Sexually transmitted diseases and human immunodeficiency virus control in Malawi: a field study of genital ulcer disease.
Men with genital ulcer disease (GUD) attending a clinic in Malawi were evaluated and treated with one of five drug regimens. Haemophilus ducreyi was isolated from 204 (26.2%) of 778 patients. Of 677 men, 198 (29.2%) had treponemes detected in ulcer material by direct immunofluorescence or had rapid plasma reagin reactivity of > or = 1:8. Human immunodeficiency virus type 1 (HIV-1) seroprevalence was 58.9% overall and 75.8% among patients reporting a history of GUD (P < .001). By logistic regression analysis, HIV-1 seropositivity was shown to impair ulcer healing (P = .003). Treatment failure rates for culture-proven chancroid were 19% for trimethoprim-sulfamethoxazole, 12.9% and 7.4%, respectively, for low- and high-dose erythromycin regimens, and 8.3% and 0, respectively, for low- and high-dose ciprofloxacin regimens. Herpes antigen was detected by EIA in 6 (23.1%) of 26 nonhealing ulcers. In Malawi, GUD should be managed as a syndrome to assure treatment of both syphilis and chancroid.
Department of Medicine, University of North Carolina, Chapel Hill 27599.
F M
FM
Behets
G
G
Liomba
G
G
Lule
G
G
Dallabetta
I F
IF
Hoffman
H A
HA
Hamilton
S
S
Moeng
M S
MS
Cohen
D002602:Chancroid / Q000188:drug therapy / Q000453:epidemiology*; D002939:Ciprofloxacin / Q000627:therapeutic use; D004917:Erythromycin / Q000627:therapeutic use; D005832:Genital Diseases, Male / Q000188:drug therapy / Q000453:epidemiology*; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D010401:Penicillin G Benzathine; D012883:Skin Ulcer / Q000188:drug therapy / Q000453:epidemiology*; D013420:Sulfamethoxazole / Q000627:therapeutic use; D013587:Syphilis / Q000188:drug therapy / Q000453:epidemiology*; D014295:Trimethoprim / Q000627:therapeutic use
D002939:Ciprofloxacin; D004917:Erythromycin; D014295:Trimethoprim; D013420:Sulfamethoxazole; D010401:Penicillin G Benzathine