ulcer (OR = 2.23). Genital ulcers were also associated with HIV-1 infection (OR = 1.87) independent of circumcision status. On follow-up, HIV-1 seropositivity was associated with incident genital ulcers. It is argued that the association between genital ulcers and HIV-1 infection may be more complex than ulcers simply being a risk factor for HIV-1 infection, and that HIV-1 infection may either increase the risk of acquiring a genital ulcer, or HIV-1 infection and genital ulcers may have some unknown risk factor in common.
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Kenya.
authors.forename: J M
authors.initials: JM
authors.lastname: Nasio
authors.forename: N J
authors.initials: NJ
authors.lastname: Nagelkerke
authors.forename: A
authors.initials: A
authors.lastname: Mwatha
authors.forename: S
authors.initials: S
authors.lastname: Moses
authors.forename: J O
authors.initials: JO
authors.lastname: Ndinya-Achola
authors.forename: F A
authors.initials: FA
authors.lastname: Plummer
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D005832:Genital Diseases, Male / Q000150:complications / Q000453:epidemiology*; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D012747:Sexual Partners; D014456:Ulcer / Q000150:complications / Q000453:epidemiology*; D014526:Urethritis / Q000150:complications / Q000453:epidemiology