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Genital ulcer disease: accuracy of clinical diagnosis and strategies to improve control in Durban, South Africa.
Genitourin Med 1994; 70(1):7-11GM

Abstract

OBJECTIVE

To investigate the accuracy of clinical diagnosis in genital ulcer disease (GUD); to devise management strategies for improving the control of GUD and thereby limit the spread of HIV-1 infection.

DESIGN

Clinical and microbiological assessment of GUD in men and women. The index of suspicion, diagnostic accuracy, diagnostic efficiency and positive and negative predictive values of a clinical diagnosis were investigated.

SETTING

City Health Sexually Transmitted Diseases Clinic, King Edward VIII Hospital, Durban, South Africa.

PARTICIPANTS

100 men and 100 women with genital ulcers.

RESULTS

The accuracy of a clinical diagnosis was, in men: lymphogranuloma venereum (LGV) 66%, donovanosis 63%, chancroid 42%, genital herpes 39%, primary syphilis 32%, mixed infections 8%, and in women; secondary syphilis 94%, donovanosis 83%, genital herpes 60%, primary syphilis 58%, chancroid 57%, LGV 40%, mixed infections 14%. Overall, diagnostic efficiency was greater in women than in men. When compared with other causes of GUD, donovanosis ulcers bled to the touch and were larger and not usually associated with inguinal lymphadenopathy. In women, extensive vulval condylomata lata were readily differentiated from all other causes of GUD.

CONCLUSION

A clinical diagnosis in genital ulceration was less accurate in men than in women. The diagnostic accuracies for donovanosis and secondary syphilis were relatively high but for most other conditions were low. Differences between clinical and laboratory diagnostic accuracies may reflect similarities between the clinical appearances of the various causes of GUD, the presence of mixed infections, atypical ulceration due to longstanding disease, and insensitive laboratory tests. In this community all large ulcers should be treated empirically for syphilis and donovanosis. Uncircumcised men with GUD are an important HIV core or "superspreader" group locally, and prevention strategies should include counselling and health education in the light of the inaccuracy of clinical diagnosis found in this study. The development of rapid accurate tests for GUD is urgently required.

Authors+Show Affiliations

City Health STD Department, King Edward VIII Hospital, Durban, South Africa.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8300105

Citation

O'Farrell, N, et al. "Genital Ulcer Disease: Accuracy of Clinical Diagnosis and Strategies to Improve Control in Durban, South Africa." Genitourinary Medicine, vol. 70, no. 1, 1994, pp. 7-11.
O'Farrell N, Hoosen AA, Coetzee KD, et al. Genital ulcer disease: accuracy of clinical diagnosis and strategies to improve control in Durban, South Africa. Genitourin Med. 1994;70(1):7-11.
O'Farrell, N., Hoosen, A. A., Coetzee, K. D., & van den Ende, J. (1994). Genital ulcer disease: accuracy of clinical diagnosis and strategies to improve control in Durban, South Africa. Genitourinary Medicine, 70(1), pp. 7-11.
O'Farrell N, et al. Genital Ulcer Disease: Accuracy of Clinical Diagnosis and Strategies to Improve Control in Durban, South Africa. Genitourin Med. 1994;70(1):7-11. PubMed PMID: 8300105.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Genital ulcer disease: accuracy of clinical diagnosis and strategies to improve control in Durban, South Africa. AU - O'Farrell,N, AU - Hoosen,A A, AU - Coetzee,K D, AU - van den Ende,J, PY - 1994/2/1/pubmed PY - 1994/2/1/medline PY - 1994/2/1/entrez KW - Africa KW - Africa South Of The Sahara KW - Biology KW - Clinic Activities KW - Counseling KW - Developing Countries KW - Diseases KW - Economic Factors KW - Education KW - English Speaking Africa KW - Examinations And Diagnoses KW - Genital Effects, Female KW - Genital Effects, Male KW - Genitalia KW - Genitalia, Female KW - Genitalia, Male KW - Health Education KW - Hiv Infections--prevention and control KW - Infections KW - Laboratory Examinations And Diagnoses KW - Needs KW - Organization And Administration KW - Physical Examinations And Diagnoses KW - Physiology KW - Program Activities KW - Programs KW - Reproductive Tract Infections KW - Research Report KW - Sexually Transmitted Diseases KW - South Africa KW - Southern Africa KW - Urogenital System KW - Viral Diseases SP - 7 EP - 11 JF - Genitourinary medicine JO - Genitourin Med VL - 70 IS - 1 N2 - OBJECTIVE: To investigate the accuracy of clinical diagnosis in genital ulcer disease (GUD); to devise management strategies for improving the control of GUD and thereby limit the spread of HIV-1 infection. DESIGN: Clinical and microbiological assessment of GUD in men and women. The index of suspicion, diagnostic accuracy, diagnostic efficiency and positive and negative predictive values of a clinical diagnosis were investigated. SETTING: City Health Sexually Transmitted Diseases Clinic, King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS: 100 men and 100 women with genital ulcers. RESULTS: The accuracy of a clinical diagnosis was, in men: lymphogranuloma venereum (LGV) 66%, donovanosis 63%, chancroid 42%, genital herpes 39%, primary syphilis 32%, mixed infections 8%, and in women; secondary syphilis 94%, donovanosis 83%, genital herpes 60%, primary syphilis 58%, chancroid 57%, LGV 40%, mixed infections 14%. Overall, diagnostic efficiency was greater in women than in men. When compared with other causes of GUD, donovanosis ulcers bled to the touch and were larger and not usually associated with inguinal lymphadenopathy. In women, extensive vulval condylomata lata were readily differentiated from all other causes of GUD. CONCLUSION: A clinical diagnosis in genital ulceration was less accurate in men than in women. The diagnostic accuracies for donovanosis and secondary syphilis were relatively high but for most other conditions were low. Differences between clinical and laboratory diagnostic accuracies may reflect similarities between the clinical appearances of the various causes of GUD, the presence of mixed infections, atypical ulceration due to longstanding disease, and insensitive laboratory tests. In this community all large ulcers should be treated empirically for syphilis and donovanosis. Uncircumcised men with GUD are an important HIV core or "superspreader" group locally, and prevention strategies should include counselling and health education in the light of the inaccuracy of clinical diagnosis found in this study. The development of rapid accurate tests for GUD is urgently required. SN - 0266-4348 UR - https://www.unboundmedicine.com/medline/citation/8300105/Genital_ulcer_disease:_accuracy_of_clinical_diagnosis_and_strategies_to_improve_control_in_Durban_South_Africa_ L2 - http://sti.bmj.com/cgi/pmidlookup?view=long&pmid=8300105 DB - PRIME DP - Unbound Medicine ER -