The Etiology and Management of Genital Ulcers in the Dominican Republic and Peru

Abstract

HSV caused 43% of genital ulcers in these populations. The modified algorithm had lower sensitivity but a reduced overtreatment rate. M-PCR testing was more sensitive than standard tests and more specific and sensitive than clinical diagnosis.

Modelling the cost per ulcer treated of incorporating episodic treatment for HSV-2 into the syndromic algorithm for genital ulcer disease

“…Limited data suggest that 29–38% of individuals with any type of HSV-2 ulcers, as determined by PCR, have had recurrent ulcers and 39–42% have vesicles upon examination 23 – 25. However, some individuals with chancroid or syphilis ulcers also have a history of recurrences (HD 22%, TP 4%) or have vesicles (HD 17%, TP 9%) 23 – 25.…”

“…Limited data suggest that 29–38% of individuals with any type of HSV-2 ulcers, as determined by PCR, have had recurrent ulcers and 39–42% have vesicles upon examination 23 – 25. However, some individuals with chancroid or syphilis ulcers also have a history of recurrences (HD 22%, TP 4%) or have vesicles (HD 17%, TP 9%) 23 – 25. If ulcers of unknown aetiology were also included, between 18 and 35% of GUD patients without HSV-2 ulcers mentioned ulcer recurrences and 18 and 28% had vesicles 23 – 25…”

Syphilis in adults

“…Syphilis is usually the second or third commonest cause of genital ulcers, either chancroid or genital herpes being commoner. Using polymerase chain reaction (PCR), GUD was caused by syphilis in 14% of affected people in Dar es Salaam, Tanzania, 26 10% in Peru, 5% in the Dominican Republic, 27 4.2% in HIV positive men and 10.6% in HIV negative men in South Africa, 28 and 10% in Pune, India. 29 In the latter, coinfection with chancroid, herpes, or both occurs in 4%.…”

Does Frequency of Genital Herpes Recurrences Predict Risk of Transmission? Further Analysis of the Valacyclovir Transmission Study

“…[1][2][3][4][5] Potential risk factors, both behavioral and biological, that influence the acquisition of HSV-2 infection have been identified from observational studies. Seroepidemiologic investigations have largely focused on susceptible persons who acquired genital HSV-2 infection rather than on source partners at risk of transmitting infection.…”