Oral Human Papillomavirus Infection: Differences in Prevalence Between Sexes and Concordance With Genital Human Papillomavirus Infection, NHANES 2011 to 2014.

BACKGROUND: The burden of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is disproportionately high among men, yet empirical evidence regarding the difference in prevalence of oral HPV infection between men and women is limited. Concordance of oral and genital HPV infection among men is unknown. OBJECTIVE: To determine the prevalence of oral HPV infection, as well as the concordance of oral and genital HPV infection, among U.S. men and women. DESIGN: Nationally representative survey. SETTING: Civilian noninstitutionalized population. PARTICIPANTS: Adults aged 18 to 69 years from NHANES (National Health and Nutrition Examination Survey), 2011 to 2014. MEASUREMENTS: Oral rinse, penile swab, and vaginal swab specimens were evaluated by polymerase chain reaction followed by type-specific hybridization. RESULTS: The overall prevalence of oral HPV infection was 11.5% (95% CI, 9.8% to 13.1%) in men and 3.2% (CI, 2.7% to 3.8%) in women (equating to 11 million men and 3.2 million women nationwide). High-risk oral HPV infection was more prevalent among men (7.3% [CI, 6.0% to 8.6%]) than women (1.4% [CI, 1.0% to 1.8%]). Oral HPV 16 was 6 times more common in men (1.8% [CI, 1.3% to 2.2%]) than women (0.3% [CI, 0.1% to 0.5%]) (1.7 million men vs. 0.27 million women). Among men and women who reported having same-sex partners, the prevalence of high-risk HPV infection was 12.7% (CI, 7.0% to 18.4%) and 3.6% (CI, 1.4% to 5.9%), respectively. Among men who reported having 2 or more same-sex oral sex partners, the prevalence of high-risk HPV infection was 22.2% (CI, 9.6% to 34.8%). Oral HPV prevalence among men with concurrent genital HPV infection was 4-fold greater (19.3%) than among those without it (4.4%). Men had 5.4% (CI, 5.1% to 5.8%) greater predicted probability of high-risk oral HPV infection than women. The predicted probability of high-risk oral HPV infection was greatest among black participants, those who smoked more than 20 cigarettes daily, current marijuana users, and those who reported 16 or more lifetime vaginal or oral sex partners. LIMITATION: Sexual behaviors were self-reported. CONCLUSION: Oral HPV infection is common among U.S. men. This study's findings provide several policy implications to guide future OPSCC prevention efforts to combat this disease. PRIMARY FUNDING SOURCE: National Cancer Institute.

Prevalence of Chlamydia trachomatis genital infection among persons aged 14-39 years--United States, 2007-2012.

Infection with the bacterium, Chlamydia trachomatis (often termed "chlamydia") is the most frequently reported sexually transmitted infection in the United States. The urethra is the most common site of infection in males, and the urethra and cervix are most commonly infected in females. Ascending infection in females can cause pelvic inflammatory disease, which can lead to infertility and ectopic pregnancy. Genital chlamydial infections are usually asymptomatic, and screening is necessary to identify most infections. Currently, chlamydia screening for sexually active women aged <25 years is recommended by the U.S. Preventive Services Task Force (grade B recommendation). Chlamydia is nationally notifiable; however, if females do not access care or clinicians do not screen, many infections go undiagnosed, unreported, and untreated. CDC monitors population prevalence of genital chlamydial infection through the National Health and Nutrition Examination Survey (NHANES), which tests a sample of the U.S. population aged 14-39 years for genital C. trachomatis and found that the overall chlamydia burden in the United States decreased during 1999-2008. Using data from the most recent cycles of NHANES (2007-2012), CDC estimated chlamydia prevalence among persons aged 14-39 years overall and by demographic characteristics and sexual behaviors. The prevalence of chlamydia among persons aged 14-39 years was 1.7% (95% confidence interval [CI] = 1.4%-2.0%). Chlamydia prevalence varied by age and race/ethnicity, with prevalence highest among non-Hispanic blacks (5.2%). Among sexually active females aged 14-24 years, the population targeted for routine screening, chlamydia prevalence was 4.7% overall and 13.5% among non-Hispanic black females. As chlamydia is common and infections are usually asymptomatic, health care providers should routinely screen sexually active young women aged <25 years for chlamydial infection, provide prompt treatment for infected persons, and ensure that infected patients' sex partners receive timely treatment to prevent reinfection.

