The etiology and management of genital ulcers in the Dominican Republic and Peru.
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.


OBJECTIVE
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.


METHODS
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%.


CONCLUSIONS
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.
Sanchez
Jorge
J
Universidad Peruana Cayetano Heredia School of Public Health and Administration, Lima, Peru.
Volquez
Claudio
C
Totten
Patricia A
PA
Campos
Pablo E
PE
Ryan
Caroline
C
Catlin
Mary
M
Hasbun
Julia
J
Rosado De Quiñones
Margarita
M
Sanchez
Cesar
C
De Lister
Martha Butler
MB
Weiss
Judith B
JB
Ashley
Rhoda
R
Holmes
King K
KK
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002602:Chancroid / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D004269:DNA, Bacterial / Q000032:analysis; D004279:DNA, Viral / Q000032:analysis; D004293:Dominican Republic / Q000453:epidemiology; D005832:Genital Diseases, Male / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D006558:Herpes Genitalis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010568:Peru / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012680:Sensitivity and Specificity; D013587:Syphilis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D014456:Ulcer / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D004279:DNA, Viral