Abstract

BACKGROUND AND OBJECTIVES:

Granuloma Inguinale (GI) is an endemic sexually transmitted disease (STD) in India. With increasing prevalence of human immunodeficiency virus (HIV) among patients with STD at a clinic in Mumbai, a study was conducted to determine clinico-epidemiologic features of GI and HIV.

GOAL:

To determine possible interaction between GI and HIV.

STUDY DESIGN:

Prospective follow-up of 21 consecutive cases (GI in HIV-seropositive individuals) and 29 controls (GI in HIV-seronegative individuals) to determine time to heal. All cases and controls received a standard treatment regimen of erythromycin, 2 g po daily, under supervision until healing occurred.

RESULTS:

Although GI ulcers at recruitment were not significantly larger among HIV-seropositive individuals as compared with those seen among HIV-seronegative individuals (mean size 4.4 cm2 vs. 3.6 sq2; odds ratio [OR] 1.22, confidence interval [CI] .95, 0.63, 2.40; p = 0.52), the former took longer time to heal completely (mean 25.7 days vs. 16.8 days; OR 1.82, CI .95, 0.99, 3.36; p = 0.03) and tended to produce greater tissue destruction (as included in results).

CONCLUSION:

These findings are important because slow-healing GI ulcers with underlying HIV infection, which may be caused by their interaction, will lead to increased transmission of both the infections.

PIP:

Infection with genital ulcer disease (GUD) facilitates the transmission of HIV. However, granuloma inguinale (GI), an endemic sexually transmitted disease (STD) in India, has been ignored as a cause of GUD. In the context of increasing prevalence of HIV infection among patients with STD at a clinic in Mumbai, a study was conducted to determine the clinico-epidemiologic features of GI and HIV, with the goal of identifying any possible interaction between the two. 21 consecutive cases of GI in HIV-seropositive individuals and 29 controls, HIV-seronegative individuals with GI, participated in the prospective follow-up study to determine how long it takes for GUD to heal. Healing was considered complete when total re-epithelization of the ulcer(s) was observed. All cases and controls received a standard treatment regimen of erythromycin under supervision until healing occurred. While the GI ulcers at recruitment were not significantly larger among HIV-seropositive individuals compared with those among HIV-seronegative individuals, the former took longer to heal completely; an average of 25.7 days compared to 16.8 days, respectively. The former ulcers also tended to produce greater tissue destruction. Slow-healing GI ulcers with underlying HIV infection can lead to the increased transmission of both infections.