Etiology of urethral discharge in West Africa: the role of Mycoplasma genitalium and Trichomonas vaginalis.

OBJECTIVE: To determine the etiological role of pathogens other than Neisseria gonorrhoeae and Chlamydia trachomatis in urethral discharge in West African men. METHODS: Urethral swabs were obtained from 659 male patients presenting with urethral discharge in 72 primary health care facilities in seven West African countries, and in 339 controls presenting for complaints unrelated to the genitourinary tract. Polymerase chain reaction analysis was used to detect the presence of N. gonorrhoeae, C. trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, and Ureaplasma urealyticum. FINDINGS: N. gonorrhoeae, T. vaginalis, C. trachomatis, and M. genitalium--but not U. urealyticum--were found more frequently in men with urethral discharge than in asymptomatic controls, being present in 61.9%, 13.8%, 13.4% and 10.0%, respectively, of cases of urethral discharge. Multiple infections were common. Among patients with gonococcal infection, T. vaginalis was as frequent a coinfection as C. trachomatis. M. genitalium, T. vaginalis, and C. trachomatis caused a similar clinical syndrome to that associated with gonococcal infection, but with a less severe urethral discharge. CONCLUSIONS: M. genitalium and T. vaginalis are important etiological agents of urethral discharge in West Africa. The frequent occurrence of multiple infections with any combination of four pathogens strongly supports the syndromic approach. The optimal use of metronidazole in flowcharts for the syndromic management of urethral discharge needs to be explored in therapeutic trials.

A survey of leprosy impairments and disabilities among patients treated by MDT in Burkina Faso.

Since 1990, Burkina Faso, a West African country, has carried out a national leprosy control program treating with WHO/MDT nearly 12,000 patients between 1990 and 1994. A sample survey of 600 cases among these patients showed that 29.8% were disabled cases. There was a predominance of males, older patients, the multibacillary form of leprosy, and former cases treated with dapsone before MDT. The actual rate increased 8.5% compared to the frequency of disabilities at detection (21.3%). The need for disability care was estimated, respectively, at 24.4% and 5% for primary and secondary grades of disability. These important needs were so great that the authors recommend the planning and initiation of a physical rehabilitation and disability prevention program in this country.