Diagnosing Genital Ulcer Disease in a Clinic for Sexually Transmitted Diseases in Amsterdam, The Netherlands

Abstract

The most common etiologic agents of genital ulcer disease (GUD) are herpes simplex virus type 1 (HSV-1), HSV-2, Treponema pallidum, and Haemophilus ducreyi. In an outpatient clinic for sexually transmitted diseases in Amsterdam, The Netherlands, specimens from 372 patients with GUD were collected from February to November 1996. Sera were collected at the time of the symptoms and, for most patients, also during follow-up visits. Swabs in viral transport medium were used for HSV culture and for detection of DNA. The most prevalent pathogen found was HSV-2, which was detected by culture in 35% of the patients and by PCR in 48% of the patients. Also, HSV-1 infection was more often detected by PCR (7.8%) than by culture (5.6%). Evidence for an active infection with T. pallidum was found in 1.9% of the patients, using serological tests. A multiplex PCR for simultaneous T. pallidum and H. ducreyi DNA detection was positive for T. pallidum in 3.3% of the samples and for H. ducreyi in only 0.9% (3 out of 368) of the samples. The sensitivity of the PCR was superior to that of culture for HSV detection and to that of serology for T. pallidum detection. Specific H. ducreyi immunoglobulin G antibodies were detected in sera of 5.2% of the patients, with no concordance between serology and PCR. In 37% of the cases, none of the tested microorganisms was detected. Performance of PCR in addition to conventional techniques significantly improved the diagnosis of GUD.

Etiology of Genital Ulcerative Disease in Conjunction with HIV Infection among Patients Attending the STD Clinic at a Tertiary Care Hospital

“…43.2% against 39.2% (Vora et al, 2011). Similarly, 48.1% herpetic cases were reported from a STD clinic in Amsterdam, Netherlands while only 4.2% non-hepetic cases were reported (Bruisten et al, 2001). Studies from Tanzania and Thailand also reveal the same pattern where the herpetic GUD cases are more than the non-herpetic GUDs (Mwansasu et al, 2002;Beyrer et al, 1998).…”

“…In developing countries, leading causes of GUD are infections with H. ducreyi, followed by infections with T. pallidum and HSV infections while the situation is different in European countries and North America, where HSV-2 infection is the leading cause of genital ulcers (Bruisten et al, 2001). A change in the prevalence patterns of the different causative agents of GUD in relation to HIV-1 infection.…”

“…The annual global incidence of GUD probably exceeds 20 million cases. Four infectious agents have so far been identified as common causes of GUD namely, herpes simplex virus type 2 (HSV-2), HSV-1, which are known to cause genital herpes Treponema pallidum, which is known to cause syphilis, and Haemophilus ducreyi, which causes chancroid (Mertz et al, 1998;Orle et al, 1996;Bruisten et al, 2001;Risbud et al, 1998). In addition, the GUD has been recognized as an epidemiologic and biologic risk factor for the transmission of the human immunodeficiency virus (HIV) (Moodley et al, 2002;Malima et al, 2008).…”

Laboratorial Diagnosis of Syphilis

“…The assay detected approximately 0.01 pg of purified T. pallidum DNA, and it was able to detect as low as one to 10 organisms per specimen with high sensitivity. T. pallidum DNA was detected in serum, CSF and amniotic fluids from syphilis patients but not in nonsyphilitic controls (Bruisten et al, 2001). The same technique was applied in several clinical materials in order to investigate the potential of PCR in diagnosis of congenital syphilis.…”

“…Multiplex nested PCR showed higher sensitivity then serological methods for diagnosis of syphilis in the population studied, from outpatient clinic for sexually transmitted diseases (STDs) in Amsterdan. Sensitivity and specificity were 75% (12/16) and 100% (348/348), respectively (Bruisten et al, 2001). The ttp47 gene PCR to detect T.pallidum DNA in clinical samples was developed by Burstain et al A 658-bp (648-1305) portion of tpp47 gene was amplified and the PCR products were probed by DNA-DNA hybridization with a 496-bp (713-1208) fragment internal to the amplified DNA.…”