Chancroid, Primary Syphilis, Genital Herpes, and Lymphogranuloma Venereum in Antananarivo, Madagascar

Chancroid, Primary Syphilis, Genital Herpes, and Lymphogranuloma Venereum in Antananarivo, Madagascar

Frieda M.-T. Behets,1,2 Jocelyne Andriamiadana,3 Daudet Randrianasolo,3 René Randriamanga,4 Désiré Rasamilalao,3 Cheng-Yen Chen,4 Judith B. Weiss,5 Stephen A. Morse,4 Gina Dallabetta,6 and Myron S. Cohen1 1Department of Medicine, University of North Carolina at Chapel Hill; 2Yale School of Public Health, New Haven, Connecticut; 3Institut d'Hygiène Sociale, Ministry of Health, Antananarivo, Madagascar; 4Centers for Disease Control and Prevention, Atlanta, Georgia; 5Roche Molecular Systems, Alameda, California; 6AIDS Control and Prevention Project, Family Health International, Arlington, Virginia Received 29 January 1999; revised 8 April 1999; electronically published 20 August 1999.

Ulcer material from consecutive patients attending clinics in Antananarivo, Madagascar, was tested using multiplex polymerase chain reaction (M-PCR) to detect Treponema pallidum, Haemophilus ducreyi, and herpes simplex virus. Sera were tested for syphilis and for IgG and IgM antibodies to Chlamydia trachomatis by microimmunofluorescence testing (MIF). By M-PCR, 33% of 196 patients had chancroid, 29% had syphilitic ulcers, and 10% had genital herpes; 32% of the ulcer specimens were M-PCR negative. Compared with M-PCR, syphilis serology was 72% sensitive and 83% specific. The sensitivity of clinical diagnosis of syphilis, chancroid, and genital herpes was 93%, 53%, and 0% and specificity was 20%, 52%, and 99%, respectively. Less schooling was associated with increased prevalence of syphilitic ulcers (P = .001). Sixteen patients (8%) were clinically diagnosed with lymphogranuloma venereum (LGV); 1 plausible case of LGV was found by MIF. In Madagascar, primary care of genital ulcers should include syndromic treatment for syphilis and chancroid.

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