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The evolution of male genitalia: patterns of genetic variation and covariation in the genital sclerites of the dung beetle Onthophagus taurus.

Three main hypotheses, have been invoked to explain divergent genital evolution, the lock and key, pleiotropy, and sexual selection hypotheses, each of which make different predictions about how genital traits are inherited. Here we used a half-sib breeding design to examine the patterns of genetic variation and covariation between male genital sclerites, and their covariance with general body morphology in the dung beetle Onthophagus taurus. We found CV(A)'s and CV(P)'s were similar for both genital and general morphological traits and that CV(R)'s were large for both trait types. We found that male genital sclerites were negatively genetically correlated with general morphological traits. Variation in male genital morphology has direct implications for a male's fertilization success and the resulting sexual selection acting on male genitalia is predicted to maintain high levels of additive genetic variance. Contrary to this prediction, we found that individual genital sclerites all had low levels of additive genetic variance and large maternal and environmental sources of variation. Our data suggest that the genital sclerites in O. taurus are not inherited independently but as a genetically integrated unit. More importantly, the way the different sclerites function to influence male fertilization success reflects this genetic integration. Even though levels of V(A) in individual genital sclerites may be low, there may still be sufficient V(A) in multivariate trait space for selection to generate evolutionary change in the overall morphology of male genitalia.

Animals↗

Antibodies and antibody-secreting cells in the female genital tract after vaginal or intranasal immunization with cholera toxin B subunit or conjugates.

We studied the antibody response including antibody-secreting cells (ASC) in the female genital tract of mice after mucosal immunizations with the recombinant B subunit of cholera toxin (rCTB) perorally, intraperitoneally, vaginally, and intranasally (i.n.). The strongest genital antibody responses as measured with a novel perfusion-extraction method were induced after vaginal and i.n. immunizations, and these routes also gave rise to specific immunoglobulin A (IgA) and IgG ASC in the genital mucosa. Specific ASC in the iliac lymph nodes, which drain the female genital tract, were seen only after vaginal immunization. Progesterone treatment increased the ASC response in the genital tissue after all mucosal immunizations but most markedly after vaginal immunization. We also tested rCTB as a carrier for human gamma globulin (HGG) and the effect of adding cholera toxin (CT) as an adjuvant for the induction of systemic and genital antibody responses to HGG after vaginal and i.n. immunizations. Vaginal immunizations with HGG conjugated to rCTB resulted in high levels of genital anti-HGG antibodies whether or not CT was added, while after i.n. immunization the strongest antibody response was seen with the conjugate together with CT. In summary, vaginal and i.n. immunization give rise to a specific mucosal immune response including ASC in the genital tissue, and vaginal immunization also elicits ASC in the iliac lymph nodes. We have also shown that rCTB can act as an efficient carrier for a conjugated antigen for induction of a specific antibody response in the genital tract of mice after vaginal or i.n. immunization.

Administration, Intranasal↗

Nucleotide sequences of genes coding for fimbrial proteins in a cryptic genospecies of Haemophilus spp. isolated from neonatal and genital tract infections.

Nineteen isolates belonging to a cryptic genospecies of Haemophilus (referred to here as genital strains) isolated from genital tract infections (6 strains) and from neonatal infections (13 strains) were studied for fimbrial genes. Sixteen strains exhibit peritrichous fimbriae observed by electron microscopy. By PCR with primers corresponding to the extreme ends of the Haemophilus influenzae type b (Hib) hifA and hifD genes and Southern blotting, a hifA-like gene (named ghfA) and a hifD-like gene (named ghfD) were identified in 6 of the 19 strains. Five of these six strains were from the genital tracts of adults, and one was from a neonate. For each gene, the nucleotide sequence was identical for the six strains. A hifE-like gene (named ghfE) was amplified from only one of the 19 genital strains of Haemophilus, but the ghfE probe gave a signal in Southern hybridization with the five other strains positive for ghfA and ghfD. Therefore, these strains may carry a ghfE-like gene. The Hib fimbrial gene cluster is located between the purE and pepN genes as previously described. For the 13 genital Haemophilus strains that lack fimbrial genes, this region corresponds to a noncoding sequence. Another major fimbrial gene designated the fimbrin gene was previously identified in a nontypeable H. influenzae strain. A fimbrin-like gene was identified for all of our 19 genital strains. This gene is similar to the ompP5 gene of many Haemophilus strains. Therefore, other, unidentified genes may explain the piliation observed in electron microscopy on genital Haemophilus strains which do not possess LKP-like fimbrial genes. Fimbrial genes were significantly associated with strains isolated from the genital tract. They may confer on the strain the ability to survive in the genital tract.

