Sexually Transmitted Diseases and Human Immunodeficiency Virus Control in Malawi: A Field Study of Genital Ulcer Disease

Abstract

Men with genital ulcer disease (GUD) attending a clinic in Malawi were evaluated and treated with one of five drug regimens. Haemophilus ducreyi was isolated from 204 (26.2%) of 778 patients. Of 677 men, 198 (29.2%) had treponemes detected in ulcer material by direct immunofluorescence or had rapid plasma reagin reactivity of > or = 1:8. Human immunodeficiency virus type 1 (HIV-1) seroprevalence was 58.9% overall and 75.8% among patients reporting a history of GUD (P < .001). By logistic regression analysis, HIV-1 seropositivity was shown to impair ulcer healing (P = .003). Treatment failure rates for culture-proven chancroid were 19% for trimethoprim-sulfamethoxazole, 12.9% and 7.4%, respectively, for low- and high-dose erythromycin regimens, and 8.3% and 0, respectively, for low- and high-dose ciprofloxacin regimens. Herpes antigen was detected by EIA in 6 (23.1%) of 26 nonhealing ulcers. In Malawi, GUD should be managed as a syndrome to assure treatment of both syphilis and chancroid.

Polymerase Chain Reaction for Detection of Herpes Simplex Virus (HSV) DNA on Mucosal Surfaces: Comparison with HSV Isolation in Cell Culture

“…That the sensitivity of virus isolation varies with ambient temperature is of more than local interest. A review of the literature on genital ulcer disease in tropical countries in which only viral culture was used has shown a relatively low frequency of HSV as an etiology of genital ulcer disease (GUD), even in populations in which HSV-2 seroprevalence was high [19][20][21][22]. Morerecent studies that used PCR-based methods have shown that HSV is the most frequent cause of GUD in these regions of the world [23][24][25].…”

Seroprevalence and incidence of genital ulcer infections in a rural Ugandan population

“…1 2 Studies done on STIs have been mainly on selected populations such as females attending gynaecological, obstetric, and family planning clinics, STI clinic attenders, and among female sex workers. [3][4][5] Findings from such studies cannot be generalised to general populations in whom most STIs are either unrecognised or asymptomatic. The scarcity of accurate data is consequently a handicap in designing appropriate control measures.…”

HIV Infection and AIDS Among Young Women in South Africa

“…An STI results in an increase in genital HIV viral load, which means that having sex with a person with an STI implies an exposal to a higher viral load (88). Furthermore, STIs also result in the recruitment of macrophages and lymphocytes which are virotrophic (87)(88)(89)(90)(91)(92). A person with STI and exposed to HIV infection through sex is likely to acquire the infection due to the breached epithelium and/or increase in white cells to which HIV will get attached for entry.…”