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Comparison of clinically directed, disease specific, and syndromic protocols for the management of genital ulcer disease in Lesotho.
Sex Transm Infect. 1998 Jun; 74 Suppl 1:S23-8.ST

Abstract

OBJECTIVE

To evaluate two protocols for the syndromic management of genital ulcer disease (GUD) in Lesotho, southern Africa and to compare the performance of these protocols with that of a conventional disease specific approach.

METHODS

A cross sectional study was conducted among consecutive patients with GUD attending an STD clinic in Maseru, Lesotho. The clinical diagnoses were made by using predefined criteria at the initial visit before the performance of laboratory tests. Attempts were made to detect the specific aetiology of the genital ulcers using PCR assays and syphilis serology. The results of PCR assays and syphilis serology were used as the gold standard against which the performance of the management approaches were applied.

RESULTS

Of 100 patients initially recruited into the study, Haemophilus ducreyi infection was detected in 56%, herpes simplex virus in 26%, Treponema pallidum in 23%, and lymphogranuloma venereum in 7%. No pathogens were detected in 6% of patients. 17% of patients had mixed infections. Sensitivity, specificity, positive and negative predictive values of the three management protocols for GUD were compared after applying each to the study population. Theoretically, the lowest correct treatment rate would have been obtained by using the disease specific protocol (62%) compared with more than 90% in both syndromic management protocols. Considerable overtreatment for primary syphilis would occur following application of both syndromic protocols. This would be the result of the overdiagnosis of chancroid, in particular the misdiagnosis of genital herpes as chancroid, which would receive treatment for syphilis unnecessarily. The HIV seroprevalence among these patients was 36%. A significantly higher rate of HIV seropositivity was detected among the patients with herpes simplex virus infection when compared with those patients having other causes of genital ulcer disease (58% v 27%; odds ratio 3.73; 95% CI 1.26-11.26; p = 0.01).

CONCLUSIONS

Poor sensitivity, specificity, and predictive values were recorded when the disease specific protocol was applied to the study population. In contrast, the syndromic management protocols provided adequate treatment for more than 90% of patients with GUD. Protocol C, which identified a minority of cases of genital herpes, was found to have an advantage when compared with protocol B (all patients with genital ulcer disease treated for both syphilis and chancroid) in that 29% of genital herpes cases would receive appropriate counselling.

Authors+Show Affiliations

National Reference Centre for Sexually Transmitted Diseases, School of Pathology, South African Institute for Medical Research, Johannesburg, South Africa.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10023349

Citation

Htun, Y, et al. "Comparison of Clinically Directed, Disease Specific, and Syndromic Protocols for the Management of Genital Ulcer Disease in Lesotho." Sexually Transmitted Infections, vol. 74 Suppl 1, 1998, pp. S23-8.
Htun Y, Morse SA, Dangor Y, et al. Comparison of clinically directed, disease specific, and syndromic protocols for the management of genital ulcer disease in Lesotho. Sex Transm Infect. 1998;74 Suppl 1:S23-8.
Htun, Y., Morse, S. A., Dangor, Y., Fehler, G., Radebe, F., Trees, D. L., Beck-Sague, C. M., & Ballard, R. C. (1998). Comparison of clinically directed, disease specific, and syndromic protocols for the management of genital ulcer disease in Lesotho. Sexually Transmitted Infections, 74 Suppl 1, S23-8.
Htun Y, et al. Comparison of Clinically Directed, Disease Specific, and Syndromic Protocols for the Management of Genital Ulcer Disease in Lesotho. Sex Transm Infect. 1998;74 Suppl 1:S23-8. PubMed PMID: 10023349.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of clinically directed, disease specific, and syndromic protocols for the management of genital ulcer disease in Lesotho. AU - Htun,Y, AU - Morse,S A, AU - Dangor,Y, AU - Fehler,G, AU - Radebe,F, AU - Trees,D L, AU - Beck-Sague,C M, AU - Ballard,R C, PY - 1999/2/19/pubmed PY - 1999/2/19/medline PY - 1999/2/19/entrez SP - S23 EP - 8 JF - Sexually transmitted infections JO - Sex Transm Infect VL - 74 Suppl 1 N2 - OBJECTIVE: To evaluate two protocols for the syndromic management of genital ulcer disease (GUD) in Lesotho, southern Africa and to compare the performance of these protocols with that of a conventional disease specific approach. METHODS: A cross sectional study was conducted among consecutive patients with GUD attending an STD clinic in Maseru, Lesotho. The clinical diagnoses were made by using predefined criteria at the initial visit before the performance of laboratory tests. Attempts were made to detect the specific aetiology of the genital ulcers using PCR assays and syphilis serology. The results of PCR assays and syphilis serology were used as the gold standard against which the performance of the management approaches were applied. RESULTS: Of 100 patients initially recruited into the study, Haemophilus ducreyi infection was detected in 56%, herpes simplex virus in 26%, Treponema pallidum in 23%, and lymphogranuloma venereum in 7%. No pathogens were detected in 6% of patients. 17% of patients had mixed infections. Sensitivity, specificity, positive and negative predictive values of the three management protocols for GUD were compared after applying each to the study population. Theoretically, the lowest correct treatment rate would have been obtained by using the disease specific protocol (62%) compared with more than 90% in both syndromic management protocols. Considerable overtreatment for primary syphilis would occur following application of both syndromic protocols. This would be the result of the overdiagnosis of chancroid, in particular the misdiagnosis of genital herpes as chancroid, which would receive treatment for syphilis unnecessarily. The HIV seroprevalence among these patients was 36%. A significantly higher rate of HIV seropositivity was detected among the patients with herpes simplex virus infection when compared with those patients having other causes of genital ulcer disease (58% v 27%; odds ratio 3.73; 95% CI 1.26-11.26; p = 0.01). CONCLUSIONS: Poor sensitivity, specificity, and predictive values were recorded when the disease specific protocol was applied to the study population. In contrast, the syndromic management protocols provided adequate treatment for more than 90% of patients with GUD. Protocol C, which identified a minority of cases of genital herpes, was found to have an advantage when compared with protocol B (all patients with genital ulcer disease treated for both syphilis and chancroid) in that 29% of genital herpes cases would receive appropriate counselling. SN - 1368-4973 UR - https://www.unboundmedicine.com/medline/citation/10023349/Comparison_of_clinically_directed_disease_specific_and_syndromic_protocols_for_the_management_of_genital_ulcer_disease_in_Lesotho_ L2 - https://antibodies.cancer.gov/detail/CPTC-ZAP70-1 DB - PRIME DP - Unbound Medicine ER -