Rise in prevalence of genital ulcers among STD clinic attenders in Jamaica: significance for HIV transmission - abstract

ABSTRACT

Two cross-sectional surveys were undertaken to estimate the prevalence of genital ulcer disease (GUD) in all clients presenting at the Comprehensive Health Centre in Kingston, Jamaica with a new STD complaint. The first survey done in 1983 involved 23,050 clients (men 11,948; women 11,102). The second survey in 1990 involved 1,001 clients (men 517; women 484). All clients were screened for syphilis and in 1990 for HIV. Culture for herpes virus was done on a subsample of 103 persons seen in 1983, but in the main, diagnoses were clinical. In 1983, GUD was found in 1,571 clients, an overall prevalence of 6.8 percent (men 1,110, 9.3 percent; women 461, 4.2 percent). Of those with GUD, genital herpes was diagnosed in 267 (17 percent); syphilis in 203 (12.9 percent); chancroid in 195 (12.4 percent); viral warts in 89 (5.7 percent); lymphogranuloma venereum in 65 (4.1 percent) and granuloma inguinale in 55 (3.6 percent). A diagnosis could not be made in 697 (44.5 percent) cases. All conditions were significantly higher in men (p<0.001) except for syphilis which was higher in women (p<0.05) and viral warts, where there was no significant difference. In 1990, GUD was found in 128 clients, an overall prevalence of 12.8 percent (men 95, 18.2 percent; women 33, 6.8 percent). Of clients with GUD, syphilis was diagnosed in 24 (18.8 percent); chancroid in 17 (13.3 percent); genital herpes in 10 (7.8 percent); viral warts in 8 (6.3 percent); lymphogranuloma venereum in 5 (3.9 percent) and granuloma inguinale in 3 (2.3 percent). A diagnosis could not be made in 61/128, 47.6 percent of cases in 1990. The prevalence of HIV was 28/1,001 (3.2 percent). A significant association was found between GUD and HIV infection (men with current GUD OR 7.3, CI1.4 - 72; women with history of "bad blood" (syphilis) OR 6.6, CI 1.3-30). Overall prevalence rates of GUD were significantly higher in 1990 than in 1983 for both sexes (p<0.001), as well as total rates for each sex (males p< 0.001, females p<0.004) (AU)