Transmission of HIV: genital ulceration, sexual behaviour, and circumcision.
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Biomedical subjects
Publications and source records attributed to N O'Farrell.
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A woman with extensive mutilating lesions of genital granuloma inguinale following rape is described. As far as is known granuloma inguinale has not previously been reported in a rape victim.
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One hundred and ninety three consecutive pregnant women attending peripheral antenatal clinics attached to Ngwelezana Hospital, Empangeni, Kwa-Zulu, were examined for evidence of sexually transmitted pathogens. The following incidences were found: Trichomonas vaginalis 49.2% (95), Candida spp 38.3% (74), Chlamydia trachomatis 11.4% (22), Gardnerella vaginalis 6.2% (12), Neisseria gonorrhoeae 5.7% (11), positive syphilis serology results 11.9% (23), hepatitis B surface antigen 4.1% (eight). No woman had antibody to human immunodeficiency virus (HIV). Dyskaryotic smears were found in 20 (10.4%). Human papillomavirus (HPV) was detected cytologically in 11 (5.7%). The range of sexually transmitted pathogens found in this rural community was similar to that found in urban groups studied in South Africa.
The prevalence of antibodies to the human immunodeficiency virus among recurrent attenders at a sexually transmitted disease clinic for blacks was investigated. Of 140 tested 4 subjects were seropositive and had no other known risk factors.
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A 28 year old man developed signs and symptoms of left ventricular failure and was found to have gross aortic regurgitation. He underwent an aortic valve replacement, and histology showed changes characteristic of syphilis. Both the age of this patient and the mode of presentation were atypical of cardiovascular syphilis.
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The cumulative incidence of sexually transmitted diseases (STD) in a cohort of 51 (35 female, 16 male) HIV-1 seropositive STD clinic attenders who had acquired HIV-1 infection via heterosexual transmission was investigated through a retrospective review of the case notes. The women were followed up for a mean 11.6 months and the men for 18 months. Thirty-one (88%) of the women and 13 (81%) of the men were of sub-Saharan African origin. Approximately half of the subjects were first diagnosed as HIV-1 positive with CD4 counts < 200 x 10(6)/1 and a quarter with CD4 counts < 50 x 10(6)/1. STDs detected in women were: genital herpes 15 (43%), candida 12 (34%), bacterial vaginosis 9 (25%), and in men: genital herpes 6 (38%), non-gonococcal urethritis 4 (25%). No cases of gonorrhoea were detected. At the time of first diagnosis of genital herpes at the clinic, the mean CD4 count in women was 275 x 10(6)/1 and in men 285 x 10(6)/1. Genital herpes was the AIDS defining diagnosis in 3 of the women. The recognized risk of HIV transmission via genital lesions should be stressed in HIV-1 positive subjects with genital herpes. The incidence of other STD was low--both knowledge of HIV status and safer sex counselling may limit unsafe sexual behaviour and should be evaluated further as a strategy for limiting the spread of HIV-1 infection.