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Etiology of genital ulcer disease in a sexually transmitted infection reference center in Manaus, Brazilian Amazon.

AbstractOBJECTIVES:
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.
AuthorsFelipe Gomes Naveca, Meritxell Sabidó, Tatiana Amaral Pires de Almeida, Elaine Araújo Veras, Matilde Del Carmen Contreras Mejía, Enrique Galban, Adele Schwartz Benzaken
JournalPloS one (PLoS One) Vol. 8 Issue 5 Pg. e63953 ( 2013) ISSN: 1932-6203 [Electronic] United States
PMID23704961 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Topics
  • Adult
  • Brazil (epidemiology)
  • Demography
  • Female
  • Humans
  • Male
  • Multiplex Polymerase Chain Reaction
  • Prevalence
  • Risk Factors
  • Sexually Transmitted Diseases (blood, epidemiology, microbiology, virology)
  • Simplexvirus (genetics)
  • Syphilis (blood, microbiology, virology)
  • Treponema pallidum (genetics)
  • Young Adult

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