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Myron S Cohen - One of the best experts on this subject based on the ideXlab platform.

  • etiology of Genital Ulcer disease and association with hiv infection in malawi
    Sexually Transmitted Diseases, 2013
    Co-Authors: Sam Phiri, Chengyen Chen, Sabrina Zadrozny, Helen A Weiss, Francis Martinson, Naomi Nyirenda, William C Miller, Myron S Cohen, Philippe Mayaud
    Abstract:

    BACKGROUND The World Health Organization recommends the use of syndromic management for patients presenting with Genital Ulcer disease (GUD) in developing countries. However, effective treatment guidelines depend on a current country-specific GUD etiological profile, which may change over time. METHODS From 2004 to 2006, we conducted a cross-sectional analysis of baseline data from patients presenting with GUD at a reference STI clinic in Lilongwe, Malawi. Participants were enrolled in a randomized clinical trial of acyclovir added to syndromic management and followed up for up to 28 days. Serologies for HIV (using parallel rapid tests), herpes simplex virus type 2 (HSV-2; using Focus HerpeSelect IgG2 ELISA [Focus Technologies, Cypress Hill, CA]), and syphilis (rapid plasma reagin confirmed by Treponema pallidum hemagglutination) were determined, with plasma HIV-1 RNA and CD4 count in HIV-positive patients. Genital Ulcer disease etiology was determined by real-time multiplex polymerase chain reaction from lesional swabs. RESULTS A total of 422 patients with GUD (313 men; 74%) were enrolled. Overall seroprevalence of HIV-1, HSV-2, and syphilis were 61%, 72%, and 5%, respectively. Ulcer etiology was available for 398 patients and showed the following: HSV-2, 67%; Haemophilus ducreyi, 15%; T. pallidum, 6%; lymphogranuloma venereum, 6%; mixed infections, 14%, and no etiology, 20%. Most HSV-2 Ulcers were recurrent (75%). Among all patients with HSV-2, HIV prevalence was high (67%) and HIV seroprevalence was higher among patients with recurrent HSV-2 compared with patients with first-episode HSV-2 (78% vs. 39%, P < 0.001). CONCLUSIONS Herpes simplex virus type 2 Ulcers are highly prevalent in this symptomatic population and strongly associated with HIV. Unlike most locations in sub-Saharan Africa, H. ducreyi remains prevalent in this population and requires periodic monitoring and an appropriate treatment regimen.

  • improving the accuracy of syndromic diagnosis of Genital Ulcer disease in malawi
    Sexually Transmitted Diseases, 2005
    Co-Authors: Cathrine Hoyo, Irving F. Hoffman, Barry K Moser, Marcia M Hobbs, Peter N Kazembe, Robert Krysiak, Myron S Cohen
    Abstract:

    Objectives/Goal: Most resource-poor settings rely on syndromic criteria to diagnose Genital Ulcer disease (GUD). However, the etiologic pathogens of GUD vary temporally and geographically, and current criteria may not reflect changes in the prevalence of specific pathogens. Study: In 1999, we estimated the prevalence of Treponema pallidum (Tp), herpes simplex virus (HSV), and Haemophilus ducreyi (Hd) in Malawi. We then used regression coefficients of independent correlates of HSV and Hd to develop weighted diagnostic algorithms, in which weights were β-coefficients corresponding to each factor. Results: Overall, a decrease in the proportion of sexually transmitted disease attributable to GUD was noted in 7 years. Thirty-five percent were attributable to HSV, 30% to H. ducreyi, and 4% to T. pallidum. Areas under the receiver operating characteristic curves for weighted and unweighted HSV diagnostic algorithms were 67.6% and 66.5%, respectively. There was no significant difference in the explanatory performance of the weighted and unweighted algorithms. Conclusions: Unweighted algorithms can therefore be used to improve diagnostic accuracy of GUD.

  • association of cd4 cell depletion and elevated blood and seminal plasma human immunodeficiency virus type 1 hiv 1 rna concentrations with Genital Ulcer disease in hiv 1 infected men in malawi
    The Journal of Infectious Diseases, 1998
    Co-Authors: John R Dyer, Irving F. Hoffman, Peter N Kazembe, Joseph J Eron, Pietro Vernazza, Eniffa Nkata, Celine Costello Daly, Susan A Fiscus, Myron S Cohen
    Abstract:

    CD4 cell counts and blood plasma and seminal plasma HIV-1 concentrations were compared in HIV-1 RNA-seropositive men with urethritis and with or without Genital Ulcer disease (GUD). GUD was associated with lower CD4 cell counts (median 258/mcl vs. 348/mcl) and increased blood plasma HIV-1 RNA (median 240 x 10 vs. 79.4 x 10 copies/ml). Men with nongonococcal urethritis and GUD shed significantly greater quantities of HIV-1 in semen (median 195 x 10 vs. 4.0 x 10 copies/ml) than men with nongonococcal urethritis without GUD. These levels decreased approximately 4-fold following antibiotic therapy. The results indicate an association between GUD and increased blood HIV-1 RNA levels. Increased HIV-1 in semen was demonstrated in some men with GUD; such an increase could lead to increased transmission thus complicating interpretation of the role of the Genital Ulcer itself in the infectiousness of HIV. Reasons for increased HIV RNA in semen in men with GUD remain to be determined. (authors)

  • association of cd4 cell depletion and elevated blood and seminal plasma human immunodeficiency virus type 1 hiv 1 rna concentrations with Genital Ulcer disease in hiv 1 infected men in malawi
    The Journal of Infectious Diseases, 1998
    Co-Authors: John R Dyer, Irving F. Hoffman, Peter N Kazembe, Joseph J Eron, Pietro Vernazza, Eniffa Nkata, Celine Costello Daly, Susan A Fiscus, Myron S Cohen
    Abstract:

    CD4 cell counts and blood plasma and seminal plasma human immunodeficiency virus type 1 (HIV-1) concentrations were compared in HIV-1 RNA-seropositive men with urethritis and with or without Genital Ulcer disease (GUD). GUD was associated with lower CD4 cell counts (median, 258 vs. 348/microL) and increased blood plasma HIV-1 RNA (median, 240 x 10[3] vs. 79.4 x 10[3] copies/mL). Men with nongonococcal urethritis and GUD shed significantly greater quantities of HIV-1 in semen (median, 195 x 10[3] vs. 4.0 x 10[3] copies/mL) than men with nongonococcal urethritis without GUD. These levels decreased approximately 4-fold following antibiotic therapy. The results indicate an association between GUD and increased blood HIV-1 RNA levels. Increased HIV-1 in semen was demonstrated in some men with GUD; such an increase could lead to increased transmission, thus complicating interpretation of the role of the Genital Ulcer itself in the infectiousness of HIV. Reasons for increased HIV RNA in semen in men with GUD remain to be determined.

  • sexually transmitted diseases and human immunodeficiency virus control in malawi a field study of Genital Ulcer disease
    The Journal of Infectious Diseases, 1995
    Co-Authors: Frieda Behets, Irving F. Hoffman, Gina Dallabetta, George N Liomba, G N Lule, Holli A Hamilton, Stoffel Moeng, Myron S Cohen
    Abstract:

    Men with Genital Ulcer disease (GUD) attending a clinic in Malawi were evaluated and treated with one of five drug regimens. Hemophilus ducreyi was isolated from 204 (26.2%) of 778 patients. Of 677 men 198 (29.2%) had treponemes detected in Ulcer material by direct immunofluorescence or had rapid plasma reagin reactivity of > or = 1:8. Human immunodeficiency virus type 1 (HIV-1) seroprevalence was 58.9% overall and 75.8% among patients reporting a history of GUD (p < 0.001). By logistic regression analysis HIV-1 seropositivity was shown to impair Ulcer healing (p = 0.003). Treatment failure rates for culture-proven chancroid were 19% for trimethoprim-sulfamethoxazole 12.9% and 7.4% respectively for low- and high-dose erythromycin regimens and 8.3% and 0 respectively for low- and high-dose ciprofloxacin regimens. Herpes antigen was detected by EIA in 6 (23.1%) of 26 nonhealing Ulcers. In Malawi GUD should be managed as a syndrome to assure treatment of both syphilis and chancroid. (authors)

David A. Lewis - One of the best experts on this subject based on the ideXlab platform.

  • Trends in the relative prevalence of Genital Ulcer disease pathogens and association with HIV infection in Johannesburg, South Africa, 2007–2015
    2018
    Co-Authors: Ranmini S. Kularatne, Etienne E. Müller, Dumisile V. Maseko, Tendesayi Kufa-chakezha, David A. Lewis
    Abstract:

    BackgroundIn South Africa, treatment of Genital Ulcer disease (GUD) occurs in the context of syndromic management. GUD aetiological studies have been conducted in Johannesburg since 2007. We report on GUD pathogen prevalence, sero-prevalence of STI co-infections and aetiological trends among GUD patients presenting to a community-based primary healthcare facility in Johannesburg over a 9-year period.Methods and findingsGUD surveys were conducted from January to April each year. Consecutive Genital Ulcers were sampled from consenting adults. Swab-extracted DNA was tested by multiplex real-time PCR assays for herpes simplex virus (HSV), Treponema pallidum (TP), Haemophilus ducreyi (HD) and Chlamydia trachomatis (CT). HSV-positive DNA extracts were further subtyped into HSV-1 and HSV-2 using a commercial PCR assay; CT-positive extracts were tested with an in-house PCR assay specific for serovars L1-L3 (lymphogranuloma venereum). Sera were tested for HIV, HSV-2, and syphilis co-infections. Giemsa-stained Ulcer smears were screened for Klebsiella granulomatis by microscopy. Data were analysed with STATATM version 14. Of 771 GUD specimens, 503 (65.2%) had a detectable pathogen: HSV 468 (60.7%); TP 30 (3.9%); CT L1-3 7 (0.9%); HD 4 (0.5%). No aetiological agents were detected in 270 (34.8%) Ulcer specimens. Seroprevalence rates were as follows: HIV 61.7%; HSV-2 80.2% and syphilis 5.8%. There was a strong association between GUD pathogen detection and HIV seropositivity (p < 0.001); 68% of cases caused by HSV were co-infected with HIV. There was a significant decline in the relative prevalence of Ulcer-derived HSV over time, predominantly from 2013–2015 (p-value for trend = 0.023); and a trend towards a decrease in the HIV seropositivity rate (p-value for trend = 0.209).ConclusionsHSV remains the leading cause of pathogen-detectable GUD in South Africa. The prevalence of HIV co-infection among GUD patients is high, underlining the importance of linkage to universal HIV testing and treatment in primary healthcare settings.

  • Prevalence and associations of Genital Ulcer and urethral pathogens in men presenting with Genital Ulcer syndrome to primary health care clinics in South Africa.
    Sexually transmitted diseases, 2012
    Co-Authors: David A. Lewis, Ronald C. Ballard, Etienne E. Müller, Lisa N. Steele, Maya Sternberg, F Radebe, Michael Lyall, Gabriela Paz-bailey
    Abstract:

    BackgroundThis study aimed to determine the prevalence of Genital Ulcer and urethral pathogens, as well as their association with clinical features, in men with Genital Ulcer disease (GUD) enrolled in a clinical trial.MethodsClinical data were collected by questionnaire. Ulcer swabs were tested for

  • health care seeking among men with Genital Ulcer disease in south africa correlates and relationship to human immunodeficiency virus 1 and herpes simplex virus type 2 detection and shedding
    Sexually Transmitted Diseases, 2011
    Co-Authors: Jami S Leichliter, David A. Lewis, Maya Sternberg, Melissa A Habel, Gabriela Pazbailey
    Abstract:

    BACKGROUND Episodic acyclovir therapy has been added to Genital Ulcer disease (GUD) syndromic management guidelines in several sub-Saharan African countries with human immunodeficiency virus (HIV) epidemics. We examined the correlates of health care seeking in men with GUD and its relationship to HIV-1 and herpes simplex virus type 2 outcomes. METHODS Men with GUD (n = 615) were recruited from primary health care clinics in Gauteng province, South Africa for a randomized controlled trial of episodic acyclovir therapy. We used baseline survey and sexually transmitted infection/HIV-testing data to examine delay in health care seeking (defined as time from Ulcer recognition to baseline study visit). RESULTS Median delay in health care seeking for GUD was 5 days, and one-quarter of men had previously sought care for the current Ulcer. Previous care seekers were older, had more episodes of Ulceration in the past year, and were more likely to test seropositive for HIV-1 and HSV-2. Delay in health care seeking was significantly associated with age, education level, and sex during the Ulceration episode. Delays in care seeking were related to poorer HIV-1 outcomes; these findings were valid after controlling for advanced HIV. CONCLUSIONS Interventions to help shorten the duration between Ulcer recognition and health care seeking for men with GUD are needed.

  • Acute HIV infections among men with Genital Ulcer disease in South Africa.
    The Journal of infectious diseases, 2010
    Co-Authors: G. Paz Bailey, David A. Lewis, Maya Sternberg, Adrian Puren
    Abstract:

    We investigated acute human immunodeficiency virus (HIV) infection among men enrolled in a Genital Ulcer treatment trial in South Africa. HIV-negative participants were tested at baseline by HIV RNA polymerase chain reaction and followed up after 1 month to measure HIV seroconversion. There were 228 HIV-negative men at baseline; 10 were positive for HIV RNA, and 8 seroconverted to HIV at day 28. The prevalence of acute HIV among HIV-negative men at baseline was 18 (7.9%) of 228 men (95% confidence interval [CI], 4.4-11.4) and 18 (2.9%) of 615 men (95% CI, 1.6-4.3) in the overall study population. These data highlight the importance of Genital Ulcer patients in HIV transmission. Trial Registration. ClinicalTrials.gov identifier: NCT00164424 .

