AN INVESTIGATION OF GENITAL ULCERS IN JACKSON, MISSISSIPPI, WITH USE OF A MULTIPLEX POLYMERASE-CHAIN-REACTION ASSAY - HIGH PREVALENCE OF CHANCROID AND HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

In 1994, an apparent outbreak of atypical genital ulcers was noted by clinicians at the sexually transmitted disease clinic in Jackson, Miss issippi. Of 143 patients with ulcers tested with a multiplex polymeras e chain reaction (PCR) assay, 56 (39%) were positive for Haemophilus d ucreyi, 44 (31%) for herpes simplex virus, and 27 (19%) for Treponema pallidum; 12 (8%) were positive for >1 organism. Of 136 patients teste d for human immunodeficiency virus (HIV) by serology, 14 (10%) a ere H IV-seropositive, compared with none of 200 patients without ulcers (P < .001), HIV-1 DNA was detected by PCR in ulcers of 6 (50%) of 12 HIV- positive patients. Multivariate analysis indicated that men with chanc roid were significantly more likely than male patients without ulcers to report sex viith a crack cocaine user, exchange of money or drugs f or sex, and multiple sex partners, The strong association between geni tal ulcers and HIV infection in this population highlights the urgency of preventing genital ulcers in the southern United States.