Adhesins, Bacterial↗

Genital injury: is it significant? A review of the literature.

The purpose of this review was to critically evaluate the available literature on genital injury in order to facilitate an understanding of its significance in relation to sexual offence trials. Wide variation exists in research objectives, study populations and methodology, hindering interpretation considerably. The most valuable research in this field identifies the range of normal genital findings and those associated with consensual sexual intercourse, to enable interpretation of genital findings in sexual assault victims. However, there are, unfortunately, few studies of this nature. Difficulties arise when examining doctors are not experienced in the genital examination of those other than sexual assault victims, limiting their ability to draw conclusions about genital injury if it is detected. If the methods of genital examination employed are not the same as those used to examine a wide range of non-sexual assault victims, comparison and thus valuable interpretation is further limited. This review of the literature finds that the most appropriate genital examinations and indeed the most legally valuable as far as interpretation is concerned, are done macroscopically by doctors with considerable experience in the examination of normal, diseased and traumatized genitalia, and a sound knowledge of the principles of injury interpretation. A deficiency exists in the literature in relation to macroscopic genital examination findings in consensually sexually active women who have been examined by forensically trained doctors. This deficiency must be addressed before the medicolegal significance of genital injury relating to sexual assault can be accurately interpreted, and before any decision is made to incorporate colposcopy or staining techniques into the routine assessment of sexual assault victims.

Female↗

Precepting genital exams: challenges in implementing a complex educational intervention in the continuity clinic.

BACKGROUND: The female genital exam is often omitted from the routine physical. This limits familiarity with normal findings and represents a missed opportunity to evaluate girls for urogenital abnormalities. Continuity clinic offers an opportunity to develop and test a teaching intervention to address this problem. OBJECTIVE: To describe the effect of precepted genital exams on resident confidence and comfort with the exam as well as knowledge and documentation of genital anatomy. METHODS: A controlled trial was conducted in 10 continuity clinics at Children's Hospital, Columbus, Ohio. Residents in 5 clinics reviewed genital anatomy, exam positions, and documentation examples. They were asked to complete 6 precepted exams of girls aged 1-6 years during well-child care over a 6-month period. Residents were given pre- and posttests assessing knowledge of, confidence, and comfort with the genital exam. Pre- and poststudy genital exam documentation was reviewed. RESULTS: Ninety-seven percent of the intervention group, compared to 73% of the control group, answered 4 or 5 on a 5-point scale of confidence with regard to recognizing a normal exam (5 = highest) following the intervention (P = .01). Ninety-four percent of the intervention group and 64% of the control group answered 4 or 5 with regard to how comfortable they were performing genital exams (P = .01). Knowledge scores and documentation of genital anatomy did not differ between groups. Thirty-two percent of residents had the full intervention. CONCLUSIONS: Resident confidence and comfort increase with precepting. Precepting did not improve knowledge or documentation of genital anatomy. We advocate use of this preliminary data to design and test future educational interventions.

Chi-Square Distribution↗

Prevalence and risk factors for vaginal candidiasis among women seeking primary care for genital infections in Dar es Salaam, Tanzania.

OBJECTIVE: To determine the prevalence and risk factors for vaginal candidiasis (VC) among women seeking primary care for genital infections. DESIGN: Cross-sectional study. SETTING: Ilala Municipal Hospital in Dar es Salaam, Tanzania. SUBJECTS: Four hundred and sixty four women presenting with complaints of genital infections. RESULTS: Of the 464 women examined, 177 (38.1%) had abnormal vaginal discharge, 68(14.7%) had genital ulcers, 272 (58.6%) had genital pruritus, 18 (3.9%) had genital warts and 58 (12.5%) had chancre. The prevalencies of VC, bacterial vaginosis, HIV, T vaginalis, N. gonorrhoeae and syphilis were 45%, 48.4%, 22%, 93%, 1.5% and 4.3%, respectively. The occurrence of VC was positively associated with HIV, (OR = 1.81, 95% CI (1.0-2.67), bacterial vaginosis; (OR = 2.6, 95% CI (1.7-3.9), genital pruritus; (OR = 1.8 1, 95% CI (1.2-2.7) genital discharge; (OR = 1.867, 95% (1.28-2.73) and negatively with T. vaginalis (OR = 0.27, 95% CI (0.12 - 0.6), occupation (OR = 0.65, 95% CI (0.35-0.86)) and with education (OR = 0.43, 95% CI (0.11-0.73). There were increased but non-significant odds for VC in patients with syphilis (OR = 1.6 95% CI (0.6-4.3) and venereal warts (OR = 2.5 95% CI (0.92-6.8) VC was not associated with N. gonorrhoeae, genital ulcers, age at first intercourse, number of sexual partners, marital status or antibiotic usage. CONCLUSION: The high prevalence of vaginal candidiasis among women with genital infections should be taken into account when updating policies concerning syndromic management of sexually transmitted diseases. More gender specific approach to syndromic management of sexually transmitted infections in females should be considered.

Adult↗

Epidemiology of genital herpes - recent advances.

Genital herpes is a common, distressing infection which, due to increasing incidence world-wide, has become a prominent public health issue over recent years, even throughout the decade of human immunodeficiency virus (HIV). Since the late 1970's, the prevalence of herpes simplex virus type 2 (HSV-2) infection has increased by approximately 30 percent in the US. The number of sufferers world-wide is currently estimated at approximately 86 million people. New serological methods based on the detection of type-specific antibodies to herpes simplex virus (HSV) glycoproteins have clarified issues concerning the true incidence of genital herpes, the modifying effect of prior HSV-1 infections, the changing proportions of HSV-1 genital herpes, and the importance of asymptomatic shedding. Patients' ignorance of their diagnosis along with the occurrence of atypical symptomatology and asymptomatic viral shedding of HSV all contribute to the transmission of genital herpes. Genital ulcer disease, of which genital herpes is the most common cause in developed countries, is an important risk factor in the acquisition and transmission of human immunodeficiency virus (HIV) infection and has contributed to the spread of this disorder. Risk factors for genital herpes HSV-2 are strongly related to lifetime number of sexual partners, number of years of sexual activity, male homosexuality, black race, female gender and a history of previous sexually transmitted diseases (STD). Understanding the epidemiology of genital herpes is of great importance in limiting the spread of this STD. In this review, we summarise current knowledge related to the epidemiology of genital herpes.

Age Factors↗

Perception of genital prolapse: a hospital-based study in Alexandria (Part II).

Genital prolapse is a common health problem, understanding women's perceptions and beliefs may illuminate our understanding of their health seeking behavior which form a first step in any effort to improve their health. The present study was designed to investigate the perception of genital prolapse among women attending the outpatient clinic in El-Shatby Maternity University Hospital in Alexandria. Data was collected from a sample of 291 women who had any form of genital prolapse. Women's knowledge about risk factors for genital prolapse, women's beliefs related to genital prolapse as well as their beliefs about assistance at delivery (beliefs were assessed through the Health Belief Model) were measured for women who knew that they were suffering of genital prolapse (n = 40). The results revealed that more than two thirds of cases (70.4%) had poor (36.4%) or fair knowledge (34%) and only 29.6% had satisfactory knowledge. The majority of women having positive perception to diagnosis and symptoms for genital prolapse had high perception of "susceptibility" to and "severity" of complications of genital prolapse (97.5% and 85% respectively). More than two thirds (67.5%) had high scores of "perceived benefits" of treatment and medical advice, while nearly one third (32.5%) scored moderate. The majority of women (82.5%) had either moderate scores (55%) or high scores (27.5%) of perceived barriers to compliance to medical instructions or recommended surgery. About two thirds of cases (65.6%) sought medical care later than one year of perception of symptoms. Women's knowledge and degree of genital prolapse were directly related to women's report of symptoms characteristic of prolapse, while the level of education was inversely related. Health education for women on different aspects of reproduction using appropriate materials is highly recommended.

