title: Etiologic pattern of genital ulcers in Lusaka, Zambia: has chancroid been eliminated?
abstract: BACKGROUND
  Genital ulcers are a public health problem in developing countries. The World Health Organization recommends the use of syndromic guidelines for sexually transmitted infection treatment in resource-constrained countries. Monitoring local etiologies provides information that may aid policy for sexually transmitted infection treatment. We investigated the etiology of genital ulcer disease among outpatients in Lusaka, Zambia.
  
  
  METHODS
  Swabs from genital ulcers of 200 patients were tested using polymerase chain reaction for Treponema pallidum, herpes simplex virus types 1 (HSV-1) and 2 (HSV-2), Haemophilus ducreyi, and Chlamydia trachomatis.
  
  
  RESULTS
  The prevalence of the detected pathogens was as follows; HSV-2, 28%; T. pallidum, 11.5%; C. trachomatis, 3%; HSV-1, 0.5%; and H. ducreyi, 0%. Coinfection with HSV-2 and T. pallidum was 1.5%, and coinfection of HSV-2 and C. trachomatis was 1%. In 55% of the patients, no etiologic diagnosis could be established.
  
  
  CONCLUSIONS
  H. ducreyi was not detected, whereas HSV-2 and T. pallidum were the commonest pathogens. Nondetection of H. ducreyi requires further studies. If the present findings are validated, treatment guidelines would require to be revised in Zambia.
authors.affiliation: Lusaka District Health Management Team, Ministry of Health, Lusaka, Zambia. Mpundu.Makasa@cih.uib.no
authors.forename: Mpundu
authors.initials: M
authors.lastname: Makasa
authors.forename: Anne
authors.initials: A
authors.lastname: Buve
authors.forename: Ingvild Fossgard
authors.initials: IF
authors.lastname: Sandøy
mesh_terms: D000293:Adolescent; D000328:Adult; D002602:Chancroid / Q000150:complications* / Q000453:epidemiology; D002690:Chlamydia Infections / Q000150:complications* / Q000453:epidemiology; D002692:Chlamydia trachomatis / Q000472:pathogenicity; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology / Q000209:etiology*; D005832:Genital Diseases, Male / Q000453:epidemiology / Q000209:etiology*; D006191:Haemophilus ducreyi / Q000472:pathogenicity; D006558:Herpes Genitalis / Q000150:complications* / Q000453:epidemiology; D006561:Herpes Simplex / Q000150:complications* / Q000453:epidemiology; D018259:Herpesvirus 1, Human / Q000472:pathogenicity; D018258:Herpesvirus 2, Human / Q000472:pathogenicity; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction; D011159:Population Surveillance; D015995:Prevalence; D013587:Syphilis / Q000150:complications* / Q000453:epidemiology; D014210:Treponema pallidum / Q000472:pathogenicity; D014456:Ulcer / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000821:virology; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology