title: Health care seeking among men with genital ulcer disease in South Africa: correlates and relationship to human immunodeficiency virus-1 and herpes simplex virus type 2 detection and shedding.
abstract: BACKGROUND
  Episodic acyclovir therapy has been added to genital ulcer disease (GUD) syndromic management guidelines in several sub-Saharan African countries with human immunodeficiency virus (HIV) epidemics. We examined the correlates of health care seeking in men with GUD and its relationship to HIV-1 and herpes simplex virus type 2 outcomes.
  
  
  METHODS
  Men with GUD (n = 615) were recruited from primary health care clinics in Gauteng province, South Africa for a randomized controlled trial of episodic acyclovir therapy. We used baseline survey and sexually transmitted infection/HIV-testing data to examine delay in health care seeking (defined as time from ulcer recognition to baseline study visit).
  
  
  RESULTS
  Median delay in health care seeking for GUD was 5 days, and one-quarter of men had previously sought care for the current ulcer. Previous care seekers were older, had more episodes of ulceration in the past year, and were more likely to test seropositive for HIV-1 and HSV-2. Delay in health care seeking was significantly associated with age, education level, and sex during the ulceration episode. Delays in care seeking were related to poorer HIV-1 outcomes; these findings were valid after controlling for advanced HIV.
  
  
  CONCLUSIONS
  Interventions to help shorten the duration between ulcer recognition and health care seeking for men with GUD are needed.
authors.affiliation: Division of STD Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. jleichliter@cdc.gov
authors.forename: Jami S
authors.initials: JS
authors.lastname: Leichliter
authors.forename: David A
authors.initials: DA
authors.lastname: Lewis
authors.forename: Maya
authors.initials: M
authors.lastname: Sternberg
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Habel
authors.forename: Gabriela
authors.initials: G
authors.lastname: Paz-Bailey
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D057210:Delayed Diagnosis; D005832:Genital Diseases, Male / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification* / Q000502:physiology; D006558:Herpes Genitalis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D018258:Herpesvirus 2, Human / Q000302:isolation & purification* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012737:Sex Factors; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014456:Ulcer / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D019562:Viral Load; D017201:Virus Shedding / Q000502:physiology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir