HIV-1 infection-associated risk factors among sexually transmitted disease patients in Athens, Greece: 1990 to 1996

OBJECTIVE: To determine trends in HIV seroprevalence and related risk factors among patients with sexually transmitted diseases (STDs) and to report the respective epidemiologic history characteristics. METHODS: A cross-sectional seroepidemiologic study conducted from 1990 to 1996 among 5,669 symptomatic STD cases was carried out. RESULTS: The overall HIV test acceptance was 98.9%, and 1.2% patients (n = 66) were seropositive. Highest rates were detected among those who were born or resided in Sub-Saharan Africa. Seropositivity fluctuates significantly by age, and is excessive in persons 45 years and older (2.6%). A significant decreasing trend in STD incidence and HIV seroprevalence among patients younger than 25 years was detected. Male homosexuals and bisexuals (MSM) exhibited the highest overall rate of infection (5.8%) followed by intravenous drug users (2%). Highly promiscuous STD patients (ie, those who had more than 10 partners during the past 6 months) presented a significantly increased HIV seroprevalence when compared with patients of the same sexual orientation. STD patients infected with HIV mostly belonged to notable risk categories of AIDS (men who have sex with men, 72.7%). Awareness of serostatus was low (13.6%). In male patients, the HIV seropositivity rate was significantly higher among early syphilis and proctitis cases, whereas in females this higher rate occurred with herpes genitalis. CONCLUSIONS: Promiscuity and sexual orientation significantly influence the seroprevalence rate. Exposure to HIV remained stable despite the above declining time trends, which implies the need for additional preventive interventions targeted to the real health and illness behavior of the partner.     

HIV prevalence in patients with sexually transmitted diseases in Yaounde, (Cameroon) in 1989 and 1990: necessity of an STD control programme.

OBJECTIVE--To monitor HIV seroprevalence among STD clinic attenders as part of a sentinel surveillance programme. DESIGN--Seroepidemiological survey on randomly selected patients. SETTING--"Elig Essono" STD clinic, Yaounde; from February 1989 to December 1990. PATIENTS--1161 randomly selected patients. MAIN OUTCOME MEASURES--HIV and syphilis seroprevalence. RESULTS--Twenty six of the 1161 patients (2.4%; CI: 95%; 1.5%-3.3%) tested were found to be HIV positive (mostly due to HIV1); 35.4% had antibodies to Treponema pallidum. There was no association between HIV seropositivity and sex, marital status, or educational level. Genital ulcer disease did not correlate with HIV seroprevalence. However, patients with a positive serological test for T pallidum were more likely to have HIV infection (rr = 2.4; 95% CI; from 1.1 to 3.0). Results from 1990 were double those of 1989 (3.3% versus 1.6%, p = 0.02). CONCLUSIONS--Compared with the findings among the same groups in metropolitan areas of various other African countries, the HIV seroprevalence is still low; this could be due to many reasons, such as the recent introduction of the virus in the country, a different spectrum of STDs, the high level of circumcision of males. HIV infection trends should continue to be monitored among risk groups such as STD patients and control programmes implemented to reduce the rapid spread of AIDS in the country.     

Declining rates of gonorrhoea and syphilis in Strasbourg, France: a 20-year study.

OBJECTIVE--To report the epidemiology of gonorrhoea and syphilis during the years 1973-1992 in the Strasbourg STD clinic and to discuss the data in the light of changes in STD rates in western countries. DESIGN--Retrospective analysis of gonorrhoea and syphilis cases recorded annually, total number of consultations, HIV serology, STD among prostitutes. SETTING--Strasbourg, Bas-Rhin, FRANCE. SUBJECTS--Patients attending the public STD clinic in Strasbourg. RESULTS--From 1973 to 1992 79,786 consultations were recorded. Since 1984, a regular fall has been noted, from more than 4500 consultations a year in the 1970s, to 1519 consultations in 1992. A major decline in gonorrhoea was observed, especially since 1984. There were 457 new cases in 1973 (15.3% of all patients) whereas only seven new cases in 1992 (0.8% of all patients). Syphilis has been declining regularly since 1979, with a reinforcement in this decline since 1984: 168 cases were recorded in 1972 (6.4% of all patients), and only two cases in 1992 (0.2% of all patients). Positive HIV tests were found in 14% and 12% of patients in 1985-86, and the positivity rate has regularly decreased to reach 0.6% in 1992. Prostitutes represented 9.2% of all patients in 1980, and only 0.8% of patients in 1992. Since 1987, syphilis and gonorrhoea have been rarely recorded among prostitutes. CONCLUSIONS--A dramatic decline in both gonorrhoea and syphilis has been observed in Strasbourg, especially since 1984, with a parallel diminution in the STD clinic frequentation. A comparable trend in gonorrhoea rates was noted in many western countries, but syphilis rates are more heterogeneous among geographic areas. Changes in sexual behaviour due to the AIDS epidemic are probably responsible in part for this decline, but nevertheless the rarity of gonorrhoea and syphilis in Strasbourg in 1992 is not clearly explained.     

HIV prevalence among clients attending a sexually transmitted diseases clinic in Amsterdam: the potential risk for heterosexual transmission.

INTRODUCTION--Patients attending a clinic for sexually transmitted diseases (STD) in general have engaged in at risk sexual behaviour. Therefore they are at increased risk of acquiring HIV through sexual contact. OBJECTIVE--To determine the HIV prevalence among patients attending a STD clinic in Amsterdam. METHODS--An anonymous cross sectional study was conducted in two 5-week periods in Spring and Autumn 1991. RESULTS--Of the 2362 patients attending the clinic during the study period, 2292 (97%) consented to participate; of these, 2138 (93%) were interviewed and anonymously tested, while 154 (7%) consented to be interviewed but refused HIV antibody testing. The HIV prevalence was 4.2% (90/2138); 93% of seropositive participants reported homosexual contacts and/or intravenous use of drugs (IVDU). HIV prevalence among heterosexual non-IVDU men was 0.5% and among non-IVDU women 0.1%. Among all heterosexually active participants, including IVDU and bisexual men, the HIV prevalence was 1.5%. The 28 of 90 HIV infected participants that were heterosexually active reported together approximately 135 heterosexual partners in the six months preceding the study; 13 of these 28 heterosexually active participants had a STD diagnosed at their present clinic visit, while four (30%) of them already knew they were HIV infected. CONCLUSIONS--From these data we conclude that there is a substantial risk of further transmission of HIV through heterosexual contact. In order to try to reduce this potential for further sexual transmission of HIV, services offered by the STD clinic should not only include voluntary confidential counselling and HIV testing, but also notification of partners of HIV infected clinic-attendants. Finally, we conclude that anonymous HIV prevalence studies that link HIV test results to risk behaviour for HIV infection can be performed with a high rate of participation. Repeating such prevalence studies in time can help in monitoring the HIV incidence in the heterosexually active population.     

上海市金山区卖淫嫖娼人员892人性病状况分析

目的了解上海市金山区2005～2007年公安强制送检的892名卖淫嫖娼人员的性病状况及其特点,为制订防病政策提供依据。方法对892名金山区各派出所强制送检的卖淫嫖娼人员的一般资料进行分析,对采集的标本进行淋病奈瑟菌(NG)的分离培养、解脲脲原体(UU)培养、沙眼衣原体(CT)检测、梅毒甲苯胺红不加热血清试验(TRUST)、梅毒螺旋体抗体凝集试验(TPPA)及人类免疫缺陷病毒(HIV)1+2型抗体(ELISA)的检测。结果892名卖淫嫖娼人员中以外省人员居多(880人),文化程度初中及以下最多(771人);该3年平均阳性检出率:448名卖淫人员中NG感染为10.49%,UU感染为74.33%,CT为感染7.14%,梅毒12.28%,HIV为0;444名嫖娼人员依次分别为2.25%,45.27%,1.35%,2.93%,0人;同时患两种性病的卖淫人员17.41%,多于嫖娼人员的2.93%,同时患3种性病的卖淫人员4.02%,多于嫖娼人员的0.68%,同时患4种性病的0.22%,多于嫖娼人员的0人。结论卖淫嫖娼人员性病感染率较高,尤其UU感染和梅毒,是艾滋病性病的重要传染源。加强对卖淫嫖娼人员的主动监测和规范治疗,提倡安全性行为,是预防与控制艾滋病性病的有效措施。     

Mucocutaneous Manifestations of Secondary Syphilis in North Indian Patients: A Changing Scenario?

During the 1990s, no studies of various clinical presentations of syphilis have been published in the indexed literature. However, a change in the clinical profile of secondary syphilis was expected during the last decade with the rapid spread of the HIV epidemic. The objective was to study the mucocutaneous manifestations of secondary syphilis in patients attending the STD clinic at the Postgraduate Institute of Medical Education & Research Chandigarh, India, during the last decade and to compare them with other similar studies published during the 1980s. All patients who were diagnosed with secondary syphilis in our STD clinic from 1990 to 1999 were examined and investigated. Serological response was measured at 3, 6, 9, 12, and 24 months post-treatment or until serological negativity was reached. Fifty-three patients (males = 34, female = 19) during this period were found to have secondary syphilis. The most common symptoms were as follows-skin rash 38 (71.7%), lymphadenopathy 26 (49%), persistent chancre 4 (7.5%), nodular syphilides 2 (3.8%), lues maligna 2 (3.8%), patches in the oral mucosa 6 (11.3%), condylomata lata 14 (26.4%), split papules 2 (3.8%). Five patients had a thin and conspicuous genital scar of the healed primary chancre. Three patients were HIV seropositive (1 patient each with lues maligna, lichenoid, and nodular syphilides). With the spread of the HIV epidemic, atypical muco-cutaneous manifestations of secondary syphilis may be seen more frequently than before and may pose problems in diagnosis. In the present study, six patients had atypical manifestations, and three of them were HIV seropositive.     

Seroepidemiologic study of hepatitis C virus in sexually transmitted disease risk groups.

To identify the importance of heterosexual activity as a possible route for the transmission of the hepatitis C virus (HCV), a screening of antibodies against HCV (anti-HCV) was performed in 200 sexually transmitted disease patients with different risks for incurring genital infections as well as in 100 registered prostitutes. Out of all 300 persons tested, 14 cases of HCV infection were detected. Anti-HCV was present in 3 of the prostitutes and in 11 of the STD patients. Evaluating known risk factors, such as intravenous drug use or blood transfusion, 6 out of the 11 STD patients and all of the prostitutes in whom anti-HCV was present were intravenous drug users and exhibited highly promiscuous behavior. Intravenous drug use was the probable means of acquisition in 9 of the 14 subjects in whom anti-HCV was present, and homosexual promiscuous behavior was assumed to be the means of acquisition in another 2 subjects. In heterosexual patients engaging in high-risk behavior (high number of sexual partners and genital infections), the exclusion of intravenous drug use decreased the prevalence of anti-HCV from 12.1% to 4.1%, demonstrating no significant increase from the prevalence among low-risk persons. Most of the patients were screened for STDs, such as syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis, human immunodeficiency virus (HIV), hepatitis B virus (HBV), trichomoniasis, and yeast infections. The highest rate of coinfection with anti-HCV was found in patients with serologic evidence of an HIV infection (50%).(ABSTRACT TRUNCATED AT 250 WORDS)     

HIV prevalence and risk behaviour among prostitutes and clients in Amsterdam: migrants at increased risk for HIV infection.

OBJECTIVES--To study groups of prostitutes and clients of prostitutes in order (i) to determine HIV prevalence and sexual risk behaviour, (ii) to determine differences between samples recruited within and outside a clinic for sexually transmitted diseases (STD) and (iii) to determine correlates of inconsistent condom use (ICU) among both groups. DESIGN--Participants were interviewed and anonymously tested for HIV-antibody; approximately half were recruited at a clinic for sexually transmitted diseases (STD) and half at prostitute working places. SETTING--An STD clinic and prostitute working places in Amsterdam in 1991. SUBJECTS--201 female prostitutes without a history of injecting drugs and 213 male clients of female prostitutes. MAIN OUTCOME MEASURES--antibodies to HIV, consistency of condom use in commercial vaginal contacts in the preceding 6 months. RESULTS--HIV prevalence was low: three prostitutes (1.5%; 95% CI 0.5-4.6%) and one client (0.5%; 95% CI 0.1-3.3%) were infected. All three HIV positive prostitutes originated from AIDS-endemic countries, came to the Netherlands only recently and were recruited outside the STD clinic. Large differences between subgroups resulted from the two recruitment methods: while clients of prostitutes with relatively high risk behaviour were strongly represented among the STD clinic sample, high risk prostitutes were underrepresented in this sample. Consistent condom use (with 100% of contacts) was reported by 66% of prostitutes and 56% of clients of prostitutes. Inconsistent condom use was found to be high among prostitutes who had migrated from Latin America and among migrant clients of prostitutes. CONCLUSIONS--When monitoring HIV infection one must take into account imported cases. HIV prevention efforts should be particularly focused at prostitutes from Latin America and at clients of prostitutes who migrated to the Netherlands.     

2008-2011年上海市金山区卖淫人员性传播疾病疫情分析

目的 了解2008-2011年上海市金山区卖淫人员性传播疾病(STD)流行情况。方法 对2008-2011年金山区各派出所强制送检的431例专职卖淫人员进行淋病和生殖道沙眼衣原体感染、梅毒、尖锐湿疣、生殖器疱疹和艾滋病的检测和流行病学调查。结果 卖淫人员均为外省市人,文化程度低,≤初中占92.80%。共检出STD患者127例,患病率为29.47%。其中梅毒居首位,感染率为21.81%,且以TRUST阴性和TPPA阳性率居多。淋病感染率为4.87%,生殖道沙眼衣原体感染率为4.65%,尖锐湿疣感染率为0.70%,HIV感染率为0.23%。未检测到生殖器疱疹患者。结论 卖淫人员STD感染率高,尤其是梅毒。HIV感染在本地区卖淫人员中开始崭露头角,应加强对其主动监测和规范治疗。     

Early syphilis with seventh nerve palsy: a case report

This report examines the case of a 45 year-old married man suffering from primary syphilis with seventh nerve palsy and generalized lymphadenopathy -- a rare clinical expression in the present antibiotic era. On March 3, 1988, the individual sought assistance a month after first noticing an ulcer genitalia. He also complained of headaches, watering, and the inability to close his right eye. Though previously free of any STD, the man was promiscuous, having exposures to prostitutes off and on. Upon a genital examination, physicians discovered over the coronal sulcus a large, solitary, nontender, nonbleeding, indurated, pinkish ulcer oozing serum. Besides excessive lacrimation and the inability to close the right eye, the examiners noticed a deviation of the angle of the mouth towards the left side and Bell's sign. A series of tests indicated that the man was suffering from syphilis. Following the diagnosis, he received injections of procaine penicillin for a period of 21 days. Although she did not show any clinical or serological evidence of syphilis, the individual's wife also received treatment for syphilis. 45 days after the beginning of specific therapy, the man's ulcer had healed completely. The facial palsy had recovered completely after 2 weeks.     

2007～2009年性病门诊HIV感染者情况分析

目的:了解性病门诊HIV感染人群的分布情况。方法:采用ELISA(酶联免疫)法,对2007年1月～2009年12月性病门诊做HIV检测的6895例患者进行了检测,并对经确诊试验阳性的47例患者情况进行了分析。结果:6895例做HIV检测的患者中47例HIV阳性(0.70%)。47例HIV阳性患者中男性同性恋41例(87.23%)、双性恋14例(29.79%)、多性伴22例(46.81%)、异性恋6例(12.77%),37例梅毒血清阳性(78.72%)。结论:男性同性恋存在传播HIV的高危行为,是HIV传播的桥梁人群。对这一人群的STD/AIDS监测、检测及干预工作已刻不容缓。同时,有效控制性病特别是梅毒的发病率,对于控制艾滋病的流行有着重要意义。     

Prevalence of human immunodeficiency virus in the patient population of a sexually transmitted disease clinic. Association with syphilis and gonorrhea.

An unlinked seroprevalence survey of human immunodeficiency virus (HIV) antibody was conducted using stored sera from all patients who attended the sexually transmitted disease (STD) clinic in Halifax, Nova Scotia between 1980 and 1986. None of the sera collected from 584 patients during 1980 were HIV positive. Of the 2867 patients who visited the clinic between 1981 and 1986, 27 (0.9%; 95% CI 0.6% to 1.2%) had the antibody. None of the 784 female patients were HIV seropositive. Of the 1,884 heterosexual men in the study, 5 (0.3%; 95% CI 0.1% to 0.5%) were HIV seropositive, and 22 (11.1%; 95% CI 6.7% to 15.5%) of the 199 homosexual men were HIV seropositive. There was a strong association between a history of syphilis and HIV antibody among heterosexual men (OR = 76.8; 95% CI 12.0 to 491.3; P = 0.001). Among homosexual men younger than 30 years of age, HIV infection was associated with a history of syphilis (OR = 18.2; 95% CI 5.1 to 64.7; P = 0.035) and a history of gonorrhea (OR = 8.2; 95% CI 4.2 to 16.0; P = 0.001). The association between a history of gonorrhea and HIV infection was strongest among homosexual men who had three or more sexual partners in the last month. These findings supplement existing evidence that STDs increase the likelihood of HIV transmission.     

暗娼1144人HBV、HIV及梅毒感染检测结果分析

目的了解暗娼人群乙肝病毒(HBV)、人类免疫缺陷病毒(HIV)及梅毒感染的情况,为制订预防措施提供依据。方法对海南省某妇教所收容的1144名暗娼分别抽取静脉血,用酶联免疫吸附实验(ELISA)进行乙肝两对半、HIV1+2抗体检测和梅毒甲苯胺红不加热血清试验(TRUST)初筛,梅毒阳性者用梅毒螺旋体明胶颗粒凝集确证试验(TP-PA)进一步确证。结果暗娼人群HBV及梅毒感染率分别为15.73%和29.26%,未发现HIV感染者。结论海南省暗娼人群HBV感染率和梅毒感染率较高,增加了HIV的感染的可能性。提示暗娼是感染性病和艾滋病的高危人群,也是向一般人群传播这些疾病的"桥梁人群",加强对暗娼人群的行为干预和监测至关重要。     

性病门诊患者梅毒与艾滋病预防知识知晓情况调查分析

目的:了解性病患者对梅毒、艾滋病预防知识的知晓情况,为进一步开展针对性的宣传干预工作提供线索和数据。方法:采用统一的梅毒、艾滋病预防知识调查问卷对我院2014年10月~2015年7月间的202例性病门诊患者进行问卷调查,了解患者对梅毒、艾滋病知识的知晓情况,分析影响知晓率的因素。结果:参与调查人员年龄以20~30岁为主,占56.93%;职业以外来务工人员、个体工商户、文员、学生为主,分别占19.80%、19.80%、13.86%和7.92%;同性恋者占19.31%。艾滋病预防知识知晓率(81.19%)高于梅毒知晓率(67.33%)(χ~2=10.15,P0.05);本科及以上学历者梅毒、艾滋病知晓率均高于高中及以下者(P值均0.05);同性恋者知晓率高于异性恋者;艾滋病预防知识的获得途径以电视为主,占57.43%。结论:性病门诊患者艾滋病知晓率明显高于梅毒知晓率,梅毒、艾滋病知识各题知晓率间也有差异,文化程度和性取向是影响梅毒、艾滋病知晓率的主要因素。因此在宣传艾滋病知识的同时更要加大对梅毒等其他性病的宣传教育。需要制定针对性的预防梅毒和人类免疫缺陷病毒(HIV)感染的性健康教育促进方案,以提高大众人群尤其是高危人群的性病预防意识,避免或减少性病的发生。     

A survey of sexually transmitted diseases/HIV coinfection testing and reporting practices among health care providers in New Jersey

OBJECTIVES: A survey was conducted to ascertain the adherence of health care providers (HCPs) to national guidelines recommending human immunodeficiency virus (HIV) testing among persons with sexually transmitted diseases (STDs) and STD testing among HIV-infected persons. STUDY: A random sample of HCPs reporting STD and HIV cases in New Jersey were surveyed regarding their STD/HIV testing and reporting practices. RESULTS: Questionnaires were returned by 90 of 162 (55.5%) STD and 73 of 135 (54.1%) HIV HCPs. Sixty-six percent of STD HCPs reported offering HIV testing to persons with gonorrhea, chlamydia, or syphilis. However, up to 42.1% of HIV HCPs who managed HIV-positive patients never or almost never performed initial STD screening in these patients. Among HIV-infected patients, 36.4% of HIV HCPs reported that they never or almost never conducted annual gonorrhea or chlamydia screening in women; 48.6% never conducted screening in men. CONCLUSIONS: Further efforts are needed to optimize the implementation of national guidelines for STD/HIV coinfection testing.     

Human immunodeficiency virus (HIV) infection, sexually transmitted diseases and HIV-antibody testing practices in Belgian prostitutes.

From December 1988 to April 1989, 154 female prostitutes in and around Ghent, Belgium, were interviewed about their knowledge, attitudes and practices in relation to the risks for sexually transmitted diseases (STD) and human immunodeficiency virus (HIV) infection in their profession. Thirty four women worked as window prostitutes, 120 picked up their clients in bars, clubs, and saunas. Blood samples were taken from 123 women. One (0.8%) was seropositive for HIV1, 19 (15.4%) had Hepatitis B core antibodies (anti-HBc), eight (6.4%) showed markers of syphilis. None of them were Hepatitis B surface antigen (HBsAg) carriers. Hepatitis C antibodies (anti-HCV) were present in the serum of three women (2.4%). Overall STD seroprevalence was higher in the group of window prostitutes than in the group of club prostitutes. One woman admitted intravenous drug use. Former testing for anti-HIV antibodies had been performed in 102 (66.5%) respondents, of whom 84 (82.3%) were tested in the year preceding the interview. In 74.5% of the cases, these tests were requested by the women themselves. These results suggest that HIV infection is not yet prevalent in non-intravenous drug using prostitutes in Ghent, but that this situation may change considering their higher rates of past STD. Window prostitutes are at higher risk than club prostitutes. Testing for HIV seems to be common practice, mostly at the request of the women themselves. Health education should discourage the notion of testing as an alternative to using condoms.     

Seroprevalence of HIV-1 infection in a cohort of homosexually active men.

A non-clinic cohort of 525 homosexually active men from London and South Wales were recruited in 1988 for a study by interview of sexual behaviour. A sample of blood was tested for HIV-1 antibodies. Seropositivity in London was 9.2% compared with 3.4% in South Wales. Men who were not regular STD clinic attenders had a lower rate of seropositivity than did those who were regular attenders. Men who were seropositive reported more sexual partners with whom they had anal intercourse and also reported more episodes of syphilis. Overall, rates of seropositivity were lower than those reported by studies from STD clinics.     

性病门诊男性就诊者性病感染现状及艾滋病知晓率影响因素分析

目的:了解性病门诊男性就诊者性病感染的现状,分析影响其艾滋病知识的因素,为下一步开展针对性的干预提供科学依据。方法:采用方便抽样的方式,利用问卷调查来进行数据收集,问卷内容包括病人的一般人口学特征、艾滋病知识、性病感染状态等。结果:研究共纳入456名就诊者,平均年龄为(34.06±11.40)岁;HIV感染率为3.29%,尖锐湿疣感染率为16.23%,生殖器疱疹为6.80%,生殖道沙眼衣原体为5.48%,淋病为4.17%,梅毒为3.95%;26.75%的就诊者仅感染1种性病,2.41%的就诊者同时感染2种,0.44%就诊者同时感染4种,0.66%同时感染5种,无就诊者同时感染3种性病。艾滋病知识知晓率仅为37.94%,教育程度低、年龄较大、已婚、月收入低和未接受过健康教育的就诊者艾滋病知识知晓率低。结论:应加强性病门诊男性就诊者各种性病的筛查,为其提供一整套规范化的诊疗服务,同时加强重点人群健康宣教,做好重点人群性病艾滋病的一级预防。     

Sexually transmitted diseases, antibodies to human immunodeficiency virus, and subsequent development of acquired immunodeficiency syndrome. Visitors of homosexual sauna clubs in Copenhagen: 1982-1983

Sera from 260 men from Denmark and elsewhere attending two Copenhagen sauna clubs for homosexual men during nine months of 1982-1983 were investigated for markers for syphilis, hepatitis A and B, and human immunodeficiency virus (HIV). Five per cent (12 men) had active syphilis, and another 35% (92) had a history of and/or serologic markers for syphilis. Ninety-four men (36%) were positive for antibodies to hepatitis A virus, ten (4%) were positive for hepatitis B surface antigen (HBsAg), and 153 (59%) were positive for antibodies to HBsAg. Antibodies to HIV were found in 45 (20%) of the 220 men investigated for this marker. Markers for hepatitis A and B and for syphilis were more frequent in the HIV antibody-positive individuals, but the association was significant only for markers for hepatitis B (relative risk = 2.0). Thus STD markers had little predictive value for seropositivity for antibodies to HIV. Among 37 men investigated more than once, a seroconversion rate of 3% per month for antibodies to HIV was found, but this estimate must be taken with reservation. The rate of seropositivity for antibodies to HIV among men from Denmark was 23%, and three (8%) of the 40 HIV-positive Danish men developed the acquired immunodeficiency syndrome (AIDS) during the four years following the initial investigation. This study shows that by 1982-1983 HIV had spread considerably in the Danish high-risk group, although there were only seven reported cases of AIDS in the country at that time.     

HIV infection and genital ulcer disease

Between December 1990 and July 1991, 17 male HIV patients between the ages of 21 and 47 years in an Indian hospital were identified and information was obtained on their history, age, source of infection, hospitalization, places and sources of sexual contact, and extramarital sexual contacts. Each patient with a sexually transmitted disease (STD) underwent HIV testing too using ELISA whose results were subsequently confirmed by Western Blot. 15 of the 17 patients also had an associated genital ulcer disease (GUD), which was a significant relationship. 12 had asymptomatic generalized lymphadenopathy and 5 were afflicted with persistent generalized lymphadenopathy. Of the 17 patients, 9 had chancroid, 2 had an early phase of syphilis, 3 had lymphogranuloma venereum, 1 each had candidal balanitis, condylomata acuminata, and acute gonorrhea. Eight patients contracted the HIV infection in Bombay. 14 patients had contracted the disease from prostitutes. Homosexual contacts were denied by all. 13 patients admitted a single instance of extramarital sexual contact. In a study of 123 HIV seronegative prostitutes monitored regularly, HIV seroconversion was significantly associated with GUD. There is convincing evidence that GUD increases the risk of acquiring HIV infection because the breach of mucosal integrity of the genitalia provides a more efficient route for viral entry. Other risk factors documented for sexual transmission of HIV in addition to STDs are: lack of male circumcision, receptive anorectal sexual intercourse, lack of condom use, and advanced HIV-related immunosuppression in the index case. Since GUD predisposes to HIV infection, it is imperative to treat genital ulcer and to increase sex education regarding HIV.