AEGiS-13IAC: Changing aetiology of genital ulcer disease (GUD) in STD clinic attenders with a rising HIV prevalence.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Changing aetiology of genital ulcer disease (GUD) in STD clinic attenders with a rising HIV prevalence.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. ThOrC728)

Kharsany AB, Mahabeer Y, Connolly C, Sturm AW
A.B.M. Kharsany, University of Natal, Dept of Medical Microbiology, Private Bag 7, Congella 4013, South Africa, Tel.: +27 31 260 4395, Fax: +27 31 260 4431, E-mail: Kharsany@med.und.ac.za

BACKGROUND: GUD is an established risk factor for HIV transmission. In contrast, how HIV infection influences the transmissability of GUD pathogens is unknown. We report on a change in prevalence of GUD in STD clinic attenders from a population with a high prevalence of HIV infection.

METHODS: A precoded questionnaire was completed by 400 men and standard microbiological methods used for the detection of recognised aetiologies of GUD. Peripheral blood was collected for syphilis serology,antibody to HIV and absolute CD4 counts. A series of studies had been conducted at the clinic using similar methodology and the results were compared.

RESULTS: Majority of men were from informal settlements, uncircumcised, unmarried, reporting only occasional or no condom use. Recognised sexually transmitted pathogens were detected in 275 (69%) men; 123 (31%) had syphilis, 161 (41%) had herpes simplex virus (HSV), 23 (6%) had Haemophilus ducreyi, 16 (4%) had Calymmatobacterium granulomatis and 13 (3%) had Chlamydia trachomatis. The HIV antibody test was positive in 249 / 387 (64%) patients of whom 25 / 237 (11%) had absolute CD4 counts of >200 / mm2 (p = 0.01). HSV infections were the commonest cause of GUD in Durban, whilst the prevalence of syphilis remains persistently high. The prevalence of chancroid decreased dramatically from 35% in 1995 to 6% in 1998 and HSV infection increased from 11% in 1995 to 45% in 1998. HSV infections were significantly associated with HIV infection only when the CD4 count was >200 / mm2.

CONCLUSIONS: This study showed that 64% of patients with GUD were HIV positive, which highlights the need for surveillance programs to monitor STDs patients to effectively implement meaningful intervention programs to reduce the burden of STDs and HIV infections. The high prevalence of HSV in the aetiology of GUD requires the syndromic management protocol to be reviewed to adequately treat such patients.

Keywords: AEGIS, Prevalence, HIV Infections, HIV Seropositivity, Chancroid, Peptic Ulcer, Urogenital Diseases, Haemophilus ducreyi, Syphilis, Risk Factors, Ambulatory Care Facilities, Human, Male, epidemiology
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