Risk of human immunodeficiency virus infection and genital ulcer disease among persons attending a sexually transmitted disease clinic in Italy

To assess the relative importance of ulcerative and non-ulcerative sexually transmitted disease in the transmission of HIV, a seroprevalence study was conducted on 2210 patients at the sexually transmitted diseases (STD) clin ic of the S. Maria e S. Gallicano Hospital in Rome, between 1989 and 1994. Among male patients, by univariate analysis, strong predictors of HIV infec tion were homosexuality, sexual exposure to a HIV-positive partner, hepatit is B virus infection, and positive syphilis serology. An increased risk was estimated for patients with past genital herpes (odds ratio (OR) 3.86, 95 % confidence intervals (CI) 0.40-18.2), and primary syphilis (OR 5.79, 95 % CI 0.59-28.6). By multivariate analysis, a positive association was found with homosexuality (OR 6.9, 95 % CI 2.9-16.5), and positive syphilis serolo gy (OR 3.5, 95 % CI 1.3-9.2). An adjusted OR of 2.41 was calculated for cur rent and/or past genital herpes. These results, although not conclusive, su ggest a role of ulcerative diseases as risk factors for prevalent HIV infec tion, and indicate that positive syphilis serology is an unbiased criterion for identifying individuals at increased risk of HIV infection.