RÉSUMÉ
BACKGROUND: Clinical diagnosis of genital ulcers is difficult, and diagnostic tests are least available in settings where rates of disease are highest. The World Health Organization (WHO) has developed protocols for the syndromic management of genital ulcers in resource-poor settings. However, because risk factors, patterns and causes of disease, and antimicrobial susceptibilities differ from region to region and over time, they must be adapted to local situations. GOAL: The goal of this study was to determine etiologic factors, evaluate syndromic management, and compare polymerase chain reaction (PCR) testing with other diagnostic alternatives for genital ulcers among patients attending sexually transmitted disease clinics in the Dominican Republic and Peru. STUDY DESIGN: Eighty-one men with genital ulcers in the Dominican Republic and 63 in Peru underwent identical interviews and identical multiplex PCR (M-PCR) tests of genital lesion specimens for etiologic diagnoses. Algorithms for managing genital ulcers were developed. RESULTS: In the Dominican Republic, 5% were M-PCR-positive for, 26% for, and 43% for herpes simplex virus (HSV); in Peru, 10%, 5%, and 43%, respectively, were positive. The WHO algorithm for treating syphilis and chancroid had a sensitivity of 100%, a positive predictive value (PPV) of 24%, and an overtreatment rate of 76%. A modified algorithm for treating only those without vesicular lesions had 88% sensitivity and a 27% PPV, and the overtreatment rate was reduced to 58%. CONCLUSION: HSV caused 43% of genital ulcers in these populations. The modified algorithm had lower sensitivity but a reduced overtreatment rate. M-PCR testing was more sensitive than standard tests and more specific and sensitive than clinical diagnosis.
Sujet(s)
Chancre mou/complications , Maladies de l'appareil génital mâle/étiologie , Maladies de l'appareil génital mâle/thérapie , Herpès génital/complications , Syphilis/complications , Ulcère/étiologie , Ulcère/thérapie , Adolescent , Adulte , Antibactériens/usage thérapeutique , Chancre mou/diagnostic , Chancre mou/épidémiologie , ADN bactérien/analyse , ADN viral/analyse , République dominicaine/épidémiologie , Maladies de l'appareil génital mâle/épidémiologie , Herpès génital/diagnostic , Herpès génital/épidémiologie , Humains , Mâle , Adulte d'âge moyen , Pérou/épidémiologie , Réaction de polymérisation en chaîne , Prévalence , Sensibilité et spécificité , Syphilis/diagnostic , Syphilis/épidémiologie , Ulcère/épidémiologieRÉSUMÉ
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 multiplex polymerase chain reaction (M-PCR) analysis. DNA from herpes simplex virus (HSV), Haemophilus ducreyi, and Treponema pallidum was detected in 158 (52.0%), 72 (23.7%), and 31 (10.2%) of 304 ulcer specimens. Of the 304 subjects, 67 (22%) were HIV-seropositive and 64 (21%) were T. pallidum-seroreactive. Granuloma inguinale was clinically diagnosed in nine (13.4%) of 67 ulcers negative by M-PCR analysis and in 12 (5.1%) 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%, 53.8%, and 75% and 91.2%, 83.6%, and 75.4%, respectively. Reactive syphilis serology was 74% sensitive and 85% 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 accuracy of clinical and locally available laboratory diagnoses pleads for syndromic management of genital ulcers in Jamaica. Prevention efforts should be intensified.
Sujet(s)
Maladies de l'appareil génital féminin/microbiologie , Maladies de l'appareil génital mâle/microbiologie , Infections à VIH/complications , Ulcère/microbiologie , Adulte , Chancre mou/complications , Chancre mou/diagnostic , Femelle , Maladies de l'appareil génital féminin/complications , Maladies de l'appareil génital féminin/diagnostic , Maladies de l'appareil génital mâle/complications , Maladies de l'appareil génital mâle/diagnostic , VIH-1 (Virus de l'Immunodéficience Humaine de type 1) , VIH-2 (Virus de l'Immunodéficience Humaine de type 2) , Haemophilus ducreyi/isolement et purification , Herpès génital/complications , Herpès génital/diagnostic , Humains , Jamaïque , Lymphogranulomatose vénérienne/complications , Lymphogranulomatose vénérienne/diagnostic , Mâle , Réaction de polymérisation en chaîne , Prévalence , Facteurs de risque , Sensibilité et spécificité , Simplexvirus/isolement et purification , Syphilis/complications , Syphilis/diagnostic , Treponema pallidum/isolement et purification , Ulcère/complicationsRÉSUMÉ
BACKGROUND AND OBJECTIVES: A better knowledge of gross and microscopic features in chancroid are important in this increased frequency disease. STUDY DESIGN: Two biopsies were taken from each one of 200 culture-proven cases of chancroid, and studied through different stains. RESULTS: The ratio male/female was 15.7/1, and adenopathies were found in 87%. Biopsies showed edema, lymphohistiocytic inflammation and fibrinoid vasculitis, as well as the presence of numerous eosinophils and Russell bodies. CONCLUSION: Biopsy should be considered as an important tool for the diagnostic of chancroid.