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Figure 2-4 Causes of STD-related deaths among U.S. women, 1992. SOURCE: Ebrahim SH, Peterman TA, Zaidi AA, Kamb ML. Mortality related to sexually transmitted diseases in women, U.S., 1973-1992. Proceedings of the Eleventh Meeting of the International Society for STD Research, August 27-30, 1995, New Orleans, LA [abstract no. 343]. ulcers and HIV infection (Kreiss et al., 1986; Greenblatt et al., 1988), but cohort studies were required to assess the temporal relationship between STDs and acquisition of HIV infection and to prospectively obtain other data that might explain away the apparent association. An extensive 1991 review article (Wasserheit, 1992) found that, of 15 studies that had prospectively analyzed the association between STDs and HIV infection, 3 (Cameron et al., 1989; Plummer et al., 1991; Laga et al., 1993) were designed to allow both accurate ascertainment of the occurrence of an STD prior to HIV infection and adjustment for potential confounding by sexual behaviors and condom use. As summarized in Table 2-4, three prospective cohort studies in Africa have demonstrated increased risk of HIV infection following genital ulcer disease among heterosexual men (Cameron et al., 1989) and among female sex workers3
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