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Background: The etiological agent is usually not established in cases of genital ulcer disease (GUD) in Tanzania, since diagnosis and treatment of this disease are based mainly on clinical rather than microbiologic parameters. GUD increases the risk of infection with HIV. However, the association between specific GUD infections and HIV infection has not been fully investigated. Goal: The goal was to determine the etiology of GUD and the prevalence of HIV infection in patients with GUD in urban areas of Tanzania. Study Design: A total of 102 clinical specimens were collected from 52 and 50 patients with GUD in Dar es Salaam and Mbeya, respectively, and from 93 patients with genital discharge in a cross-sectional study. Two polymerase chain reaction (PCR) assays were used to identify either a single target DNA or all three DNAs of the major causes of GUD: Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus type 2 (HSV-2). The sera from all patients were tested for antibodies to HIV and T pallidum. Results: In Dar es Salaam, DNA from HSV-2, H ducreyi, and T pallidum was detected in 63%, 13%, and 2%, respectively, of the 52 genital ulcer specimens. The corresponding figures in Mbeya were 34%, 10%, and 0% of 50 specimens. Overall, 9% of the 102 patients with GUD were infected with both HSV-2 and H ducreyi, and 39/102 genital ulcer specimens (38%) were negative for the DNA of all three pathogens. The HIV infection rates among GUD patients were 46% and 52% in Dar es Salaam and Mbeya, respectively; among the non-GUD patients, the corresponding rates were 35% and 45%, respectively. The HIV infection rate in Dar es Salaam was significantly higher among women (11/14; 78%) than among men (13/38; 34%) (P = 0.004). Among the HIV-seropositive GUD patients, 71% and 46% (P < 0.003) were coinfected with HSV-2 in Dar es Salaam and Mbeya, respectively. Furthermore, women with HSV-2 in Dar es Salaam were significantly more likely to be HIV-infected than men (60% versus 39%; P [less than or equal to] 0.006). T pallidum antibodies were detected in 27 (26%) of the 102 GUD patients and 16 (17%) of the 93 non-GUD patients. Conclusion: HSV-2 was the most commonly identified agent in the genital ulcer specimens in two urban STD clinics in Tanzania. The prevalence of HIV was high among the STD patients. HSV-2 was detected at significantly higher rates among HIV-seropositive than HIV-seronegative patients with GUD in both Dar es Salaam and Mbeya.

The number of people infected with HIV in the Kagera region of Tanzania has dropped significantly since 1987. This may be due to extensive interventions promoting behavioral change since the first cases were reported in 1983. In the town of Bukoba, the percentage of HIV-infected residents dropped from 24% in 1987 to 18% in 1993. The decline was greatest in women, dropping over 10 percentage points overall. The rate in women between 15 and 24 years old dropped the most, from 28% to 11%. Among rural residents, the rates in these young women dropped from 10% to 3%.

In some African cities, including Dar es Salaam in Tanzania, bar-maids and waitresses in public houses (bars, public lodgings, and restaurants) are often prostitutes. A survey conducted in 1986 revealed that a high percentage of female public workers in Dar es Salaam were infected with the human immunodeficiency virus type-1 (HIV-1, which causes AIDS), as indicated by antibodies to the virus in their blood. A program that included behavioral counseling and the distribution of condoms was started in 1988 to control the spread of HIV-1 among 605 public house workers in Dar es Salaam. One year later the participants were assessed for condom use, behavioral changes, and prevalence of antibodies to HIV-1 and Treponema pallidum (which causes syphilis). Both HIV-1 and Treponema pallidum are sexually transmitted diseases. The data from the participants were compared with similar information obtained from new workers and workers from other establishments; the two latter groups served as controls. Only 40 percent of the original workers were available for re-evaluation. Those who participated in the program used condoms more frequently than the controls and their behavior, including not engaging in prostitution and not having sex with strangers or others besides those with whom they had a stable relationship, was modified. Female barmaids who participated in the program used condoms more frequently, but did not change their sexual behavior. The authors speculate that the poor economy in this area is a significant factor in this outcome. However, the study indicates that programs aimed at controlling the spread of HIV-1 can be effective. Additional prevention programs are needed, as well as programs aimed at social and economic change. To provide opportunities for alternative employment for prostitutes, education and technical training, job development and job placement assistance are especially important. (Consumer Summary produced by Reliance Medical Information, Inc.)