International Journal of STD & AIDS > Volume 20, Number 9 > Pp. 650-651

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Aetiology of genital ulcer disease in female partners of male participants in a circumcision trial in Uganda

A E Brankin MSc ^*, A A R Tobian MD PhD , O Laeyendecker MS MBA ^* , T R Suntoke PhD ^*, A Kizza BLT , B Mpoza DipLabTech , G Kigozi MBChB MPH , F Nalugoda MHS , B Iga MT(ASCP) , M Z Chen MSc ^**, R H Gray MD MSc ^**, M J Wawer MD MHSc ^**, T C Quinn MD MSc ^*   and S J Reynolds MD MPH ^* 

^* Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda; Department of Pathology; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Rakai Health Sciences Program, Entebbe, Uganda; ^** Department of Population, Family, and Reproductive Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA

Correspondence to: Dr T C Quinn, Johns Hopkins University, School of Medicine, Rangos Building, Room 531, 855 N Wolfe Street, Baltimore, MD 21215, USA Email: tquinn{at}jhmi.edu

HIV acquisition is associated with herpes simplex virus type 2 (HSV-2) infection and genital ulcer disease (GUD). Three randomized control trials demonstrated that male circumcision significantly decreases HIV, HSV-2, human papillomavirus and self-reported GUD among men. GUD is also decreased among female partners of circumcised men, but it is unknown whether male circumcision status affects GUD pathogens in female partners. For the evaluation of GUD aetiology, two separate multiplex assays were performed to detect Haemophilus ducreyi, Treponema pallidum, HSV-1 and HSV-2. Of all the female GUD swabs evaluated, 67.5% had an aetiology identified, and HSV-2 was the primary pathogen detected (96.3%). However, there was no difference in the proportion of ulcers due to HSV-2 or other pathogens between female partners of circumcised men (11/15, 73.3%) compared with uncircumcised men (15/25, 60.0%, P = 0.39). The seroprevalence of HSV-2 is high in this population and therefore most of the detected HSV-2 infections represent reactivation. Since GUD is associated with HIV acquisition and one-third of GUD in this study did not have an aetiological agent identified, further research is needed to better understand the aetiology of GUD in Africa, and its relationship to circumcision and HIV infection.

Key Words: herpes simplex virus type 2 (HSV-2) • T. pallidum (TP) • H. ducreyi (HD) • genital ulcer disease (GUD) • HIV • circumcision

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