Reference standard of penile size and prevalence of buried penis in Japanese newborn male infants.

The present study set forth the reference values for penile size and determined the prevalence of buried penis in Japanese full-term newborns. The stretched penile length was measured and the presence of buried penis was assessed at 1-7 days of age in 547 Japanese full-term newborn infants born between 2008 and 2012 in Tokyo. The stretched penile lengths were compared at 1-12 hours and 1-7 days of age in 63 infants and by two observers in 73 infants to estimate postnatal changes and interobserver variation, respectively. The mean stretched penile length was 3.06 cm (SD, 0.26; 95% confidence interval [CI], 3.04-3.08) and the mean ratio of penile length to body length was 6.24 × 100(-1) (SD, 0.55 × 100(-1)), both of which were significantly smaller than those in Caucasian newborn infants. Buried penis was identified in 20 of 547 infants (3.7%; 95% CI, 2.1-5.2%). The first measurements of penile length at 1-12 hours were significantly smaller than the next measurements at 1-7 days (95% CI of the difference, 0.22-0.34). The 95% CI for the limits of agreement in the penile lengths measured by the two observers was -0.58 to -0.40 for the lower limit and 0.33 to 0.51 for the upper limit. These findings indicate that the penile length should be assessed after 24 hours of age by the reference standard of the same ethnicity for identifying micropenis and that buried penis is not uncommon in Japanese full-term newborns.

Two-step irradiance schedule versus single-dose tramadol sustained-release tablets for pain control during topical 5-aminolevulinic acid-photodynamic therapy of condyloma acuminatum in Chinese patients: a randomized comparative study.

BACKGROUND AND OBJECTIVE: Photodynamic therapy with 5-aminolevulinic acid (ALA-PDT) offers promising results for the treatment of condyloma acuminatum. However, patients have to dwell with pain to benefit from this otherwise effective and safe "off-label" treatment modality. Several techniques have been explored to control ALA-PDT-induced pain, but the desperate search for a universally accepted method is still ongoing. This study compares the two-step irradiance approach with single-dose administration of 100 mg tramadol sustained-release tablets for pain induced by ALA-PDT of condyloma acuminatum in Chinese patients. PATIENTS AND METHODS: Adult Chinese patients with condyloma acuminatum were enrolled in a randomized comparative study. Pain levels were compared using the Numeric Rating Scale (NRS) at pre-defined assessment points during and after irradiation. RESULTS: The pain was dominated by characteristics such as burning and pricking and was almost always local and superficial. DURING IRRADIATION: The median pain scores were lower in the two-step irradiance group at 1 minute (U = 621.5, P = 0.002) but higher at 20 minutes (U = 585.5, P = 0.002). The median pain scores between the two groups did not differ significantly at other assessment points. The pain was moderate in both groups and peaked earlier in the analgesics group (median: 5 minutes) but later in the two-step irradiance group (median: 15 minutes). AFTER IRRADIATION: The pain was generally mild. The median pain scores were equal at each assessment point, except at 3 hours where the median was lower in the analgesics group (1.0) as compared with the two-step irradiance group (2.0) (U = 725.0, P = 0.056). CONCLUSIONS: Pain in the two-step irradiance protocol is irradiance-dependent. The two-step irradiance approach produces significant benefits over analgesics during the initial stages of therapy but analgesics offer significant benefits thereafter. There are potential benefits of combining the two approaches in minimizing ALA-PDT-induced pain.

Penile length nomogram for Asian Indian prepubertal boys.

BACKGROUND: Penile length-for-age nomograms in prepubertal boys may aid in early recognition of endocrine and genetic disorders associated with abnormal phallic size. There are scarce data on the penile length measurements in children beyond the neonatal period and there is a lack of such a nomogram for Asian Indians. MATERIALS AND METHODS: Of the boys who were admitted in our ward or seen in the outpatient setting for genitalia-unrelated surgical problems, 20 consecutive boys were included in each of the following ten age slots (total of 200 subjects): 0-1, 1-2, 2-3, 3-4, 4-5, 5-6, 6-7, 7-8, 8-9, and 9-10 years. Their stretched penile length (SPL) measurements were used to establish the normal range (mean ± 2 SD) of penile length-for-age in prepubertal Indian boys. Mean ± 2.5 SD was also calculated to define the cut-offs for micropenis and macropenis, respectively, in each age group. RESULTS: A rapid increase is seen in penile length up to 4 years of age. A much slower increase is implied thereafter. CONCLUSION: This study provides reference values of penile lengths for Asian Indian boys aged 0-10 years.

Racial differences in the incidence and clearance of human papilloma virus (HPV): the HPV in men (HIM) study.

BACKGROUND: This analysis assessed the acquisition (incidence) and persistence (clearance) of human papilloma virus (HPV) infection by self-reported race among men in The HPV in Men (HIM) Study, a multinational prospective study of the natural history of genital HPV infections. METHODS: Self-reported race was categorized as White, Black, Asian/Pacific Islander (PI), or multiple and mixed race. Genital samples were combined for HPV DNA testing and categorized by any, oncogenic, and non-oncogenic HPV infections. RESULTS: Asian/PI race had significantly the lowest incidence of any, oncogenic, and non-oncogenic HPV infection (P < 0.001). In multivariable analyses, Asian/PI race was associated with a lower probability of acquiring any [HR = 0.63; 95% confidence interval (CI), 0.42-0.95] and non-oncogenic HPV infection (HR = 0.61; 95% CI, 0.40-0.93) when compared to Whites. No significant associations were evident for Asian/PI race for clearance. Multiple and mixed race was significantly associated with lower probability of acquiring non-oncogenic HPV infection (HR = 0.83; 95% CI, 0.69-0.99) and borderline significant associations were observed for any HPV (HR = 0.91) and oncogenic infections (HR = 0.92). Multiple and mixed race was associated with a lower probability of clearing any (HR = 0.92; 95% CI, 0.84-1.00) and oncogenic HPV infections (HR = 0.85; 95% CI, 0.75-0.95). CONCLUSION: Asian/PI race had the lowest incidence of HPV and exhibited a lower probability of acquiring new HPV infections. Multiple and mixed race had the second lowest incidence of infection and was associated with a lower probability of acquiring and clearing an HPV infection. IMPACT: Race-specific differences in HPV infection could be due to behavior, innate genetic differences, or circulating intratypic HPV variants.

5-aminolevulinic acid-based photodynamic therapy for the treatment of condylomata acuminata in Chinese patients: a meta-analysis.

OBJECTIVE: This meta-analysis was designed to assess the efficacy of topical 5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) in Chinese patients with condylomata acuminata (CA). METHODS: Electronic literature databases (Medline, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang database) were searched for relevant randomized controlled trials (RCTs) published prior to October 2012. Only RCTs that compared ALA-PDT to non-ALA-PDT for patients with genital condylomata were selected. The outcomes included the recurrence rate and adverse events. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated as the ALA-PDT vs. without ALA-PDT. RESULTS: Twenty RCTs composed of 1903 patients (ALA-PDT, n = 1106; non-ALA-PDT, n = 797) were included in the meta-analysis. ALA-PDT decreased the recurrence rate within 12 week after treatment (vs. without ALA-PDT, RR: 0.28, 95% CI: 0.22-0.35) and 24 week after treatment (vs. without ALA-PDT, RR: 0.24, 95% CI: 0.17-0.34) in a fixed-effect model. The common adverse events related ALA-PDT included a mild burning and/or stinging sensation, erythema, mild edema, erosion, and hyperpigmentation. CONCLUSION: Local application of ALA-PDT reduced recurrence rate vs. without ALA-PDT. The use of ALA-PDT should be considered as a feasible therapy for the treatment of CA.

Race and prevalence of human papillomavirus infection among men residing in Brazil, Mexico and the United States.

