Genital ulcer disease among STD clinic attenders in Nairobi: association with HIV-1 and circumcision status

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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.

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