GENITAL ULCER DISEASE AMONG STD CLINIC ATTENDERS IN NAIROBI - ASSOCIATION WITH HIV-1 AND CIRCUMCISION STATUS

In previous studies, genital ulcers in men have been found to be assoc iated with increased risk of HIV-1 seroconversion. To further explore this association male patients attending a sexually transmitted diseas e (STD) clinic in Nairobi for either urethritis (controls, n=276) or a genital ulcer (cases, n=607) were compared with respect to sexual beh aviour, presence of HIV-1 antibody and circumcision status. Patients w ere 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 ci rcumcision was associated with both HIV-1 infection (OR=4.67) and the presence of a genital ulcer (OR=2.23). Genital ulcers were also associ ated with HIV-1 infection (OR=1.87) independent of circumcision status . On follow-up, HIV-1 seropositivity was associated with incident geni tal ulcers. It is argued that the association between genital ulcers a nd 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 incre ase the risk of acquiring a genital ulcer, or HIV-1 infection and geni tal ulcers may have some unknown risk factor in common.