Human papillomavirus (HPV) causes anal, penile and oropharyngeal cancers in men. Genital HPV prevalence in men appears to vary by world region with men residing in Asia having among the lowest prevalence. Unfortunately, there is little information on prevalence of HPV infection in men by race. The purpose of this study was to examine HPV prevalence by race across three countries. 3,909 men ages 18-70 years enrolled in an ongoing prospective cohort study of the natural history of HPV in men (The HIM Study) were included in the analysis. Participants completed risk factor questionnaires and samples were taken from the penile epithelium and scrotum for HPV detection. HPV testing of the combined DNA extract was conducted using PCR and genotyping. Asian/Pacific Islanders had the lowest HPV prevalence of 42.2% compared to Blacks (66.2%), and Whites (71.5%). The Asian/Pacific Islander race was strongly protective in univariate analysis (prevalence ratio (PR) = 0.59; 95% confidence interval (CI): 0.48-0.74) and multivariate analysis for any HPV infection (PR = 0.65; 95% CI: 0.52-0.8). Stratified analysis by lifetime number of female partners also showed strong inverse associations with the Asian/Pacific Islander race. We consistently observed the lowest prevalence of HPV infection among Asian/Pacific Islanders with moderate inverse associations even after various adjustments for potential confounding factors. Unmeasured behavioral factors, sexual mixing with low risk women, and/or race-specific differences in the frequency of germline variations among immune regulating genes may underlie these associations. Further studies among Asian populations that incorporate measures of immuno-genetics are needed to understand this phenomenon.

How do perceptions of sensitive skin differ at different anatomical sites? An epidemiological study.

BACKGROUND: People with sensitive skin vary not only in the signs and symptoms they experience, but also in the degree of sensitivity at different anatomical sites. AIM: To determine patterns of perceived sensitive skin using an epidemiological approach among a general population, evaluating the results for ethnic, gender and age differences. METHODS: Questionnaires designed to evaluate perceptions of sensitive skin in general and at specific body sites (face, body and genital area) were given to 1039 people. Respondents were not selected based on any criteria related to sensitive skin, but consisted of people participating in other studies on consumer products. RESULTS: Of the study population, 68.4% claimed their skin was sensitive to some degree, 77.3% claimed sensitive facial skin, 60.7% claimed sensitive body skin and 56.3% claimed sensitive skin in the genital area. There were no significant gender, ethnic or age differences, except in the genital area; a higher percentage of women and African Americans claimed sensitive skin in this area. CONCLUSIONS: The prevalence of perceived sensitive skin was higher in this study than in previous reports. Individuals had different perceptions about the degree of sensitivity at different anatomical sites.

Black and minority ethnic men who have sex with men: a London genitourinary medicine clinic experience.

The aim was to examine sexual behaviour and rates of sexually transmitted infections (STIs) in black and minority ethnic (BME) men who have sex with men (MSM) attending a London genitourinary medicine clinic. A case-note review of BME MSM (n = 203) attending our service between 1 April 2005 and 31 March 2006 was carried out. BME MSM were those who self-identified as being of Black (Caribbean, African or Other), South Asian (Indian, Pakistani, Bangladeshi or Sri Lankan) and Chinese/South-East Asian (Malaysian, Thai, Filipino, Japanese) ethnicities. Consecutively attending self-identified white British (WB) MSM (n = 203) were used as a comparative group. BME MSM were significantly more likely to report unprotected anal intercourse with casual male partners in the preceding three months (P = 0.0016) and were more likely to report female sexual partners (P = 0.0018). Rectal gonorrhoea was more common in WB MSM (P = 0.02). Numbers of other bacterial STIs and HIV infection were similar in both groups. The higher reported rates of risk behaviour in BME MSM are of concern and support the need for focussed sexual health promotion.

Estimates of Chlamydia trachomatis infections among men: United States.