  • comparison of lavage and swabs for the collection of Genital Ulcer specimens to measure hiv rna shedding
    Journal of Clinical Virology, 2009
    Co-Authors: Gabriela Pazbailey, David A. Lewis, Maya Sternberg, Ewalde Cutler, Mariza Vos, Ron Ballard, Adrian Puren
    Abstract:

    Abstract Background The optimum collection procedure for the evaluation of HIV-1 burden in Ulcer secretions has not been well defined. Objectives The objective of this study was to compare Ulcer swabs and Ulcer lavages for the detection and quantitation of HIV-1 RNA in Genital Ulcers. Study design A convenience sample of the first 84 HIV-positive participants in a randomized double blind placebo controlled trial of acyclovir episodic treatment among men with Genital Ulcer disease were included in this evaluation. At baseline, participants were screened for HIV, syphilis and HSV-2 by serology and for Ulcer etiology by PCR. Ulcer specimens were collected by using (1) a non-traumatic washing procedure with 10 ml of PBS, and (2) sterile dry swabs. Ulcer samples were tested with HIV-1 Amplicor 1.5 Ultra Sensitive Assay with a lower threshold of 50 copies/ml. Results Of Ulcer samples 35 (41.7%) had HIV detected by Ulcer lavage and 32 (38.1%) by swabs ( p  = 0.68). Overall, 45 (53.6%) were positive by one or both methods. The overall proportion of agreement was 73% (61/84). The chance-corrected proportion of agreement was 0.46 (95% CI: 0.26, 0.65) as estimated by the Kappa statistic. The log mean viral load from lavages (1.49 log 10  copies/ml, 95% CI: 1.17–1.81) did not differ significantly from that of swabs (1.41 log 10  copies/ml, 95% CI: 1.16–1.71) ( p  = 0.29) with a mean difference of 0.08 log copies/ml (SD 0.96) . Conclusion Ulcer lavage and Ulcer swab performed in moderate agreement in the detection and quantitation of HIV RNA from Ulcer specimens.

Ronald C. Ballard - One of the best experts on this subject based on the ideXlab platform.

  • Prevalence and associations of Genital Ulcer and urethral pathogens in men presenting with Genital Ulcer syndrome to primary health care clinics in South Africa.
    Sexually transmitted diseases, 2012
    Co-Authors: David A. Lewis, Ronald C. Ballard, Etienne E. Müller, Lisa N. Steele, Maya Sternberg, F Radebe, Michael Lyall, Gabriela Paz-bailey
    Abstract:

    BackgroundThis study aimed to determine the prevalence of Genital Ulcer and urethral pathogens, as well as their association with clinical features, in men with Genital Ulcer disease (GUD) enrolled in a clinical trial.MethodsClinical data were collected by questionnaire. Ulcer swabs were tested for

  • the molecular diagnosis of sexually transmitted Genital Ulcer disease
    Methods of Molecular Biology, 2012
    Co-Authors: Chengyen Chen, Ronald C. Ballard
    Abstract:

    Highly sensitive and specific nucleic acid amplification tests (NAATs) have emerged as the gold standard diagnostic tests for many infectious diseases. Real-time PCR has further refined the technology of nucleic acid amplification with detection in a closed system and enabled multiplexing to simultaneously detect multiple pathogens. It is a versatile, fast, and high-throughput system for pathogen detection that has reduced the risk of PCR contamination, eliminated post-PCR manipulations, and improved the cost-effectiveness of testing. In addition, real-time PCR can be applied to self-collected noninvasive specimens. Here, we describe an in-house developed TaqMan-based real-time multiplex PCR (M-PCR) assay for the diagnosis of sexually transmitted Genital Ulcer disease (GUD) and discuss briefly on issues associated with validation of assay performance.

