Aetiology of genital ulcer disease in patients attending an STD clinic in Kingston, Jamaica

ABSTRACT

The purpose of this study was to determine the aetiology of genital ulcers (GUD) in STD clinic attenders, using state-of-the-art diagnostic tests, and to compare this with clinical diagnosis. Patients attending an STD clinic in Kingston, Jamaica for a new STD complaints were screened for GUD and clinically diagnosed. Swabs of ulcers were taken and tested for T. pallidum (TP), herpes simplex virus (HSV), and H. ducreyi (HD), using polymerase chain reaction (PCR). Sera were tested for syphilis and HIV infection. Of 4873 patients screened, 304 (6.2 percent) had GUD. In patients with ulcers, 158 (52 percent) were HSV (+), 73 (24 percent) were HD (+), and 31 (10 percent) were TP (+). Dual infections were identified in 20 (7 percent) ulcers. Clinically, herpes was diagnosed in 85/158 (54 percent) of HSV (+) ulcers, chancroid in 54/72 (75 percent) of HD (+) ulcers, and syphilis in 21/31 (68 percent) of TP (+) ulcers. Over three-quarters of GUD in Kingston had defined aetiology for herpes, chancroid or syphilis using PCR, with herpes being the commonest. Uniformly, clinical diagnosis performed poorly and Jamaican algorithms for the management of GUD will need to take into account the findings of this study, and should include counselling for herpes.(AU)