title: Comparison of clinical diagnosis and standard laboratory and molecular methods for the diagnosis of genital ulcer disease in Lesotho: association with human immunodeficiency virus infection.
abstract: A multiplex polymerase chain reaction (M-PCR) assay for Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus (HSV) was compared with clinical and standard laboratory methods for the diagnosis of genital ulcer disease (GUD) in 105 patients; 36% were human immunodeficiency virus (HIV)-seropositive. Chancroid (80%), syphilis (8%), and genital herpes (8%) were the most frequent diagnoses. H. ducreyi and HSV were isolated from ulcers of 43% and 18% of patients, respectively; in 35%, all cultures were negative and the laboratory diagnosis indeterminate. M-PCR detected H. ducreyi, T. pallidum, and HSV in 56%, 23%, and 26% of patients, respectively; (no definitive diagnosis, 6%). The proportion of patients with more than one agent was 4% by culture and 17% by M-PCR (P = .002). Resolved sensitivities of M-PCR for H. ducreyi and HSV cultures were 95% and 93%, respectively. The sensitivities of H. ducreyi and HSV cultures were 75% and 60%, respectively. HSV, detected in 47% of specimens from HIV-infected versus 16% from HIV-uninfected patients (P < .001), may be emerging as a more frequent cause of GUD.
authors.affiliation: Division of AIDS, Sexually Transmitted Diseases and Tuberculosis Laboratory Research, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Morse
authors.forename: D L
authors.initials: DL
authors.lastname: Trees
authors.forename: Y
authors.initials: Y
authors.lastname: Htun
authors.forename: F
authors.initials: F
authors.lastname: Radebe
authors.forename: K A
authors.initials: KA
authors.lastname: Orle
authors.forename: Y
authors.initials: Y
authors.lastname: Dangor
authors.forename: C M
authors.initials: CM
authors.lastname: Beck-Sague
authors.forename: S
authors.initials: S
authors.lastname: Schmid
authors.forename: G
authors.initials: G
authors.lastname: Fehler
authors.forename: J B
authors.initials: JB
authors.lastname: Weiss
authors.forename: R C
authors.initials: RC
authors.lastname: Ballard
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D002602:Chancroid / Q000150:complications / Q000175:diagnosis; D004269:DNA, Bacterial / Q000032:analysis; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis* / Q000382:microbiology; D005832:Genital Diseases, Male / Q000175:diagnosis* / Q000382:microbiology; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D006191:Haemophilus ducreyi / Q000235:genetics; D006558:Herpes Genitalis / Q000276:immunology; D006801:Humans; D007927:Lesotho; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D018139:Simplexvirus / Q000235:genetics / Q000276:immunology; D013587:Syphilis / Q000150:complications / Q000175:diagnosis; D014210:Treponema pallidum / Q000235:genetics; D014456:Ulcer / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology
chemical_list: D000914:Antibodies, Viral; D004269:DNA, Bacterial; D004279:DNA, Viral