Chancroid, primary syphilis, genital herpes, and lymphogranuloma venereum in Antananarivo, Madagascar.
Ulcer material from consecutive patients attending clinics in Antananarivo, Madagascar, was tested using multiplex polymerase chain reaction (M-PCR) to detect Treponema pallidum, Haemophilus ducreyi, and herpes simplex virus. Sera were tested for syphilis and for IgG and IgM antibodies to Chlamydia trachomatis by microimmunofluorescence testing (MIF). By M-PCR, 33% of 196 patients had chancroid, 29% had syphilitic ulcers, and 10% had genital herpes; 32% of the ulcer specimens were M-PCR negative. Compared with M-PCR, syphilis serology was 72% sensitive and 83% specific. The sensitivity of clinical diagnosis of syphilis, chancroid, and genital herpes was 93%, 53%, and 0% and specificity was 20%, 52%, and 99%, respectively. Less schooling was associated with increased prevalence of syphilitic ulcers (P=.001). Sixteen patients (8%) were clinically diagnosed with lymphogranuloma venereum (LGV); 1 plausible case of LGV was found by MIF. In Madagascar, primary care of genital ulcers should include syndromic treatment for syphilis and chancroid.
Behets
F M
FM
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7030, USA. behetsf@aol.com
Andriamiadana
J
J
Randrianasolo
D
D
Randriamanga
R
R
Rasamilalao
D
D
Chen
C Y
CY
Weiss
J B
JB
Morse
S A
SA
Dallabetta
G
G
Cohen
M S
MS
D000328:Adult; D002602:Chancroid / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006191:Haemophilus ducreyi / Q000302:isolation & purification; D006558:Herpes Genitalis / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008219:Lymphogranuloma Venereum / Q000175:diagnosis / Q000453:epidemiology*; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D016133:Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D018139:Simplexvirus / Q000302:isolation & purification; D012959:Socioeconomic Factors; D013587:Syphilis / Q000175:diagnosis / Q000453:epidemiology*; D014210:Treponema pallidum / Q000302:isolation & purification; D014456:Ulcer / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology