Human Immunodeficiency Virus Infection among Men with Sexually Transmitted Diseases

Department of Medical Microbiology, University of Nairobi, Kenya.
New England Journal of Medicine (Impact Factor: 55.87). 09/1988; 319(5):274-8. DOI: 10.1056/NEJM198808043190504
Source: PubMed


Heterosexual transmission of the human immunodeficiency virus (HIV) appears to occur readily in Africa but less commonly in North America and Europe. We conducted a case-control study among men attending a clinic for sexually transmitted diseases in Nairobi to determine the prevalence of HIV infection and the risk factors involved. HIV antibody was detected in 11.2 percent of 340 men who enrolled in the study. Reports of nonvaginal heterosexual intercourse and homosexuality were notably rare. Recent injections and blood transfusions were not associated with HIV infection. Travel and frequent contact with prostitutes were associated with HIV seropositivity. Men who were uncircumcised were more likely to have HIV infection (odds ratio, 2.7; P = 0.003), as were those who reported a history of genital ulcers (odds ratio, 7.2; P less than 0.001). A current diagnosis of genital ulcers was also associated with HIV seropositivity (odds ratio, 2.0; P = 0.028). Multivariate analysis revealed an independent association of genital ulcers with HIV infection in both circumcised and uncircumcised men. Uncircumcised men were more frequently infected with HIV, regardless of a history of genital ulcers. Our study finds that genital ulcers and an intact foreskin are associated with HIV infection in men with a sexually transmitted disease. Genital ulcers may increase men's susceptibility to HIV, or they may increase the infectivity of women infected with HIV. The intact foreskin may operate to increase the susceptibility to HIV.

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    • "Recently, many researchers have investigated an association between circumcision and the prevention of HIV transmission in Africa. Several cohort studies have shown a lower prevalence of the virus among circumcised males (Simonsen et al, 1988; Urassa et al, 1997). However, some cross-sectional surveys from Africa have shown no association or an inverse association (Van Howe, 1999). "
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    ABSTRACT: As one of the oldest surgical procedures, circumcision continues to attract active debate on risks and benefits when performed for ''elective'' reasons. The argument spans a wide range of ages and topics, including neonates and adults, cause and effect on sexual function, penile sensitivity, and preventive medical benefits. There exists in the literature a large body of information regarding circumcision derived from different sources, which include surgeons, family doctors, psychiatrists, lawyers, the mothers of patients, and health policy makers. However, there is relatively little research on this topic within the community of urologists. There are few published reports regarding the effects of adult circumcision on sexual function, despite the fact that approximately 75% of U.S.-born males are circumcised (Laumann et al, 1997).
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    • "In developing countries where chancroid is endemic, the usefulness of treatment-based strategies may be limited by antibiotic resistance (Ison et al., 1998). Apart from curbing the disease, a chancroid vaccine may also help limit the human immunodeficiency virus (HIV) epidemic , as chancroid acts as a facilitating cofactor in its sexual transmission (Simonsen et al., 1988; Cameron et al., 1989), and they are epidemiologically tightly associated in regions endemic with chancroid (Cameron and Padian, 1990). Oral bacterial vaccines are easier to administer, safer, and have greater compliance than an injectable one (Kotton and Hohmann, 2004). "
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    • "If one considers syphilis alone, there are many conflicting studies regarding the role of the prepuce in disease risk [33] [45] [46]. Uncircumcised men may be at increased risk for infection with HIV, but several studies have shown circumcised men to be at higher risk, and others show no effect of circumcision status [47] [48] [49] [50]. Such conflicting studies yield the conclusion that circumcision as a routine procedure cannot be justified as a means of preventing STDs. "
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    ABSTRACT: The debate about whether to circumcise infants in the neonatal period likely will continue for some time. As the medical and ethical issues are discussed and studied, however, economic factors are beginning to limit the practice in the United States. For example, Medicaid no longer funds neonatal circumcision in 11 states [63]. Private insurers likely will follow the lead of state health insurance, and a decline in the rate of circumcision will follow. As this shift in reimbursement occurs, parents who believe that circumcision is a medically necessary practice will need to be reassured that their child may lead a healthy life with an intact foreskin.
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