Egypt↗

The intercellular adhesion molecule type-1 is required for rapid activation of T helper type 1 lymphocytes that control early acute phase of genital chlamydial infection in mice.

Recent studies in animal models of genital chlamydial disease revealed that early recruitment of dendritic cells and specific T helper type-1 (Th1) cells into the genital mucosae is crucial for reducing the severity of the acute phase of a cervico-vaginal infection and arresting ascending disease. These immune effectors are therefore important for preventing major complications of genital chlamydial infection. Other in vitro studies showed that intercellular adhesion molecule-1 (ICAM-1) plays a role in the antichlamydial action of specific CD4+ and CD8+ T cells. In the present study, we investigated the clinicopathological consequences of ICAM-1 deficiency during chlamydial genital infection in ICAM-1 knockout (ICAM-1KO) mice, and analysed the cellular and molecular immunological bases for any observed pathology or complication. Following a primary genital infection of female ICAM-l-/- and ICAM-1+/+ mice, the intensity of the disease during the first 3 weeks (as assessed by shedding of chlamydiae in the genital tract) was significantly greater in ICAM-1KO mice than in ICAM-1+/+ mice (P < 0.0001), although both ICAM-l-/- and ICAM-1+/+ mice subsequently cleared the primary infection. There was greater ascending disease during the initial stage of the infection, and a higher incidence of tubal disease (hydrosalpinx formation) after multiple infections in ICAM-l-/- mice. Analysis of the cellular and molecular bases for the increased acute and ascending disease in ICAM-l-/- mice revealed that the high affinity of ICAM-1 for leucocyte function antigen type-1 is a property that promotes rapid activation of specific Th1 cells, as well as their early recruitment into the genital mucosa. Moreover, ICAM-1 was more important for naive T-cell activation than primed Th1 cells, although its absence delayed or suppressed immune T-cell activation by at least 50%. Taken together, these results indicated that ICAM-1 is crucial for rapid T-cell activation, early recruitment and control of genitally acquired Chlamydia trachomatis.

Acute Disease↗

Immunological memory in B-cell-deficient mice conveys long-lasting protection against genital tract infection with Chlamydia trachomatis by rapid recruitment of T cells.

The role of antibodies and antigen deposition for the development of immunological memory has been incompletely investigated. We addressed whether long-term protection and T-cell memory can be stimulated against a genital tract infection with human Chlamydia trachomatis serovar D in B-cell-deficient (muMT) mice. At 6 months following a primary infection with C. trachomatis, both muMT and wild-type (WT) mice exhibited strong and comparable protection against reinfection. Evidence of long-lasting CD4+ T-cell memory was found in both muMT and WT mice, typified by comparable delayed-type hypersensitivity (DTH) reactions against chlamydial antigens. No bacterial or chlamydial DNA was found in the genital tract of muMT memory mice, suggesting that immunological memory was maintained in the absence of antigen. Whereas few T cells were present in the genital tract of memory mice, rapid recruitment of CD4+, and some CD8+, T cells into the genital tract tissue was observed after challenge with live bacteria. Accumulation of T cells in the genital tract was preceded by a short transient infection of similar magnitude in both muMT and WT memory mice, arguing against a long-term protective role of local antibodies. The rapid recruitment of CD4+ T cells into the genital tract was associated with a transient detection of interferon-gamma (IFN-gamma) mRNA in the genital tract in chlamydia-immune memory mice, which was not found in naïve, challenged mice. Thus, long-term protection in the genital tract against C. trachomatis infection is conveyed by IFN-gamma-producing CD4+ memory T cells, which appear to be maintained in the absence of antibodies and local antigen deposition.

Animals↗

Prevalence and predictors of chronic lower genital tract discomfort.