OBJECTIVE: To describe the epidemiology of genital Chlamydia trachomatis infections among men in the United States. STUDY DESIGN: Data from the notifiable disease case surveillance system, the National Health and Nutrition Examination Survey (NHANES), the National Longitudinal Study of Adolescent Health (AddHealth), the National Job Training Program, the Men Having Sex with Men (MSM) Prevalence Monitoring Project, and adult and juvenile corrections facilities were used to summarize national chlamydia case and prevalence rates. Data were stratified by age and race/ethnicity. RESULTS: In 2005, 232,781 chlamydia cases among men were reported, corresponding to a rate of 161.1 cases per 100,000 men, an increase of 43.5% compared with the case rate in 2001 (112.3). Population-based chlamydia prevalence rates from NHANES (1999-2002) were highest among men aged 20 to 29 years (3.2%); men aged 18 to 26 years participating in AddHealth (2001-2002) had a 3.7% prevalence rate. Rates were highest among black men in both NHANES (5.3%) and AddHealth (11.1%). The prevalence rate among men (aged 16-24 years) participating in the National Job Training Program was 8.1%. Among MSM, the 2005 median urethral chlamydia prevalence rate was 6%. Overall, chlamydia rates were highest in adult corrections facilities; the 2005 positivity rate among men aged 21 to 25 years was 7.8%. In juvenile corrections facilities, the 2005 positivity rate among men aged 15 to 17 years was 6.7%. CONCLUSIONS: Rates of genital C. trachomatis infections among men are persistently high, particularly among men entering the National Job Training Program and men in corrections facilities. The burden of disease is generally highest among young men and black men.

Genital and nongenital nonmelanoma skin cancer: more epidemiological studies are needed.

Although black men in the United States have a lower mortality of nongenital nonmelanoma skin cancer (NMSC) than white men, they have a higher mortality of genital NMSC than white men. Mortality of NMSC has declined over time. Ethnicity-specific incidence and survival analyses of NMSC can be used to determine to what degree earlier detection and/or more efficient therapies have contributed to these observations.

Koro--the psychological disappearance of the penis.

The aim of this article is to present a summarizing overview on ethnomedical aspects of koro (in Chinese called suo-yang), the panic anxiety state in which affected males believe that the penis is shrinking and/or retracting, and perhaps disappearing. While reduction of penile volume occurs physiologically due to vasoconstriction in cold temperature and intense anxiety, it is believed in certain cultures that genital shrinking leads to impotence and sterility, and eventually to death. Traditional Chinese medicine treats suo-yang, the reduction of the male principle yang, as a dangerous disturbance of the life-sustaining yin-yang equilibrium of the organism. Koro has therefore been held to be a Chinese "culture-bound" condition. However , the koro phenomenon is also known among diverse ethnic and religious groups in Asia and Africa, typically in cultures in which reproductive ability is a major determinant of a young person's worth. Koro epidemics of panic anxiety due to widespread fears of losing one's genitals, procreative ability, and even one's life, are triggered by rumors of genital disappearance supposedly caused in China by female fox spirits, in Singapore and Thailand by mass poisoning, and in Africa by sorcery, usually in the context of socioeconomic or political tension. Today, in contemporary Western societies, ideas of genital disappearance are not culturally endorsed. But historically, it should be remembered that in the late Middle Ages in Europe, a man could lose his membrum virile through magical attacks by witches. The conclusion is that the psychological disappearance of the penis is a universal syndrome that was described recently in Asia and Africa and already in Medieval Europe.

Behcet disease in adult Druzes in north Israel: the influence of ethnic origin on disease expression and severity.