  • changes in the etiology of sexually transmitted diseases in botswana between 1993 and 2002 implications for the clinical management of Genital Ulcer disease
    Clinical Infectious Diseases, 2005
    Co-Authors: Gabriela Pazbailey, Ronald C. Ballard, Mafiz Rahman, Cheng Chen, Howard Moffat, Tom Kenyon, Peter H Kilmarx, Patricia A Totten, Sabina G Astete, Marieclaude Boily
    Abstract:

    BACKGROUND: In recent years, increasing evidence has accumulated that suggests the majority of cases of Genital Ulcer disease in sub-Saharan Africa are due to viral and not bacterial infections. Although many cross-sectional studies support such a trend, few serial cross-sectional data are available to show the evolution of Genital Ulcer disease over time. METHODS: We surveyed the prevalence of sexually transmitted diseases (STDs) among patients with STD symptoms and women recruited from family planning clinics in 3 cities in Botswana in 2002 and compared our findings with those from a survey of a similar population conducted in 1993. RESULTS: The observed proportion of cases of Genital Ulcer disease due to chancroid decreased from 25% in 1993 to 1% in 2002, whereas the proportion of Ulcers due to herpes simplex virus increased from 23% in 1993 to 58% in 2002. Although the proportion of Ulcers due to syphilis was similar for both surveys, the rate of positive serologic test results for syphilis among patients with Genital Ulcer disease decreased from 52% in 1993 to 5% in 2002. During this period, decreases in the prevalence of gonorrhea, syphilis-reactive serologic findings, chlamydial infection, and trichomoniasis were also detected among patients with STDs and women from family planning clinics. These changes remained significant after estimates were adjusted for the sensitivity and specificity of diagnostic tests. CONCLUSIONS: Our findings suggest a decrease in the prevalence of bacterial STDs and trichomoniasis, a reduction in the proportion of Ulcers due to bacterial causes, and an increase in the proportion of Ulcers due to herpes simplex virus during the period 1993-2002. These changes should be taken into consideration when defining new guidelines for the syndromic management of Genital Ulcer disease.

  • coexistence of urethritis with Genital Ulcer disease in south africa influence on provision of syndromic management
    Sexually Transmitted Infections, 2002
    Co-Authors: Ronald C. Ballard, F Radebe, Ye Htun, H G Fehler, Jorgen Skov Jensen, D Taylorrobinson
    Abstract:

    Objective: To assess whether syndromic management of Genital Ulcer disease was sound, if based on the premise that men with Genital Ulcers rarely have a concomitant urethral infection. Methods: Specimens were taken in 1998 from 186 mine workers in Carletonville, South Africa, who were seen consecutively with Genital Ulcers. The specimens comprised a swab from the Ulcer, a urethral swab for a Gram stained smear, and 10‐15 ml of a first catch urine sample. The latter was tested by ligase chain reaction assays for Neisseria gonorrhoeae and Chlamydia trachomatis specific DNA sequences and by a polymerase chain reaction (PCR) assay for Mycoplasma Genitalium. Ulcer inducing micro-organisms were detected either by a multiplex PCR assay, or in the case of lymphogranuloma venereum (LGV) serologically, and human immunodeficiency virus (HIV) infection was detected by an enzyme linked immunosorbent assay (ELISA) test. Results: Most (54%) of the Ulcers were chancroidal, 18% were herpetic (HSV type 2), 6.5% primary syphilitic, and 3.2% due to LGV. More than one micro-organism was detected in 9.1% of the Ulcers and less than 10% were undiagnosed. Microscopic examination of the urethral smears showed that 99 (53%) of the men had urethritis, of whom 45 (45%) were infected with N gonorrhoeae. Of the 54 men (55%) who had non-gonococcal urethritis (NGU), 11 (19.6%) harboured C trachomatis or M Genitalium. Almost two thirds (64.5%) of the men had HIV infection, but this did not seem to have influenced the aetiology of the Ulcers. Nor was a particular Ulcer associated with one type of urethritis more than the other. Neither C trachomatis nor M Genitalium was associated significantly with non-gonococcal urethritis (NGU) in either HIV positive or HIV negative men. Conclusion: The combination of antibiotics used for the management of Genital Ulcer disease in men in this South African mining population needs to be widened to encompass frequently occurring concomitant gonococcal urethritis and NGU infections. This means treatment with long acting penicillin, combined with ciprofloxacin and azithromycin or erythromycin. A similar situation may exist in other geographical locations with a need to provide appropriate antimicrobial combinations depending on the patterns of infection detected.

