Genital ulcer disease among STD clinic attenders in Nairobi: Association with HIV-1 and circumcision status

In previous studies, genital ulcers in men have been found to be associated with increased risk of HIV-1 seroconversion. To further explore this association male patients attending a sexually transmitted disease (STD) clinic in Nairobi for either urethritis (controls, n=276) or a genital ulcer (cases, n=607) were compared with respect to sexual behaviour, presence of HIV-1 antibody and circumcision status. Patients were followed to study risk factors for incident genital ulcers and HIV-1 seroconversion. At entry, being married was associated with higher prevalence of HIV-1 (OR=1.76) and genital ulcers (OR=1.42). Lack of circumcision was associated with both HIV-1 infection (OR=4.67) and the presence of a genital ulcer (OR=2.23). Genital ulcers were also associated with HIV-1 infection (OR=1.87) independent of circumcision status. On follow-up, HIV-1 seropositivity was associated with incident genital ulcers. It is argued that the association between genital ulcers and HIV-1 infection may be more complex than ulcers simply being a risk factor for HIV-1 infection, and that HIV-1 infection may either increase the risk of acquiring a genital ulcer, or HIV-1 infection and genital ulcers may have some unknown risk factor in common.