BACKGROUND: Behcet's disease (BD) is known to vary in severity and manifestations in different populations. OBJECTIVE: In an attempt to sort out genetic and environmental influences on disease expression, we carried out a study to assess the clinical features of BD in the adult Druze and Arab populations in north Israel, comparing 2 disparate ethnic groups of similar genetic background inhabiting the same geographic region. METHODS: We compared 23 Druze and 30 Arab patients with BD. All patients fulfilled the classification criteria of the International Study Group for BD. RESULTS: Manifestations were similar in 2 groups. The most frequent BD manifestations among the Druzes were recurrent oral aphthae (100%) and genital aphthae (61%) versus 100% and 53% in Arab patients, followed by inflammatory ocular involvement, 65% versus 53%, respectively. Arthritis was noted in 39% of Druze, with 27% in Arabs. Anterior uveitis occurred in 9 Druze patients (48%) and panuveitis in 4, with no case of blindness when compared with 30% with anterior uveitis, 4 with panuveitis, and 4 cases of blindness (P < 0.04) among the Arabs. One Druze BD patient had deep vein thrombosis versus 8 Arab patients (P < 0.017). No pulmonary embolism, aortic aneurysm, nor valvular involvement was documented in the Druze versus 1 case of each in Arabs. No case of neuro-Behcet was reported in Druzes versus 6 cases of neuro-Behcet among Arabs (P < 0.023). The severity score was 4.0 (SD, 1.2) in Druze and 5.8 (SD, 1.9) in Arabs (P = 0.0004). The prevalence of HLA B51 did not differ significantly between the groups. CONCLUSION: Druze BD patients in Israel have a milder disease than do Arabs, similar to observations in familial Mediterranean fever. Druze BD patients had significantly less severe ocular disease and neurologic manifestations. Our results suggest an ethnic influence on expression of BD not related to HLA B 51.

Trends in nonmelanoma skin cancer mortality rates in the United States, 1969 through 2000.

The purpose of this population-based study was to assess trends in mortality rates for nonmelanoma skin cancer (NMSC) in the United States. Particular emphasis was placed on the subgroup of malignancies arising on genital skin. Nearly 75,000 deaths in the United States were attributed to NMSC from 1969 to 2000. The age-adjusted US mortality rate for NMSC arising on nongenital skin from 1969 to 2000 was 0.69/10(5)/year; the rate among men was twice that among women. Mortality rates among white men exceeded that of black men by a factor of two; the same was observed among women, but by a smaller multiple. Corresponding mortality rates for malignancies arising from genital skin (penis, scrotum, vulva) were higher in women (0.54) than in men (0.30). In contrast to nongenital NMSC, mortality rates among black men were twice that of white men; however, rates for white and black women were similar. These results suggest that greater emphasis could be placed on reducing mortality from genital NMSC while continuing to stress reduction of excess sun exposure.

[The syndrome of genital retraction from a transcultural psychiatric point of view. Chinese suo yang, Indonesian koro and non-Asian forms (koro-like symptoms)]. / Das Syndrom der genitalen Retraktion aus Sicht der transkulturellen Psychiatrie. Chinesisches Suo yang, indonesisches Koro und nichtasiatische Formen (Koro-ähnliche Symptome).

The present article reviews the syndrome of genital retraction (SGR) from the perspective of transcultural psychiatry. It is best known as a culture-bound syndrome in Asia, e. g. koro in Indonesia or suo yang in Southern China, where it can be also observed in so-called epidemics. The syndrome is characterised by the sensation that the genitals are shrinking and being pulled back into the abdomen; this perception is associated with fear of death, because the subjects expect to die as soon as the genital has disappeared completely. Particularly in the case of suo yang, the involvement of local traditional concepts of illness can be established. In the Western world, however, SGR is observed only in single cases. The symptoms are less dramatic and do not show a particular cultural context. This form of SGR is called "koro-like" (koro-like symptoms, KLS). In contrast to the Asian form, KLS are not observed in healthy subjects, but as an unspecific syndrome related to other neuropsychiatric illnesses. In this review, we compare both forms of the SGR in terms of symptoms, cultural aspects and therapeutic strategies.

Racial origin, sexual behaviour, and genital infection among heterosexual men attending a genitourinary medicine clinic in London (1993-4).

