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Genitourin Med. 1993 August; 69(4): 297–300.
PMCID: PMC1195092

Soap and water prophylaxis for limiting genital ulcer disease and HIV-1 infection in men in sub-Saharan Africa.


In general, East, Central and Southern Africa appear to be worse affected by HIV-1 infection than West Africa. So far there is little evidence to suggest that differences in either sexual behaviour or numbers of sexual partners could account for this disparity. Two risk factors in men for acquiring HIV-1, that tend to vary along this geographical divide, are lack of circumcision and genital ulcer disease (GUD) which are much less common in West Africa. Although uncircumcised men with GUD are an important high frequency HIV-1 transmitter core group, few interventions have targeted such individuals. Given the recent expansion in AIDS-related technologies, is it possible that methods effective in limiting GUD in the preantibiotic era have been overlooked? During the first and second world wars, chancroid, the commonest cause of GUD in Africa today, was controlled successfully with various prophylactics including soap and water. Many parts of Africa are undergoing social upheaval against a background of violence, and in this environment soap and water prophylaxis would now seem to merit re-evaluation as an intervention for preventing both GUD and HIV-1 in uncircumcised men. By facilitating healing of traumatic, inflammatory and infected penile lesions, pre- and post-exposure prophylaxis with soap and water could be a cheap and effective method for decreasing the risks of acquiring GUD and HIV in this vulnerable group of uncircumcised men.

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Selected References

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  • Prual A, Chacko S, Koch-Weser D. Sexual behaviour, AIDS and poverty in Sub-Saharan Africa. Int J STD AIDS. 1991 Jan-Feb;2(1):1–9. [PubMed]
  • O'Farrell N, Windsor I. Sexual behavior in HIV-1-seropositive Zulu men and women in Durban, South Africa. J Acquir Immune Defic Syndr. 1991;4(12):1258–1259. [PubMed]
  • Rowley JT, Anderson RM, Ng TW. Reducing the spread of HIV infection in sub-Saharan Africa: some demographic and economic implications. AIDS. 1990 Jan;4(1):47–56. [PubMed]
  • Moses S, Plummer FA, Ngugi EN, Nagelkerke NJ, Anzala AO, Ndinya-Achola JO. Controlling HIV in Africa: effectiveness and cost of an intervention in a high-frequency STD transmitter core group. AIDS. 1991 Apr;5(4):407–411. [PubMed]
  • Cameron DW, Ngugi EN, Ronald AR, Simonsen JN, Braddick M, Bosire M, Kimata J, Kamala J, Ndinya-Achola JO, Waiyaki PG, et al. Condom use prevents genital ulcers in women working as prostitutes. Influence of human immunodeficiency virus infection. Sex Transm Dis. 1991 Jul-Sep;18(3):188–191. [PubMed]
  • O'Farrell N, Hoosen AA, Coetzee KD, van den Ende J. Sexual behaviour in Zulu men and women with genital ulcer disease. Genitourin Med. 1992 Aug;68(4):245–248. [PMC free article] [PubMed]
  • O'Farrell N, Windsor I. Prevalence of HIV antibody in recurrent attenders at a sexually transmitted disease clinic. S Afr Med J. 1988 Aug 6;74(3):104–105. [PubMed]
  • Cameron DW, Simonsen JN, D'Costa LJ, Ronald AR, Maitha GM, Gakinya MN, Cheang M, Ndinya-Achola JO, Piot P, Brunham RC, et al. Female to male transmission of human immunodeficiency virus type 1: risk factors for seroconversion in men. Lancet. 1989 Aug 19;2(8660):403–407. [PubMed]
  • Hart G. Factors influencing venereal infection in a war environment. Br J Vener Dis. 1974 Feb;50(1):68–72. [PMC free article] [PubMed]
  • Moses S, Bradley JE, Nagelkerke NJ, Ronald AR, Ndinya-Achola JO, Plummer FA. Geographical patterns of male circumcision practices in Africa: association with HIV seroprevalence. Int J Epidemiol. 1990 Sep;19(3):693–697. [PubMed]
  • Bongaarts J, Reining P, Way P, Conant F. The relationship between male circumcision and HIV infection in African populations. AIDS. 1989 Jun;3(6):373–377. [PubMed]
  • Sogbetun AO, Alausa KO, Osoba AO. Sexually transmitted diseases in Ibadan, Nigeria. Br J Vener Dis. 1977 Jun;53(3):155–160. [PMC free article] [PubMed]
  • WILLCOX RR. Venereal syphilis and other venereal infections in non-venereal treponematoses areas in Africa. Cent Afr J Med. 1958 Oct;4(10):432–443. [PubMed]
  • O'Farrell N, Hoosen AA, Coetzee KD, van den Ende J. Genital ulcer disease in men in Durban, South Africa. Genitourin Med. 1991 Aug;67(4):327–330. [PMC free article] [PubMed]
  • Diallo MO, Ackah AN, Lafontaine MF, Doorly R, Roux R, Kanga JM, Heroin P, De Cock KM. HIV-1 and HIV-2 infections in men attending sexually transmitted disease clinics in Abidjan, Côte d'Ivoire. AIDS. 1992 Jun;6(6):581–585. [PubMed]
  • Amofah GK. AIDS in Ghana: profile, strategies and challenges. AIDS Anal Afr. 1992 Sep-Oct;2(5):5–5. [PubMed]
  • Mabey DC, Wall RA, Bello CS. Aetiology of genital ulceration in the Gambia. Genitourin Med. 1987 Oct;63(5):312–315. [PMC free article] [PubMed]
  • Pépin J, Quigley M, Todd J, Gaye I, Janneh M, Van Dyck E, Piot P, Whittle H. Association between HIV-2 infection and genital ulcer diseases among male sexually transmitted disease patients in The Gambia. AIDS. 1992 May;6(5):489–493. [PubMed]

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