title: Risk factors for genital ulcerations in Kenyan sex workers. The role of human immunodeficiency virus type 1 infection.
abstract: 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.
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Kenya.
authors.forename: R
authors.initials: R
authors.lastname: Kaul
authors.forename: J
authors.initials: J
authors.lastname: Kimani
authors.forename: N J
authors.initials: NJ
authors.lastname: Nagelkerke
authors.forename: F A
authors.initials: FA
authors.lastname: Plummer
authors.forename: J J
authors.initials: JJ
authors.lastname: Bwayo
authors.forename: R C
authors.initials: RC
authors.lastname: Brunham
authors.forename: E N
authors.initials: EN
authors.lastname: Ngugi
authors.forename: A
authors.initials: A
authors.lastname: Ronald
mesh_terms: 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*
chemical_list: D003276:Contraceptives, Oral