OBJECTIVES: To compare variables of sexual behaviour and incidence of genital infections among heterosexual men of different racial origins. DESIGN: A prospective cross sectional study of sexual behaviour reported by a standardised self administered questionnaire in new patients who presented for screening and diagnosis. SETTING: A genitourinary medicine clinic in west London. SUBJECTS: 1212 consecutive heterosexual men newly attending in 1993-4. MAIN OUTCOME MEASURES: Variables relating to sociodemographic status, sexual behaviour, condom use, sexually transmitted diseases, and other genital infections stratified by racial origin. RESULTS: There were 941 evaluable heterosexual men of whom the majority were white (79%) and 17% were black. The black men comprised more teenagers (11% cf 2%; p < 0.00001), were more likely to be unemployed (26% cf 12%; p < 0.00001), to have commenced intercourse much earlier (45% cf 22% before aged 16: p < 0.0001), and to have had intercourse with an African woman (14% cf 6%; p < 0.001). Both fellatio (64% cf 96%; p < 0.00001) and cunnilingus (40% cf 92%; p < 0.00001) were practised less frequently by the black men and so too was anal intercourse (11% cf 27%; p < 0.00001). Similar proportions from both groups were non-smokers (53% cf 57%), but a significantly higher proportion of the black men did not drink alcohol (13% cf 5%; p < 0.001). Gonorrhoea (15% cf 1%; p < 0.00001), chlamydial infection (17% cf 8%; p < 0.001), and non-gonococcal urethritis (37% cf 24%; p = 0.001) were diagnosed more frequently in the black men. These findings remained significant after logistic regression and are therefore independently associated with black race. However, there was no significant difference in numbers of sexual partners in the preceding year (median 2), nor in condom use with regular and non-regular partners. The Asian men had commenced intercourse later (mean 19.1 years) than both the black men (mean 15.9 years) and the white men (mean 17.3 years). CONCLUSIONS: Compared with white men, black men attending a genitourinary medicine clinic were much more likely to be unemployed, to have commenced intercourse earlier and to have urethral infection. They were much less likely to practice fellatio, cunnilingus, or anal intercourse. However, there was no difference between the two racial groups in respect of numbers of sexual partners and condom use.

Sexual behaviour in Zulu men and women with genital ulcer disease.

OBJECTIVE--To investigate patterns of sexual behaviour in men and women with genital ulcer disease (GUD) and their relevance to HIV-1 transmission. METHODS--A sexual behaviour questionnaire was administered by the same interviewer to all participants who were also entered into a study of the microbial aetiology of GUD. SETTING--City Health Sexually Transmitted Diseases Clinic, King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS--100 Zulu men and 100 Zulu women. RESULTS--36 (%) of men and 36 (%) of women had continued with sexual intercourse despite GUD. Patients with donovanosis and secondary syphilis were more likely than those with other causes of GUD to have intercourse despite ulcers. During swab collection bleeding was observed from ulcers in 59 women and 26 men. Prostitutes were not identified and were rarely named as source contacts. Men had more sexual partners (190) than women (122) during the previous three months. Condom use was minimal. Men who migrated between urban and rural areas appeared to have the most sexual partners. Urban women had more partners than women from rural areas. CONCLUSIONS--Men and women with GUD are practising riskful sexual behaviour and could benefit from behaviour modification programmes. In this community men who travel between urban and rural areas and who present late with GUD that bleeds easily are probably the most important high-frequency HIV transmitter core group. A significant potential risk of blood to blood contact during sexual intercourse exists in patients with GUD.

PIP: This study sought to investigate the patterns of sexual behavior in men and women with genital ulcer disease (GUD) and their relevance to HIV-1 transmission. Participants were 100 Zulu men and 100 Zulu women at the City Health Sexually Transmitted Disease Clinic. King Edward VIII Hospital, in Durban, South Africa; a sexual behavior questionnaire was administered by the same interviewer to all of the above participants who were also included in a study of the microbial etiology of GUD. 36% of the men and 36% of the women continued with sexual intercourse despite GUD. Patients with donovanosis and secondary syphilis were more likely than those with other causes for their GUD to have intercourse despite ulcers. During swab collection, bleeding was observed from ulcers in 59 women and 26 men. Prostitutes were not identified and were rarely named as source contacts. Men had more sexual partner (190) than women (122) during the previous 3 months. Condom use was minimal. Men who migrated between urban and rural areas appeared to have the most sexual partners. Urban women had more partners than women from rural areas. The authors concluded that men and women with GUD are practicing risky sexual behavior and could benefit from behavior modification programs. In this community, men who travel between rural and urban areas and who present late with GUD that bleeds easily are probably the most important high-frequency HIV transmitter core group. A significant potential risk of blood-to-blood contact during sexual intercourse exists in patients with GUD.