GENITAL ULCER DISEASE IN WOMEN INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

OBJECTIVE: The purpose of this study was to determine the prevalence a nd microbiologic characteristics of genital ulcer disease in a populat ion of human immunodeficiency virus-infected women. STUDY DESIGN: A re trospective cohort study was performed in university-affiliated, hospi tal-based women's human immunodeficiency virus clinics. A total of 307 women with human immunodeficiency Virus infection were followed up du ring 20 months. There were no interventions. Age, race, CD4(+) cell co unts, bacteriologic and virologic analyses in cases of ulcers, serolog ic testing for syphilis, and histopathologic examination in selected c ases (n = 6). RESULTS: Among 307 women followed up over a 20-month per iod, 43 ulcers were detected with a prevalence of 14%. Among the ulcer cases the average absolute CD4(+) lymphocyte number was 210/mm(3). Di agnostic evaluation yielded no proven etiologic agent in 26 (60%) of t he cases. Twelve of the 43 cases (28%) were positive for herpes simple x-2. Five cases (12%) yielded unusual or mixed bacteriologic types. No cases were attributable to primary syphilis infection. One case each of an ulcer infected with cytomegalovirus, Chlamydia trachomatis, and Gardnerella vaginalis, as well as three unusual presentations of herpe tic ulcers, is analyzed in detail. CONCLUSION: These cases exemplify t he often dramatic presentation of human immunodeficiency virus-related genital ulcers and the clinical complexity of both diagnosis and mana gement. The frequent lack of an infectious or neoplastic cause in huma n immunodeficiency virus-infected women with genital ulcer disease sug gests that human immunodeficiency virus may play a local role in causa tion or exacerbation. Biopsies of atypical genital ulcers should be co nsidered to aid diagnosis. Further studies are needed to elucidate the pathogenesis of genital ulcer disease in human immunodeficiency virus -infected women.