OBJECTIVE: We sought to determine the prevalence of chronic lower genital tract discomfort in the general population and to identify demographic and reproductive characteristics associated with this disorder. STUDY DESIGN: We surveyed a random sample of 480 women (age range, 20 to 59 years; 60 women for each 5-year age category) from 1 Boston area suburban community. Participants were asked to complete a 1-page self-administered optically scannable questionnaire that pertained to current and previous genital tract discomfort. RESULTS: After 2 mailings and 1 telephone follow-up, as well as the elimination of 42 ineligible women, 303 (70%) questionnaires were returned. Fifty-six women (18.5%) reported a history of lower genital tract discomfort that persisted for >3 months. Approximately 12% reported a history of chronic knife-like or excessive pain on contact to the genital area, whereas 6.6% experienced persistent lower genital tract itching or burning. Women who reported their age at menarche to be <or=11 years old were more than twice as likely to report a history of chronic lower genital tract discomfort compared with women who began menses at age 12 or later (odds ratio, 2.4; 95% confidence interval, 1.1 to 4.8). Reported pain at the time of first use of tampons was associated with an increased risk of chronic lower genital tract discomfort later in life (odds ratio, 2.4; 95% confidence interval, 1.1 to 4.9). CONCLUSIONS: We have shown that women from the general population are willing to provide sensitive information on lower genital tract discomfort-a first step toward bringing notice to this understudied disorder. In addition, our data support the theory that vulvar trauma in early life may influence or serve as a marker for risk of subsequent chronic vulvar disorders.

Adult↗

Genital porokeratosis: a series of 10 patients and review of the literature.

BACKGROUND: Porokeratosis (PK) is an uncommon disorder of epidermal keratinization with a unique clinical appearance, unknown aetiology, and an unpredictable outcome. Genital PK (defined as localized PK confined to the genital area in this study) is extremely rare and is not well documented. OBJECTIVES: To evaluate the clinical manifestations, histopathology, clinical course and treatment response for genital PK. METHODS: We reviewed the clinicohistological data from 10 patients with genital PK seen at Chang Gung Memorial Hospital from 1990 to 2005. RESULTS: Seven patients had lesions only in the genital area, and three patients had genital and adjacent areas involved. All patients were male and the mean age at initial diagnosis was 46.0 years (range 36-59). All but one patient presented with pruritic lesions. Three patients (30%) had diabetes mellitus. No malignant transformation was observed. Surgical excision was the most effective treatment if it could be performed. CONCLUSIONS: Genital PK appeared more frequently in the Asian population than in reports from western countries. Genital PK presented mostly as pruritic lesions in Taiwan, with a wide age distribution. Long-term follow-up might be needed.

Adult↗

The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria.

OBJECTIVE: To examine the association between female genital cutting and frequency of sexual and gynaecological symptoms among a cohort of cut versus uncut women in Edo State of Nigeria. DESIGN: Cross sectional study. SETTING: Women attending family planning and antenatal clinics at three hospitals in Edo State, South-south Nigeria. POPULATION: 1836 healthy premenopausal women. METHODS: The sample included 1836 women. Information about type of female genital cutting was based on medical exams while a structured questionnaire was used to elicit information on the women's sociodemographic characteristics, their ages of first menstruation (menarche), first intercourse, marriage and pregnancy, sexual history and experiences of symptoms of reproductive tract infections. Associations between female genital cutting and these correlates of sexual and gynaecologic morbidity were analysed using univariate and multivariate logistic regression and Cox models. MAIN OUTCOME MEASURES: Frequency of self-reported orgasm achieved during sexual intercourse and symptoms of reproductive tract infections. RESULTS: Forty-five percent were circumcised and 71% had type 1, while 24% had type 2 female genital cutting. No significant differences between cut and uncut women were observed in the frequency of reports of sexual intercourse in the preceding week or month, the frequency of reports of early arousal during intercourse and the proportions reporting experience of orgasm during intercourse. There was also no difference between cut and uncut women in their reported ages of menarche, first intercourse or first marriage in the multivariate models controlling for the effects of socio-economic factors. In contrast, cut women were 1.25 times more likely to get pregnant at a given age than uncut women. Uncut women were significantly more likely to report that the clitoris is the most sexually sensitive part of their body (OR = 0.35, 95% CI = 0.26-0.47), while cut women were more likely to report that their breasts are their most sexually sensitive body parts (OR = 1.91; 95% CI = 1.51-2.42). Cut women were significantly more likely than uncut women to report having lower abdominal pain (OR = 1.54, 95% CI = 1.11-2.14), yellow bad-smelling vaginal discharge (OR = 2.81, 95% CI = 1.54-5.09), white vaginal discharge (OR = 1.65, 95% CI = 1.09-2.49) and genital ulcers (OR = 4.38, 95% CI 1.13-17.00). CONCLUSION: Female genital cutting in this group of women did not attenuate sexual feelings. However, female genital cutting may predispose women to adverse sexuality outcomes including early pregnancy and reproductive tract infections. Therefore, female genital cutting cannot be justified by arguments that suggest that it reduces sexual activity in women and prevents adverse outcomes of sexuality.

