HIV in sub-Saharan Africa is almost exclusively transmitted by heterosexual sex. Prospective randomized clinical trials (RCTs) in Africa, including 2 conducted by Hopkins researchers in Uganda, demonstrate that adult male circumcision reduces HIV acquisition by 60% and herpes simplex virus-2 (HSV-2) acquisition."""""""" Little is known about the immunology and pathophysiology of the foreskin. We propose to describe the immunology of foreskin inflammation and assess its role in HIV and HSV-2 acquisition and transmission using data and foreskin specimens obtained from the circumcision RCTs. The Hopkins Uganda circumcision trials enrolled both HIV+ and HIV--index male subjects and their female partners and archived the surgical foreskin specimens. With this repository, we have a unique opportunity to evaluate this hypothesis and to understand inflammation in the foreskin. The K23 candidate, Dr. Kristine Johnson, has specific interests in HIV immunology and sexually transmitted infections. The proposal provides for structured training and mentorship support to develop a translational research program to explore these relationships. Using methods already developed by Dr. Johnson, she will define local lymphocyte populations within the foreskin tissues, by confocal microscopy and immunohistochemistry. Using tissue PCR, she will quantify and characterize associated inflammation patterns and tissue HIV and HSV-2 viral content. After this work is completed, using the rich data collected on index subjects and partners, she will assess the impact of the foreskin cellular components on HIV acquisition events among initially HIV-uninfected men and the impact of foreskin cellular and viral components on HIV transmission events to serodiscordant female partners. Kristine Johnson, MD, joined the faculty of Johns Hopkins University Division of Infectious Diseases in July 2008. This application integrates epidemiology and immunological approaches using a unique sample set to answer critical questions in HIV/HSV-2 transmission. There is an especially strong mentorship team of experts in HIV/STI transmission and prevention, including Drs. Jonathan Zenilman, Ronald Gray and Thomas Quinn.

Public Health Relevance

As a beginning, we propose here to evaluate relationships between foreskin inflammation, epithelial lymphocyte populations, cytokines and HIV and HSV-2 infection and transmission. The results of this work will lead to a better understanding of the male foreskin immune milieu and may inform the development of new modalities for targeted HIV and STI prevention.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
Application #
Study Section
Acquired Immunodeficiency Syndrome Research Review Committee (AIDS)
Program Officer
Elharrar, Vanessa
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Johns Hopkins University
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
Smith, Maria Elisa; Robinowitz, Natanya; Chaulk, Patrick et al. (2015) High rates of abscesses and chronic wounds in community-recruited injection drug users and associated risk factors. J Addict Med 9:87-93
Smith, Maria Elisa; Robinowitz, Natanya; Chaulk, Patrick et al. (2014) Self-care and risk reduction habits in older injection drug users with chronic wounds: a cross-sectional study. Harm Reduct J 11:28
Smith, Maria Elisa; Robinowitz, Natanya; Chaulk, Patrick et al. (2014) Comparison of chronic wound culture techniques: swab versus curetted tissue for microbial recovery. Br J Community Nurs Suppl:S22-6
Robinowitz, Natanya; Smith, Maria Elisa; Serio-Chapman, Chris et al. (2014) Wounds on wheels: implementing a specialized wound clinic within an established syringe exchange program in Baltimore, Maryland. Am J Public Health 104:2057-9
Johnson, K E; Kiyatkin, D E; An, A T et al. (2012) PCR offers no advantage over culture for microbiologic diagnosis in cellulitis. Infection 40:537-41
Johnson, Kristine E; Redd, Andrew D; Quinn, Thomas C et al. (2011) Effects of HIV-1 and herpes simplex virus type 2 infection on lymphocyte and dendritic cell density in adult foreskins from Rakai, Uganda. J Infect Dis 203:602-9