INCREASING HIV-1 SEROPREVALENCE ASSOCIATED WITH GENITAL-ULCER-DISEASE, NEW-YORK-CITY, 1990-1992

Objective: To measure HIV seroprevalence trends associated with sexual ly transmitted diseases (STD) causing ulcerative lesions [genital ulce r disease (CUD)], such as syphilis, chancroid and genital herpes, in N ew York City between 1990 and 1992. Design: Unlinked HIV-1 serosurvey using remnant serum drawn originally for routine syphilis screening. S etting and patients: Consecutive sample of patients presenting to New York City Department of Health STD clinics for STD examination (n = 41 678). Main outcome measure: Serologic evidence of antibody to HIV-1. Results: Although overall HIV seroprevalence and CUD incidence decline d between 1990 and 1992, seroprevalence in patients with GUD increased from 10 to 16%. In contrast, seroprevalence in patients with non-ulce rative STD decreased. The most dramatic changes in seroprevalence asso ciated with GUD occurred in patients using crack cocaine and injecting drugs. Conclusions: Despite declining HIV seroprevalence and GUD inci dence, the association between GUD and HIV infection has strengthened over time in New York City STD clinics. Longitudinal incidence studies are needed to elucidate the biological, behavioral and temporal assoc iations between GUD and HIV. Timely diagnosis and treatment of acute S TD and more intensive risk reduction strategies at the clinics and ass ociated testing sites, with a particular focus on GUD patients, are in dicated.