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Association Between HIV and Subpreputial Penile Wetness in Uncircumcised Men in South Africa

O'Farrell, Nigel MD, FRCP*†; Morison, Linda MSc; Moodley, Prashini MB, ChB, PhD; Pillay, Keshree MB, ChB; Vanmali, Trusha MB, ChB; Quigley, Maria MSc; Hayes, Richard MSc, DSc; Sturm, A. Willem MD, PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: September 2006 - Volume 43 - Issue 1 - p 69-77
doi: 10.1097/01.qai.0000225014.61192.98
Epidemiology and Social Science

Objectives: To describe the prevalence and characteristics of subpreputial penile wetness and to investigate the association between current levels of penile wetness and HIV infection.

Methods: Male attenders at a sexually transmitted infections clinic in Durban, South Africa were enrolled and treated for their presenting sexually transmitted infection complaint. They were asked to return after 14 days when a structured questionnaire was administered, and the degree of wetness of the glans penis and coronal sulcus was assessed clinically.

Results: Six hundred and fifty men were enrolled, and 488 (75%) returned. Three hundred eighty-six uncircumcised men were included for statistical analysis of whom 215 (56%) were HIV positive. One hundred ninety-six (50.8%) had no penile wetness, and 190 (49.2%) had penile wetness. In the adjusted analysis, penile wetness was associated with younger age, low level of attained education, low income, higher lifetime numbers of sexual partners, and not washing after sex. The prevalence of HIV was greater in those with penile wetness 126 of 190 (66.3%) compared with 90 of 196 (45.9%) with no penile wetness, crude prevalence odds ratio 2.32 (95% confidence interval [CI], 1.54-3.50, P = < 0.001), crude prevalence relative risk 1.44 (95% CI, 1.23-1.63, P = < 0.001), and adjusted for predictors of HIV, confounders and herpes type 2 antibodies, odds ratio 2.38 (95% CI, 1.42-3.97, P = < 0.001), and relative risk 1.46 (95% CI, 1.19-1.68, P = < 0.001).

Conclusions: This is the first study to show an association between subpreputial penile wetness and HIV. Consideration should be given to providing advice about improving penile hygiene in uncircumcised men in areas where HIV is a significant problem. Good penile hygiene should also be promoted at the community level to become a desirable social norm.

From the *Pasteur Suite, Ealing Hospital, London, UK; †Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; and ‡Department of Medical Microbiology, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.

Received for publication February 11, 2006; accepted April 17, 2006.

Reprints: Nigel O'Farrell, MD, FRCP, Pasteur Suite, Ealing Hospital, Uxbridge Road, London UB1 3HW, UK (e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.