  • human immunodeficiency virus infection and Genital Ulcer disease in south africa the herpetic connection
    Sexually Transmitted Diseases, 2000
    Co-Authors: Cheng Y Chen, Y Dangor, Ronald C. Ballard, G. Fehler, Consuelo M Becksague, Frans Radebe, Scott Schmid, Judith B Weiss, Vanessa Tshabalala, Ye Htun
    Abstract:

    This cross-sectional study of 558 men with Genital Ulcer disease (GUD) and 602 men with urethritis aimed to determine the etiology of GUD in HIV-infected and noninfected men attending sexually transmitted disease (STD) clinics in Durban Johannesburg and Cape Town South Africa. Statistical analysis shows that patients with GUD were more likely to be infected with HIV than patients with urethritis (39.4% vs. 21.4%). Most importantly it was found that herpes simplex virus 2 (HSV-2) is a more common cause of GUD than has been suggested by previous studies conducted in South Africa. In addition serologic evidence of HSV-2 infection and current initial or recurrent Genital herpes are strongly associated with HIV infection among men who attended STD clinics with GUD or urethritis. In view of these findings it is suggested that future approaches for reducing HIV transmission by STD control should include efforts to address HSV-2 infection.

F Radebe - One of the best experts on this subject based on the ideXlab platform.

  • Prevalence and associations of Genital Ulcer and urethral pathogens in men presenting with Genital Ulcer syndrome to primary health care clinics in South Africa.
    Sexually transmitted diseases, 2012
    Co-Authors: David A. Lewis, Ronald C. Ballard, Etienne E. Müller, Lisa N. Steele, Maya Sternberg, F Radebe, Michael Lyall, Gabriela Paz-bailey
    Abstract:

    BackgroundThis study aimed to determine the prevalence of Genital Ulcer and urethral pathogens, as well as their association with clinical features, in men with Genital Ulcer disease (GUD) enrolled in a clinical trial.MethodsClinical data were collected by questionnaire. Ulcer swabs were tested for

  • the detection of urethritis pathogens among patients with the male urethritis syndrome Genital Ulcer syndrome and hiv voluntary counselling and testing clients should south africa s syndromic management approach be revised
    Sexually Transmitted Infections, 2008
    Co-Authors: Vivian Black, F Radebe, P Magooa, Mandy Myers, Cadwill Pillay, David A. Lewis
    Abstract:

    Objectives: To determine the prevalence of urethritis pathogens amongst male symptomatic urethritis (MUS) patients, Genital Ulcer (GUS) patients without urethritis symptoms and men requesting HIV testing at a voluntary counselling and testing (VCT) clinic. Methods: A prospective study was conducted in Johannesburg, South Africa. Men from the three groups were screened for urethritis pathogens using molecular tests. Culture for Neisseria gonorrhoeae and, initially, trichomoniasis was performed. Antimicrobial susceptibility testing was undertaken for ciprofloxacin on all gonococcal isolates; ciprofloxacin resistant isolates were screened for ceftriaxone resistance. Results: 664 participants were recruited (438 MUS, 76 GUS and 158 VCT) over 2 years. Gonorrhoea was detected in 62.3% MUS, 15.8% GUS and 3.2% VCT participants. Chlamydial infection was detected in 19.3% MUS, 13.2% GUS and 8.2% VCT participants. Trichomoniasis was detected in 4.9% MUS, 19.7% GUS and 3.8% VCT participants. Mycoplasma Genitalium infection was detected in 14.4% MUS, 13.2% GUS and 7.0% VCT participants. Ciprofloxacin resistance increased from 13.0% in the first year to 26.3% in the second year; all resistant isolates were susceptible to ceftriaxone. Conclusions: Urethritis pathogens, including Trichomonas vaginalis, should be covered in syndromic management treatment of Genital Ulcers in the absence of clinical urethritis. Consideration should be given to adding metronidazole to existing MUS treatment. Ciprofloxacin can no longer be relied upon to treat presumptive gonococcal infections in South Africa.

  • coexistence of urethritis with Genital Ulcer disease in south africa influence on provision of syndromic management
    Sexually Transmitted Infections, 2002
    Co-Authors: Ronald C. Ballard, F Radebe, Ye Htun, H G Fehler, Jorgen Skov Jensen, D Taylorrobinson
    Abstract:

