Genital ulcers: etiology, clinical diagnosis, and associated human immunodeficiency virus infection in Kingston, Jamaica

Individuals presenting consecutively with genital ulcers in Kingston, Jamaica, underwent serological testing for human immunodeficiency virus (HIV) infection , chlamydial infection, and syphilis. Ulcer material was analyzed by the multiplex polymerase chain reaction (M-PCR) analysis DNA from herpes simplex virus (HSV), Haemophilus ducreyi, and Treponema pallidum was detected in 158 (52.0 percent), 72 (23.7 percent), and 31 (10.2 percent) of 304 ulcer specimens. Of the 304 subjects, 67 (22 percent) were HIV-seropositive and 64 (21 percent) were T. pallidum-seroactive. Granuloma inguinale was clinically diagnosed in nine (13.4 percent) of 67 ulcers negative by M-PCR analysis and in 12 (5.1 percent) of 237 ulcers positive by M-PCR analysis (P = .03). Lymphogranuloma venereum was clinically diagnosed in eight patients. Compared with M-PCR analysis, the sensitivity and specificity of a clinical diagnosis of syphilis, herpes, and chancroid were 67.7 percent, 53.8 percent, and 75 percent and 91.2 percent, 83.6 percent, and 75.4 percent, respectively. Reactive syphilis serology was 74 percent sensitive and 85 percent specific compared with M-PCR analysis. Reported contact with a prostitute in the preceding 3 months was associated with chancroid (P = .009), reactive syphilis serology (P = .011), and HIV infection (P = .007). The relatively poor pleads for syndromic management of genital ulcers in Jamaica. Prevention efforts should be intensified.(Au)

A comparison of prevalence rates of genital ulcers among persons attending a sexually transmitted disease clinic in Jamaica

Two cross-sectional surveys were undertaken, from December 1982 to August 1983 and from November 1990 to January 1991, to estimate the prevalence rates of genital ulcer disease (GUD) in all patients presenting with a new sexually transmitted disease (STD) complaint to the STD clinic at the Comprehensive Health Centre in Kingston, Jamaica. Diagnosis of syphilis and human immunodeficiency virus (HIV) infection was based on results of laboratory tests, but diagnosis of other STDs was based on clinical features. Data from these two surveys were compared, and reported national annual incidence data for GUD reviewed. In 1982/83 6.8 percent of 23,050 patients had GUD, men (9.3 percent) more often than women (4.2 percent; p < 0.001). In 1990/91 the prevalence rate was 12.8 percent with increased rates for both men (18.2 percent) and women (6.8 percent; p < 0.001). In patients with GUD, a clinical diagnosis of genital herpes was made, in 1982/83 and 1990/91, respectively, in 16.8 percent and 7.8 percent of the patients; syphilis, in 12.9 percent and 18.8 percent; chancroid, in 12.4 percent and 13.3 percent; viral warts, in 5.7 percent and 6.3 percent; lymphogranuloma venereum, in 4.1 percent and 3.9 percent; and granuloma inguinale, in 3.6 percent and 2.3 percent. In men the rate for syphilis was 19 percent in 1990/91 and 8 percent in 1982/83 (p=0.001); and for genital herpes it was 7 percent in 1990/91 and 17 percent in 1982/83 (p=0.025). These reversals were attributed to intense media coverage of herpes in 1982/83. There was no difference in prevalence rates between the two surveys for these diseases in women, or for lymphogranuloma venereum, granuloma inguinale and genital warts in men and women. A clinical diagnosis could not be made in 44.4 percent of cases in 1982/83 (particularly in men), and in 47.6 percent of cases in 1990/91. GUDs faciltate transmission and adversely affect the prognosis of HIV. The increase in their prevalence has implications for the evolution of the local HIV epidemic, and should be addressed effectively by stregthening the STD/HIV control programme.(AU)

Rise in prevalence of genital ulcers among STD clinic attenders in Jamaica: significance for HIV transmission - abstract

