Risk factors for genital ulcerations in Kenyan sex workers. The role of human immunodeficiency virus type 1 infection.
OBJECTIVE
Genital ulcer disease (GUD) is a major risk factor for human immunodeficiency virus (HIV) transmission. Cross-sectional studies have suggested that HIV infection may itself predispose to genital ulceration (GU).


OBJECTIVE
To prospectively study the effects of HIV type 1 (HIV-1) infection and behavioral variables on GU incidence.


METHODS
A cohort of 302 Kenyan female sex-workers was established in April 1991. Women were scheduled for assessment every 2 weeks, and bloods were collected every 6 months for HIV serology, rapid plasma reagin (RPR) and CD4 counts. Logistic regression was used to study risk factors for incident genital ulcers.


RESULTS
189 women (62.5%) had at least one incident ulcer over 24.3 +/- 15.3 months. GU incidence was higher in seropositive than initially seronegative women (82% vs. 48%; odds ratio [OR]) = 4.33; P < 0.01). Only HIV-1 seropositivity (OR = 3.42), a CD4 count < 200/ml (OR = 1.94), and oral contraceptive use (OR = 1.35) were associated (P < 0.05) with GU incidence in regression analysis. For those ulcers where an etiology was actively sought, Hemophilus ducreyi was confirmed in 54 (19%) of cases, and syphilis in 30 (29%).


CONCLUSIONS
GU incidence in Kenyan sex workers is independently affected by HIV-1 serostatus, degree of immunosuppression, and oral contraceptive use.
Kaul
R
R
Department of Medical Microbiology, University of Nairobi, Kenya.
Kimani
J
J
Nagelkerke
N J
NJ
Plummer
F A
FA
Bwayo
J J
JJ
Brunham
R C
RC
Ngugi
E N
EN
Ronald
A
A
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D003276:Contraceptives, Oral / Q000009:adverse effects; D005260:Female; D005831:Genital Diseases, Female / Q000209:etiology*; D015497:HIV-1; D006801:Humans; D011446:Prospective Studies; D012307:Risk Factors; D011477:Sex Work; D014456:Ulcer / Q000209:etiology*
D003276:Contraceptives, Oral