    Objective: To assess whether syndromic management of Genital Ulcer disease was sound, if based on the premise that men with Genital Ulcers rarely have a concomitant urethral infection. Methods: Specimens were taken in 1998 from 186 mine workers in Carletonville, South Africa, who were seen consecutively with Genital Ulcers. The specimens comprised a swab from the Ulcer, a urethral swab for a Gram stained smear, and 10‐15 ml of a first catch urine sample. The latter was tested by ligase chain reaction assays for Neisseria gonorrhoeae and Chlamydia trachomatis specific DNA sequences and by a polymerase chain reaction (PCR) assay for Mycoplasma Genitalium. Ulcer inducing micro-organisms were detected either by a multiplex PCR assay, or in the case of lymphogranuloma venereum (LGV) serologically, and human immunodeficiency virus (HIV) infection was detected by an enzyme linked immunosorbent assay (ELISA) test. Results: Most (54%) of the Ulcers were chancroidal, 18% were herpetic (HSV type 2), 6.5% primary syphilitic, and 3.2% due to LGV. More than one micro-organism was detected in 9.1% of the Ulcers and less than 10% were undiagnosed. Microscopic examination of the urethral smears showed that 99 (53%) of the men had urethritis, of whom 45 (45%) were infected with N gonorrhoeae. Of the 54 men (55%) who had non-gonococcal urethritis (NGU), 11 (19.6%) harboured C trachomatis or M Genitalium. Almost two thirds (64.5%) of the men had HIV infection, but this did not seem to have influenced the aetiology of the Ulcers. Nor was a particular Ulcer associated with one type of urethritis more than the other. Neither C trachomatis nor M Genitalium was associated significantly with non-gonococcal urethritis (NGU) in either HIV positive or HIV negative men. Conclusion: The combination of antibiotics used for the management of Genital Ulcer disease in men in this South African mining population needs to be widened to encompass frequently occurring concomitant gonococcal urethritis and NGU infections. This means treatment with long acting penicillin, combined with ciprofloxacin and azithromycin or erythromycin. A similar situation may exist in other geographical locations with a need to provide appropriate antimicrobial combinations depending on the patterns of infection detected.

  • comparison of clinically directed disease specific and syndromic protocols for the management of Genital Ulcer disease in lesotho
    Sexually Transmitted Infections, 1998
    Co-Authors: Ye Htun, Y Dangor, G. Fehler, F Radebe, Stephen A Morse, David L Trees, Consuelo M Becksague, Ronald C. Ballard
    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.

  • comparison of clinical diagnosis and standard laboratory and molecular methods for the diagnosis of Genital Ulcer disease in lesotho association with human immunodeficiency virus infection
    The Journal of Infectious Diseases, 1997
    Co-Authors: Stephen A Morse, Y Dangor, F Radebe, Ye Htun, David L Trees, Consuelo M Becksague, Scott Schmid, Karina Anna Orle, Glenda Fehler, Judith B Weiss
    Abstract:

    A multiplex polymerase chain reaction (M-PCR) assay for Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus (HSV) was compared with clinical and standard laboratory methods for the diagnosis of Genital Ulcer disease (GUD) in 105 patients; 36% were human immunodeficiency virus (HIV)-seropositive. Chancroid (80%), syphilis (8%), and Genital herpes (8%) were the most frequent diagnoses. H. ducreyi and HSV were isolated from Ulcers of 43% and 18% of patients, respectively; in 35%, all cultures were negative and the laboratory diagnosis indeterminate. M-PCR detected H. ducreyi, T. pallidum, and HSV in 56%, 23%, and 26% of patients, respectively; (no definitive diagnosis, 6%). The proportion of patients with more than one agent was 4% by culture and 17% by M-PCR (P = .002). Resolved sensitivities of M-PCR for H. ducreyi and HSV cultures were 95% and 93%, respectively. The sensitivities of H. ducreyi and HSV cultures were 75% and 60%, respectively. HSV, detected in 47% of specimens from HIV-infected versus 16% from HIV-uninfected patients (P < .001), may be emerging as a more frequent cause of GUD.

Ye Htun - One of the best experts on this subject based on the ideXlab platform.

  • coexistence of urethritis with Genital Ulcer disease in south africa influence on provision of syndromic management
    Sexually Transmitted Infections, 2002
    Co-Authors: Ronald C. Ballard, F Radebe, Ye Htun, H G Fehler, Jorgen Skov Jensen, D Taylorrobinson
    Abstract:

    Objective: To assess whether syndromic management of Genital Ulcer disease was sound, if based on the premise that men with Genital Ulcers rarely have a concomitant urethral infection. Methods: Specimens were taken in 1998 from 186 mine workers in Carletonville, South Africa, who were seen consecutively with Genital Ulcers. The specimens comprised a swab from the Ulcer, a urethral swab for a Gram stained smear, and 10‐15 ml of a first catch urine sample. The latter was tested by ligase chain reaction assays for Neisseria gonorrhoeae and Chlamydia trachomatis specific DNA sequences and by a polymerase chain reaction (PCR) assay for Mycoplasma Genitalium. Ulcer inducing micro-organisms were detected either by a multiplex PCR assay, or in the case of lymphogranuloma venereum (LGV) serologically, and human immunodeficiency virus (HIV) infection was detected by an enzyme linked immunosorbent assay (ELISA) test. Results: Most (54%) of the Ulcers were chancroidal, 18% were herpetic (HSV type 2), 6.5% primary syphilitic, and 3.2% due to LGV. More than one micro-organism was detected in 9.1% of the Ulcers and less than 10% were undiagnosed. Microscopic examination of the urethral smears showed that 99 (53%) of the men had urethritis, of whom 45 (45%) were infected with N gonorrhoeae. Of the 54 men (55%) who had non-gonococcal urethritis (NGU), 11 (19.6%) harboured C trachomatis or M Genitalium. Almost two thirds (64.5%) of the men had HIV infection, but this did not seem to have influenced the aetiology of the Ulcers. Nor was a particular Ulcer associated with one type of urethritis more than the other. Neither C trachomatis nor M Genitalium was associated significantly with non-gonococcal urethritis (NGU) in either HIV positive or HIV negative men. Conclusion: The combination of antibiotics used for the management of Genital Ulcer disease in men in this South African mining population needs to be widened to encompass frequently occurring concomitant gonococcal urethritis and NGU infections. This means treatment with long acting penicillin, combined with ciprofloxacin and azithromycin or erythromycin. A similar situation may exist in other geographical locations with a need to provide appropriate antimicrobial combinations depending on the patterns of infection detected.

  • human immunodeficiency virus infection and Genital Ulcer disease in south africa the herpetic connection
    Sexually Transmitted Diseases, 2000
    Co-Authors: Cheng Y Chen, Y Dangor, Ronald C. Ballard, G. Fehler, Consuelo M Becksague, Frans Radebe, Scott Schmid, Judith B Weiss, Vanessa Tshabalala, Ye Htun
    Abstract:

    This cross-sectional study of 558 men with Genital Ulcer disease (GUD) and 602 men with urethritis aimed to determine the etiology of GUD in HIV-infected and noninfected men attending sexually transmitted disease (STD) clinics in Durban Johannesburg and Cape Town South Africa. Statistical analysis shows that patients with GUD were more likely to be infected with HIV than patients with urethritis (39.4% vs. 21.4%). Most importantly it was found that herpes simplex virus 2 (HSV-2) is a more common cause of GUD than has been suggested by previous studies conducted in South Africa. In addition serologic evidence of HSV-2 infection and current initial or recurrent Genital herpes are strongly associated with HIV infection among men who attended STD clinics with GUD or urethritis. In view of these findings it is suggested that future approaches for reducing HIV transmission by STD control should include efforts to address HSV-2 infection.

  • comparison of clinically directed disease specific and syndromic protocols for the management of Genital Ulcer disease in lesotho
    Sexually Transmitted Infections, 1998
    Co-Authors: Ye Htun, Y Dangor, G. Fehler, F Radebe, Stephen A Morse, David L Trees, Consuelo M Becksague, Ronald C. Ballard
    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.

  • comparison of clinical diagnosis and standard laboratory and molecular methods for the diagnosis of Genital Ulcer disease in lesotho association with human immunodeficiency virus infection
    The Journal of Infectious Diseases, 1997
    Co-Authors: Stephen A Morse, Y Dangor, F Radebe, Ye Htun, David L Trees, Consuelo M Becksague, Scott Schmid, Karina Anna Orle, Glenda Fehler, Judith B Weiss
    Abstract:

    A multiplex polymerase chain reaction (M-PCR) assay for Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus (HSV) was compared with clinical and standard laboratory methods for the diagnosis of Genital Ulcer disease (GUD) in 105 patients; 36% were human immunodeficiency virus (HIV)-seropositive. Chancroid (80%), syphilis (8%), and Genital herpes (8%) were the most frequent diagnoses. H. ducreyi and HSV were isolated from Ulcers of 43% and 18% of patients, respectively; in 35%, all cultures were negative and the laboratory diagnosis indeterminate. M-PCR detected H. ducreyi, T. pallidum, and HSV in 56%, 23%, and 26% of patients, respectively; (no definitive diagnosis, 6%). The proportion of patients with more than one agent was 4% by culture and 17% by M-PCR (P = .002). Resolved sensitivities of M-PCR for H. ducreyi and HSV cultures were 95% and 93%, respectively. The sensitivities of H. ducreyi and HSV cultures were 75% and 60%, respectively. HSV, detected in 47% of specimens from HIV-infected versus 16% from HIV-uninfected patients (P < .001), may be emerging as a more frequent cause of GUD.