Risk factors for genital ulcerations in Kenyan sex workers: The role of human immunodeficiency virus type 1 infection

Rupert Kaul, Joshua Kimani, Nico J.D. Nagelkerke, Francis A. Plummer, Job J. Bwayo, Robert C. Brunham, Elizabeth N. Ngugi, Allan Ronald

Research output: Contribution to journalArticlepeer-review

31 Citations (Scopus)


Background and Objectives: Genital ulcer disease (GUD) is a major risk factor for human immunodeficiency virus (HIV) transmission. Cross-sectional studies have suggested that HIV infection may itself predispose to genital ulceration (GU). Goal: To prospectively study the effects of HIV type 1 (HIV- 1) infection and behavioral variables on GU incidence. Methods: A cohort of 302 Kenyan female sex-workers was established in April 1991. Women were scheduled for assessment every 2 weeks, and bloods were collected every 6 months for HIV serology, rapid plasma reagin (RPR) and CD4 counts. Logistic regression was used to study fish factors for incident genital ulcers. Results: 189 women (62.5%) had at least one incident ulcer over 24.3±15.3 months. GU incidence was higher in seropositive than initially seronegative women (82% vs. 48%; odds ratio [OR]) = 4.33; P < 0.01). Only HIV-1 seropositivity (OR = 3.42), a CD4 count < 200/ml (OR = 1.94), and oral contraceptive use (OR = 1.35) were associated (P < 0.05) with GU incidence in regression analysis. For those ulcers where an etiology was actively sought, Hemophilus ducreyi was confirmed in 54 (19%) of cases, and syphilis in 30 (29%). Conclusion: GU incidence in Kenyan sex workers is independently affected by HIV-1 serostatus, degree of immunosuppression, and oral contraceptive use.

Original languageEnglish
Pages (from-to)387-392
Number of pages6
JournalSexually Transmitted Diseases
Issue number7
Publication statusPublished - Aug 1997
Externally publishedYes

ASJC Scopus subject areas

  • Dermatology
  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)
  • Infectious Diseases


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