Increasing HIV-1 seroprevalence associated with genital ulcer disease, New York City, 1990-1992

Abstract

Objective: To measure HIV seroprevalence trends associated with sexually transmitted diseases (STD) causing ulcerative lesions [genital ulcer disease (GUD)], such as syphilis, chancroid and genital herpes, in New York City between 1990 and 1992. Design: Unlinked HIV-1 serosurvey using remnant serum drawn originally for routine syphilis screening. Setting and patients: Consecutive sample of patients presenting to New York City Department of Health STD clinics for STD examination (n = 41 678). Main outcome measure: Serologic evidence of antibody to HIV-1. Results: Although overall HIV seroprevalence and GUD incidence declined between 1990 and 1992, seroprevalence in patients with GUD increased from 10 to 16%. In contrast, seroprevalence in patients with non-ulcerative STD decreased. The most dramatic changes in seroprevalence associated with GUD occurred in patients using crack cocaine and injecting drugs. Conclusions: Despite declining HIV seroprevalence and GUD incidence, the association between GUD and HIV infection has strengthened over time in New York City STD clinics. Longitudinal incidence studies are needed to elucidate the biological, behavioral and temporal associations between GUD and HIV. Timely diagnosis and treatment of acute STD and more intensive risk reduction strategies at the clinics and associated testing sites, with a particular focus on GUD patients, are indicated.