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High-risk sexual behaviour in men attending a sexually transmitted infection clinic in Durban, South Africa
  1. N O’Farrell1,
  2. L Morison2,
  3. P Moodley3,
  4. K Pillay3,
  5. T Vanmali3,
  6. M Quigley2,
  7. A W Sturm3
  1. 1Pasteur Suite, Ealing Hospital, London UB1 3HW, UK
  2. 2Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1, UK
  3. 3Department of Medical Microbiology, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
  1. Correspondence to:
 Dr Nigel O’Farrell
 Pasteur Suite, Ealing Hospital, Uxbridge Road, London UB1 3HW, UK; nigel.o’farrell{at}


Objectives: A study of men with genital ulcer disease (GUD) in Durban, South Africa, at the start of the local HIV epidemic in 1988/1989 found that 36% of men with GUD continued with sexual intercourse despite symptoms. The aim of this study was to determine whether this high-risk behaviour was still prevalent and to enquire about similar risk behaviours with other sexually transmitted infection (STI)-related problems.

Methods: 650 Men attending the main Durban STI clinic with a new complaint were enrolled. A standard questionnaire was administered. Polymerase chain reaction (PCR) tests were performed to diagnose genital herpes from ulcer specimens and gonorrhoea and chlamydia from those with urethral discharge and/or dysuria. Serology tests were performed for HIV, herpes simplex virus type 2 (HSV-2) and syphilis.

Results: Sex since the start of symptoms was reported by between 33.3% and 43.9% of men with GUD, herpetic ulcers, gonorrhoea and/or chlamydia or dysuria. The incidence of condom use was very low in all groups having sex despite symptoms. In 87 men with genital ulcers confirmed positive for genital herpes by PCR testing, 30 (34.4%) had had sex since the start of symptoms, 28 (93.3%) of whom had had unprotected sex.

Conclusions: There is a high level of risk behaviour in this group of men in whom genital herpes is the most common cause of GUD. This risky sexual behaviour could reflect disinhibition, possibly because so many have already been infected with HSV-2, lack of education or other unknown factors. Syndromic STI management should be strengthened with intensive health education to promote community awareness of both genital ulceration and genital herpes and their role in facilitating HIV transmission. The low level of condom use indicates that condom promotion programmes still have much to achieve.

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  • Funding: The study received some funding from the UK Department for International Development.

  • Competing interests: None declared.

  • Contributions: NO’F, LM, PM, MQ and AWS designed the study and contributed to the final manuscript. NO’F, KP and TM participated in the implementation of the study and data collection. PM and AWS were responsible for laboratory testing. LM and NO’F undertook the data analysis.