Background Herpes simplex virus (HSV) is the leading cause of genital ulcer disease (GUD) in Africa. Although some studies have examined the demographics and sexual behaviours of men with GUD, less is known about the differences that may exist between men with new sexually-acquired ulcers and men with other forms of GUD.
Methods Men with GUD (n=615), who were 18 years and older, were recruited from several primary healthcare clinics in Gauteng Province, South Africa. Participants received syndromic management, were tested for ulcer aetiology and urethritis pathogens by PCR, and for HIV, syphilis and HSV-2 by serology. We used survey and STI test data to examine correlates of initial vs recurrent HSV and acute ulcer outcomes. Of men with HSV (n=451), initial HSV was defined as a HSV-positive ulcer specimen and HSV-negative serology. Recurrent herpes was defined as a positive HSV specimen and serology. For all men, the acute ulcer outcome compared men who had initial HSV or who had Treponema pallidum, Haemophilus ducreyi, or Chlamydia trachomatis L1–L3 detected in their ulcer specimens (termed “acute ulcers”) to men with GUD who did not have any of the four etiologies (termed “non-acute ulcers”). Correlates consisted of demographic characteristics and sexual behaviours often associated with STI.
Results Among all men, 29% had an acute ulcer, and of those with HSV, 30% had initial HSV. As compared to men with a non-acute ulcer, men with an acute ulcer were younger (p<0.01), more likely to be single (p<0.05), less likely to always use condoms with regular partners (p=0.03), had more casual partners in the last 3 months (p=0.03) but had fewer lifetime partners (p=0.02). As compared to men with recurrent HSV, men with initial HSV were significantly more likely to be younger (p<0.01), have multiple regular partners (p=0.03), and report having sex in last week (p=0.04), but were less likely to report ever exchanging sex for money (p=0.01) and had fewer lifetime partners (p<0.01).
Conclusions Findings suggest that young age and recent sexual behaviour were associated with initial HSV and acute ulcers in this group of men. These data emphasise the importance of targeting STI/HIV prevention programs in South Africa to young men engaging in high-risk sexual activities. To facilitate this, it is important to ensure that young men are equipped with the appropriate knowledge and skills to either avoid acquiring, or to seek early treatment for, STIs.
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