Two cross-sectional surveys were undertaken to estimate the prevalence of genital ulcer disease (GUD) in all clients presenting at the Comprehensive Health Centre in Kingston, Jamaica with a new STD complaint. The first survey done in 1983 involved 23,050 clients (men 11,948; women 11,102). The second survey in 1990 involved 1,001 clients (men 517; women 484). All clients were screened for syphilis and in 1990 for HIV. Culture for herpes virus was done on a subsample of 103 persons seen in 1983, but in the main, diagnoses were clinical. In 1983, GUD was found in 1,571 clients, an overall prevalence of 6.8 percent (men 1,110, 9.3 percent; women 461, 4.2 percent). Of those with GUD, genital herpes was diagnosed in 267 (17 percent); syphilis in 203 (12.9 percent); chancroid in 195 (12.4 percent); viral warts in 89 (5.7 percent); lymphogranuloma venereum in 65 (4.1 percent) and granuloma inguinale in 55 (3.6 percent). A diagnosis could not be made in 697 (44.5 percent) cases. All conditions were significantly higher in men (p<0.001) except for syphilis which was higher in women (p<0.05) and viral warts, where there was no significant difference. In 1990, GUD was found in 128 clients, an overall prevalence of 12.8 percent (men 95, 18.2 percent; women 33, 6.8 percent). Of clients with GUD, syphilis was diagnosed in 24 (18.8 percent); chancroid in 17 (13.3 percent); genital herpes in 10 (7.8 percent); viral warts in 8 (6.3 percent); lymphogranuloma venereum in 5 (3.9 percent) and granuloma inguinale in 3 (2.3 percent). A diagnosis could not be made in 61/128, 47.6 percent of cases in 1990. The prevalence of HIV was 28/1,001 (3.2 percent). A significant association was found between GUD and HIV infection (men with current GUD: OR 7.3, CI1.4 - 72; women with history of "bad blood" (syphilis): OR 6.6, CI 1.3-30). Overall prevalence rates of GUD were significantly higher in 1990 than in 1983 for both sexes (p<0.001), as well as total rates for each sex (males p< 0.001, females p<0.004) (AU)

Genital herpes in Jamaica: a clinical and pathological study (1982-1984)

Five hundred and four patients with suspected genital herpes simplex virus (HSV) infection were investigated in Jamaica between 1982 and 1984. Of these, 100 (19.8 percent) were virologically confirmed. There were 12 patients with primary/first episode, 45 recurrent and 6 "provoked' type of genital herpes simplex virus infections. Genital herpes in women was more severe than in men. Eighty-eight per cent of genital herpes was confirmed by virus isolation. Forty HSV isolates were identified as HSV type 2. There was a sero-response in 75 percent primary, 18 percent recurrent and 17 percent provoked type of genital herpes. Virus isolation is the most sensitive and specific test for the diagnosis of genital herpes simplex virus infection. The measurement of serum anti herpes simplex complement-fixing antibodies was not useful in the diagnosis of suspected patients with genital ulcers and their contacts. The infectiousness of the virus, clinical manifestations, complications such as neonatal herpes infections, psychosocial problems and methods of prevention are issues that clinicians should discuss with patients with genital herpes (AU)

Influenza virus infections in Jamaica between 1977 and 1985

Data on influenza virus infections between 1977 and 1985 in Jamaica are presented. The occurrence of influenza varied each year. The peak incidence correlated generally with the peak occurrence of acute respiratory illness each year. The influenza-associated neurological (17 percent) and cardiac (9.7 percent) manifestations were seen during the period of study. Antigenic variants of influenza viruses circulating in Jamaica were similar to those recorded world-wide. Continuous virological and non-virological surveillance are vital in determining the impact of influenza on associated mortality and morbidity in a developing country like Jamaica. (AU)

Genital herpes in Jamaica: a clinical and laboratory study (1982-1984) - abstract

The prevalence of genital herpes simplex infection is unknown in Jamaica and in other Caribbean countries. From November 1982 to October 1984, 504 patients with suspected genital herpes simplex virus infection were investigated in Jamaica. Of these 100 (19.8 percent) were virologically confirmed. The confirmation rate was 21.3 percent in patients attending the sexually transmitted disease clinic and 16.8 percent of patients referred from private practitioners. Of the virologically confirmed cases, there were 12 patients with primary/first episode, 45 recurrent and 6 provoked type of genital herpes simplex virus infection. In 35 patients, the type was unknown. Symptoms of genital herpes were more severe in women than men. Genital herpes in women was accompanied by systematic symptoms (53 percent), local pain (70 percent), itching (46 percent) and genital ulcers (100 percent). There was a serological response in 75 percent primary, 18 percent recurrent and 17 percent provoked type of genital herpes simplex infections. Twenty herpes virus isolates were identified as Herpes simplex type 2 by indirect immunofluorescent antibody test. No Herpes simplex type I isolates were made. Virus isolation is the most sensitive and specific test for the diagnosis of genital herpes simplex virus infection. The measurement of serum anti-herpes simplex complement fixing antibodies was not useful in the diagnosis of suspected genital ulcer patients and their contacts. The presence of genital herpes in Jamaica should alert clinicians to the possibility of unrecognised neonatal Herpes infections and aseptic meningitis (AU)