Human immunodeficiency virus infection and genital ulcer disease in South Africa - The herpetic connection

Background with Objectives: While genital ulcers are a risk factor in HIV i nfection, the association of specific agents of genital ulcer disease (GUD) with HIV infection may vary. Goal: To determine the etiology of GUD in HIV-infected and HIV-uninfected m en attending sexually transmitted disease (STD) clinics in Durban, Johannes burg, and Cape Town, South Africa, and the association of previous and curr ent sexually transmitted infections with HIV infection in men with ulcerati ve and nonulcerative STDs, Study Design: A cross-sectional study of 558 men with genital ulcers and 60 2 men with urethritis, Results: Patients with GUD were more likely to be infected with HIV than pa tients with urethritis (39.4% versus 21.4%, P less than or equal to 0.001), Herpes simplex virus 2 (HSV-2) was the most common agent identified in ulc er specimens (35.9%), and was detected in a significantly higher proportion of ulcer specimens from HIV-infected patients than in specimens from HIV-u ninfected patients (47.3% versus 28.2%, P less than or equal to 0.001), Pat ients infected with HIV-1 were significantly more likely to have HSV-2 infe ction, as measured by the presence of the antibody to glycoprotein G-2, tha n patients not infected with HIV (63.1% versus 38.5 %, P less than or equal to 0.001), Patients infected with HIV-1 were also significantly more likel y to have initial HSV-2 infection than HIV-uninfected patients with GUD (50 .0% versus 31.6%, P = 0.007), Haemophilus ducreyi was detected in 31.7% of ulcer specimens; prevalence did not vary by HIV-infection status, Treponema pallidum DNA was detected significantly less frequently in ulcer specimens from patients infected with HIV than in specimens from patients not infect ed with HIV (10.2% versus 26%, P less than or equal to 0.001); no associati on was found between HIV-infection status and fluorescent treponemal antibo dy absorption test seroreactivity, even when men with M-PCR-positive syphil is lesions were excluded from the analyses. Conclusion: The authors found that HSV-2 is a more common etiology of GUD t han has been suggested by previous studies conducted in South Africa; serol ogic evidence of HSV-2 infection and current cases of genital herpes are st rongly associated with HIV infection among men who present to STD clinics w ith GUD or urethritis.