HIV-1 infection among heterosexual attenders at a sexually transmitted diseases clinic in Durban.

In a study of 2,682 selected attenders at a sexually transmitted diseases (STD) clinic for blacks in Durban, antibodies to human immunodeficiency virus type 1 (HIV-1) were detected in 63 (2.4%)--30 of 937 women (3.2%) and 33 of 1,745 men (1.9%). Women aged 15-19 years (P = 0.002) were at greater risk of HIV-1 infection than women of other age groups. Among men, HIV-1 seropositivity was associated with genital ulcer disease (GUD) (P = 0.007) and donovanosis (granuloma inguinale) (P = 0.02). Among seropositive men with donovanosis the probability of HIV-1 infection increased as the duration of lesions increased. When HIV-1 seropositive women were compared with a subgroup of 73 seronegative women with GUD, inflammatory cytological changes were associated with antibodies to HIV-1 (P = 0.02). Among women overall, HIV-1 seropositivity was associated with previous syphilis (P = 0.03). In men herpes zoster (P = 0.04) and in women lymphadenopathy (P = 0.002) accounted for HIV-1 seropositivity in patients with medical complaints. HIV-1 seropositivity in men with gonorrhoea and genital warts was less than in men without gonorrhoea (P = 0.001) and genital warts (P = 0.03). These results support the causal hypothesis of HIV transmission whereby mucosal discontinuity acts as a portal of entry for the virus. GUD and cervical inflammation secondary to STDs in seronegative subjects may facilitate HIV transmission. The relative risk of various STDs are probably dependent upon the duration of epithelial damage and exposure to HIV-1.