Etiology of Genital Ulcer Disease in a Sexually Transmitted Infection Reference Center in Manaus, Brazilian Amazon

Abstract

ObjectivesTo 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.MethodsUlcer 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.ResultsOverall, 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.ConclusionsThe 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.

Síndromes Infecciosas Sexualmente Transmissíveis Em Homens: Prevalência E Fatores De Risco

“…Mesmo considerando essa limitação, esse achado é corroborado por outros trabalhos científicos (MAKASA et al, 2012;CAVALCANTI et al, 2012;GOMES et al, 2013).…”

“…O DNA do Herpes Simplex Virus (HSV) tipo 2 foi detectado em 55,3% das amostras, Treponema pallidum em 8,3%, HSV tipo 1 em 3,2%, e nenhum caso de Haemophilus ducreyi foi identificado. As sorologias para HIV e sífilis foram positivas em 3,2% e 5,8% dos pacientes, respectivamente (GOMES et al, 2013). Em um estudo semelhante realizado no continente africano, apenas 45% dos pacientes tiveram o diagnóstico etiológico estabelecido (MAKASA et al, 2012), o qual demonstra limitações da abordagem sindrômica.…”

“…Essa é uma observação diferente em comparação aos dados literários encontrados, que apontaram idade, escolaridade e situação financeira como fatores sociodemográficos de risco para alguma DST (GUO et al, 2011;SEN, 2013). Essa disparidade pode ser parcialmente explicada por tratar-se de amostra exclusiva de homens atendidos em ambulatório especializado, além do desfecho pesquisado ser definido como síndrome infecciosa e não como diagnóstico etiológico (MAKASA et al, 2012;CAVALCANTI et al, 2012;GOMES et al, 2013).…”

Doenças sexualmente transmissíveis atendidas em unidade primária de saúde no Nordeste do Brasil

“…O fato de não causar dor e de ser autolimitado, além da dificuldade de acesso aos serviços de saúde, pode fazer com que as pessoas com cancro dificilmente procurem os serviços ainda na fase inicial da infecção. Ademais, estudo realizado em pacientes com úlcera genital em clínicas de DST em Manaus encontrou uma predominância do vírus herpes simples como causador de úlcera genital 24 .…”

Genital Ulcers in Women with HIV Proposed Revision on Management Algoritm

“…Management algorithm of genital ulcer issued by WHO (World Health Organization) and adapted by Brazil stated that in the case which history of vesicular lesions or clinically vesicular lesion is absent, patients were treated with genital ulcers caused by syphilis or chancroid. [5] Management guidelines of sexually transmitted disease issued by the Ministry of Health of the Republic of Indonesia in 2011 provide similar algorithms, it can give an 'open space' for a delay of genital ulcer therapy in HIV patients with HSV-2 infection which is atypical due to lack of clear guideline for the determining diagnosis and treatment. [6] In this paper, author reported four cases of genital ulcer without a history and physical examination that shows vesicles in patient with HIV.…”