Adolescent↗

Route of infection that induces a high intensity of gamma interferon-secreting T cells in the genital tract produces optimal protection against Chlamydia trachomatis infection in mice.

The induction of local T helper type 1 (Th1)-mediated cellular immunity is crucial for resistance of mice to genital infection by the obligate intracellular bacterium Chlamydia trachomatis. We tested the hypothesis that the route of immunization that elicits relatively high numbers of chlamydia-specific, gamma interferon (IFN-gamma)-secreting T lymphocytes (ISTLs) in the genital tract would induce optimal protective immunity against reinfection. Female BALB/c mice were infected intravaginally (i.v.), intranasally (i.n.), orally (p.o.), or subcutaneously (s.c.) with C. trachomatis. At days 7, 14, 21, and 28 postinfection, T cells isolated from the genital tract tissues were restimulated with chlamydial antigen in vitro, and the amounts of IFN-gamma induced were measured by a sandwiched enzyme-linked immunosorbent assay method. At day 7 postinfection, i.n.- and i.v.-immunized mice had high levels of chlamydia-specific ISTLs in their genital tracts (203.58 +/- 68.1 and 225.5 +/- 12.1 pg/ml, respectively). However, there were no detectable ISTLs in the genital tracts of p.o.- or s.c.-infected mice. When preinfected mice were challenged i.v. 70 days later, animals preexposed by the i.n. route were highly resistant to reinfection, with greatly reduced chlamydial burden, and suffered an attenuated infection that resolved by day 6 postchallenge. Animals preexposed by the i.v. route were modestly protected, whereas p.o. and s.c. groups were indistinguishable in this regard from control mice. The resistance of i.n.-immunized mice (and to some extent the i.v.-exposed mice) to reinfection was associated with early appearance (within 24 h) of high levels of genital ISTLs compared with mice preinfected by other routes. Furthermore, although i.n. and i.v.-immunized mice had comparable levels of chlamydia-specific immunoglobulin A (IgA) antibodies in their vaginal washes, the levels of IgG2a were four- sixfold higher in i.n.-immunized mice than in any of the other groups. The results suggested that immunization routes that foster rapid induction of vigorous genital mucosal cell-mediated immune (CMI) effectors (e.g., IFN-gamma), the CMI-associated humoral effector, IgG2a, and to some extent secretory IgA produce protective immunity against chlamydial genital infection. Therefore, i.n. immunization is a potential delivery route of choice in the development of a vaccine against Chlamydia.

Administration, Intranasal↗

Comparison of clinical and laparascopic features of infertile women suffering from genital tuberculosis (TB) or pelvic inflammatory disease (PID) or endometriosis.

OBJECTIVE: The objective of the study was to analyze the clinical and laparoscopic features, which may help to differentiate between infertility in females due to Genital Tuberculosis from Pelvic Inflammatory Disease (PID) and Endometriosis. METHODS: This case control study was carried out in a teaching tertiary care hospital. Medical records were searched from 1st January 1987 to 31st December 2000 and 43 infertile women with biopsy proven genital tract tuberculosis were found. Equal number of infertile females with diagnosed PID and Endometriosis were randomly selected. Comparisons were done between features of Genital Tuberculosis with PID and Endometriosis separately and also genital tuberculosis with combined controls of PID and Endometriosis. RESULTS: Patients with genital tuberculosis commonly had primary infertility. PID and Endometriosis patients had early menarche and increased duration of menstruation. On physical examination, patients with Genital Tuberculosis were found to have short heights. No significant findings were observes in the pelvic examination and menstruation history between the comparison groups. Laparascopic examination revealed that fallopian tubes were abnormal, tortuous, bilaterally blocked and thickly adherent more commonly in Genital Tuberculosis when compared to other groups. CONCLUSION: The primary infertility patients with chronic malnutrition and massive adhesive fallopian tubes on laproscopic examination should be evaluated for genital tuberculosis.

