title: Etiology of genital ulcer disease in a sexually transmitted infection reference center in Manaus, Brazilian Amazon.
abstract: OBJECTIVE
  To determine the etiology and factors associated with genital ulcer disease (GUD) among patients presenting to a sexually transmitted infections clinic in Manaus, Brazil; and to compare a multiplex polymerase chain reaction (M-PCR) assay for the diagnosis of GUD with standard methods.
  
  
  METHODS
  Ulcer swabs were collected and used for Tzanck test and processed in an M-PCR to detect herpes simplex virus (HSV-1/2), Treponema pallidum (T. pallidum), and Haemophilus ducreyi (H. ducreyi). Sera were tested for HIV and syphilis antibodies. Multivariable analysis was used to measure the association between clinical aspects and GUD. M-PCR results were compared with syphilis serology and Tzanck tests.
  
  
  RESULTS
  Overall, 434 GUD samples were evaluated, 84.8% from men. DNA from HSV-2 was detected in 55.3% of GUD samples, T. pallidum in 8.3%, HSV-1 in 3.2%, and 32.5% of GUD specimens were negative for the DNA of all three pathogens. No cases of H. ducreyi were identified. HIV serology among GUD patients was 3.2%. Treponemal antibodies and Tzanck test positivity for genital herpes was detected in 25 (5.8%) and in 125 (30.3%) of GUD patients, respectively. In multivariable analysis genital herpes etiology by M-PCR was associated with the vesicular, multiple and recurrent lesions whereas T. pallidum with non-vesicular, non-recurrent lesions. Compared to M-PCR, syphilis serology was 27.8% sensitive and 96.2% specific whereas Tzanck test was 43.8% sensitive and 88.9% specific.
  
  
  CONCLUSIONS
  The predominance of genital herpes etiology suggests a revision of existing national syndromic treatment guidelines in Brazil to include antiherpetic treatment for all GUD patients. The use of M-PCR can significantly improve the diagnosis of GUD and provide a greater sensitivity than standard diagnostics.
authors.affiliation: Fundação Alfredo da Matta, Manaus, Brazil ; Instituto Leônidas e Maria Deane - Fiocruz Amazônia, Manaus, Brazil.
authors.forename: Felipe
authors.initials: F
authors.lastname: Gomes Naveca
authors.forename: Meritxell
authors.initials: M
authors.lastname: Sabidó
authors.forename: Tatiana
authors.initials: T
authors.lastname: Amaral Pires de Almeida
authors.forename: Elaine
authors.initials: E
authors.lastname: Araújo Veras
authors.forename: Matilde Del Carmen
authors.initials: Mdel C
authors.lastname: Contreras Mejía
authors.forename: Enrique
authors.initials: E
authors.lastname: Galban
authors.forename: Adele Schwartz
authors.initials: AS
authors.lastname: Benzaken
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D060885:Multiplex Polymerase Chain Reaction; D015995:Prevalence; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000097:blood / Q000453:epidemiology / Q000382:microbiology* / Q000821:virology*; D018139:Simplexvirus / Q000235:genetics; D013587:Syphilis / Q000097:blood / Q000382:microbiology / Q000821:virology; D014210:Treponema pallidum / Q000235:genetics; D055815:Young Adult