Bullous impetigo in homosexual men - A risk marker for HIV-1 infection?

Abstract

Objective - To determine the incidence of bullous impetigo in a group of homosexual men at high risk of HIV-1 infection. Design - A longitudinal descriptive study (1984-9). Setting - A private primary care and STD clinic in Sydney, Australia. Subjects - 88 homosexual men documented to seroconvert to HIV-1, and 37 homosexual controls who had practised unprotected anal intercourse with another man known to be HIV-1 positive but who remained HIV-1 negative. Main outcome measure - Incidence of bullous impetigo. Results - The crude annual incidence of bullous impetigo was 0.015 in subjects while they remained HIV-1 negative (10 cases) and 0.045 in early HIV-1 positive subjects (2 cases). Overall, 9% of the HIV-1 seroconverters and 9% of the HIV-1 negative controls were documented as suffering bullous impetigo over a mean of 29.2 and 39.3 months, respectively. Conclusions - Bullous impetigo in an adult could prove to be a clinical indication that a person is either infected with HIV-1 or is in close (possibly sexual) contact with a person with HIV-1 infection. If true, the recognition of bullous impetigo could provide an opportunity for behavioural intervention to limit the spread of HIV-1.