Adolescent↗

Human immunodeficiency virus, genital ulcers and the male foreskin: synergism in HIV-1 transmission.

Epidemiologic studies in Nairobi and elsewhere in Africa, have shown that men infected with HIV-1 more commonly have a history of genital ulcer disease compared to uninfected men. In one study, HIV infected men were three times as likely to have a recent history of genital ulcers. In a prospective study of seronegative men, those presenting with chancroid had a five-fold risk of seroconversion during follow-up compared to men presenting with urethritis. Uncircumcised men had an increased risk of seroconversion which was independent of their risk of genital ulcer disease. Over 95% of attributable risk in men with STD was either genital ulceration or the presence of a foreskin. Genital ulcers are a major risk factor for HIV infection among prostitutes. The increased risk is about 10-fold among prostitutes with ulcers compared to a cohort who did not. We hypothesize from these studies that genital ulcers are the major portals of entry for HIV infection and also increased shedding of virus infected cells into the vaginal secretions. HIV seropositive prostitutes are more susceptible to chancroid with a two-fold increase in the prevalence of genital ulcers as compared to HIV negative women. The use of condoms by their clients prevents both genital ulcer disease and HIV acquisition among prostitutes. Chancroid is more difficult to treat in HIV infected men with one-third of patients failing single dose treatment regimens as compared to less than five percent of men without HIV infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Base Sequence↗

Genital herpes simplex virus infections.

In recent years, a great increase in interest in genital herpes has been stimulated partly by the rising prevalence of this disease and partly by observations suggesting that genital herpes is a cause of cervical cancer. The clinical pictures produced by genital herpes simplex virus infections are similar in men and women. In contrast to recurrent attacks, initial episodes of infection are generally more extensive, last longer, and are more often associated with regional lymphadenopathy and systemic symptoms. Genital herpes in pregnancy may pose a serious threat to the newborn infant. Although the data suggesting genital herpes simplex virus infection is a cause of cervical cancer are quite extensive, the evidence is largely circumstantial. In spite of these more serious aspects of genital herpes simplex virus infection, episodes of genital herpes are almost always self-limited and benign. Frequent recurrences pose the major therapeutic and management problem. At present, there is no satisfactory treatment for recurrent genital herpes simplex virus in fection. Many of the suggested therapies, although some sound very promising, are potentially dangerous and should be used only under carefully controlled conditions.

Female↗

Frequent recovery of HIV-1 from genital herpes simplex virus lesions in HIV-1-infected men.

CONTEXT: Genital ulcer disease has been epidemiologically linked as a risk factor in the transmission of the human immunodeficiency virus 1 (HIV-1). While herpes simplex virus 2 (HSV-2) is the most common cause of genital ulcers, no study has systematically evaluated the frequency or titer of HIV-1 virus in HSV-2 lesions. OBJECTIVE: To compare lesional HIV-1 RNA levels during and after genital HSV-2 reactivation and to evaluate the frequency, titer, and duration of HIV-1 RNA shedding in lesions due to HSV-2. DESIGN: Convenience sample. SETTING: Sexually transmitted disease research clinic at the University of Washington, Seattle. PATIENTS: Twelve HIV-infected men with a history of symptomatic HSV-2 infection who underwent daily sampling of genital lesions for HIV-1 RNA by polymerase chain reaction assay and HSV-2 by culture. MAIN OUTCOME MEASURE: Detection of lesional HIV RNA and HSV-2. RESULTS: HIV-1 RNA was detected from lesional swabs in 25 of 26 consecutively studied HSV-2 episodes and on 67% of days in which genital lesions were noted. The HIV-1 RNA titers in lesional swabs exceeded 10000 copies/mL of swab sample in 75% of samples (range, 2.2-3.2 x 10(5) copies/mL of swab sample). HIV-1 RNA in genital lesion swabs was seen in persons with high and low titers of plasma HIV-1 RNA and was not associated with plasma HIV-1 RNA levels. CONCLUSIONS: HIV-1 virions can consistently be detected in genital ulcers caused by HSV-2, which suggests that genital herpes infection likely increases the efficiency of the sexual transmission of HIV-1.

Adult↗