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Sex Transm Dis. 2013 Dec;40(12):923-8. doi: 10.1097/OLQ.0000000000000051.

Etiology of genital ulcer disease and association with HIV infection in Malawi.

Author information

1
From the *Lighthouse Centre, Lilongwe, Malawi; †University of North Carolina, Chapel Hill, NC; ‡Infectious Disease Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, UK; §University of North Carolina Project, Lilongwe, Malawi; §Centres for Disease Control and Prevention, Atlanta, GA; and ¶Clinical Research Unit, London School of Hygiene & Tropical Medicine, London, UK.

Abstract

BACKGROUND:

The World Health Organization recommends the use of syndromic management for patients presenting with genital ulcer disease (GUD) in developing countries. However, effective treatment guidelines depend on a current country-specific GUD etiological profile, which may change over time.

METHODS:

From 2004 to 2006, we conducted a cross-sectional analysis of baseline data from patients presenting with GUD at a reference STI clinic in Lilongwe, Malawi. Participants were enrolled in a randomized clinical trial of acyclovir added to syndromic management and followed up for up to 28 days. Serologies for HIV (using parallel rapid tests), herpes simplex virus type 2 (HSV-2; using Focus HerpeSelect IgG2 ELISA [Focus Technologies, Cypress Hill, CA]), and syphilis (rapid plasma reagin confirmed by Treponema pallidum hemagglutination) were determined, with plasma HIV-1 RNA and CD4 count in HIV-positive patients. Genital ulcer disease etiology was determined by real-time multiplex polymerase chain reaction from lesional swabs.

RESULTS:

A total of 422 patients with GUD (313 men; 74%) were enrolled. Overall seroprevalence of HIV-1, HSV-2, and syphilis were 61%, 72%, and 5%, respectively. Ulcer etiology was available for 398 patients and showed the following: HSV-2, 67%; Haemophilus ducreyi, 15%; T. pallidum, 6%; lymphogranuloma venereum, 6%; mixed infections, 14%, and no etiology, 20%. Most HSV-2 ulcers were recurrent (75%). Among all patients with HSV-2, HIV prevalence was high (67%) and HIV seroprevalence was higher among patients with recurrent HSV-2 compared with patients with first-episode HSV-2 (78% vs. 39%, P < 0.001).

CONCLUSIONS:

Herpes simplex virus type 2 ulcers are highly prevalent in this symptomatic population and strongly associated with HIV. Unlike most locations in sub-Saharan Africa, H. ducreyi remains prevalent in this population and requires periodic monitoring and an appropriate treatment regimen.

PMID:
24220352
DOI:
10.1097/OLQ.0000000000000051
[Indexed for MEDLINE]

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