title: Chancroid, primary syphilis, genital herpes, and lymphogranuloma venereum in Antananarivo, Madagascar.
abstract: 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.
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7030, USA. behetsf@aol.com
authors.forename: F M
authors.initials: FM
authors.lastname: Behets
authors.forename: J
authors.initials: J
authors.lastname: Andriamiadana
authors.forename: D
authors.initials: D
authors.lastname: Randrianasolo
authors.forename: R
authors.initials: R
authors.lastname: Randriamanga
authors.forename: D
authors.initials: D
authors.lastname: Rasamilalao
authors.forename: C Y
authors.initials: CY
authors.lastname: Chen
authors.forename: J B
authors.initials: JB
authors.lastname: Weiss
authors.forename: S A
authors.initials: SA
authors.lastname: Morse
authors.forename: G
authors.initials: G
authors.lastname: Dallabetta
authors.forename: M S
authors.initials: MS
authors.lastname: Cohen
mesh_terms: 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