Institutional members access full text with Ovid®

Share this article on:

Etiologic Pattern of Genital Ulcers in Lusaka, Zambia: Has Chancroid Been Eliminated?

Makasa, Mpundu MD, MPH*†; Buve, Anne MD, MSc, PhD; Sandøy, Ingvild Fossgard MD, PhD

doi: 10.1097/OLQ.0b013e31826ae97d
Original Study

Background Genital ulcers are a public health problem in developing countries. The World Health Organization recommends the use of syndromic guidelines for sexually transmitted infection treatment in resource-constrained countries. Monitoring local etiologies provides information that may aid policy for sexually transmitted infection treatment. We investigated the etiology of genital ulcer disease among outpatients in Lusaka, Zambia.

Methodology Swabs from genital ulcers of 200 patients were tested using polymerase chain reaction for Treponema pallidum, herpes simplex virus types 1 (HSV-1) and 2 (HSV-2), Haemophilus ducreyi, and Chlamydia trachomatis.

Results The prevalence of the detected pathogens was as follows; HSV-2, 28%; T. pallidum, 11.5%; C. trachomatis, 3%; HSV-1, 0.5%; and H. ducreyi, 0%. Coinfection with HSV-2 and T. pallidum was 1.5%, and coinfection of HSV-2 and C. trachomatis was 1%. In 55% of the patients, no etiologic diagnosis could be established.

Conclusions H. ducreyi was not detected, whereas HSV-2 and T. pallidum were the commonest pathogens. Nondetection of H. ducreyi requires further studies. If the present findings are validated, treatment guidelines would require to be revised in Zambia.

HSV-2 was the commonest pathogen detected by PCR while Haemphilus ducreyi was not detected in any of the patients with genital ulceration attending government clinics in Lusaka, Zambia.

From the *Lusaka District Health Management Team, Ministry of Health, Lusaka, Zambia; †Centre for International Health, University of Bergen, Bergen, Norway; and ‡Unit of Epidemiology and Control of HIV/STD, Institute of Tropical Medicine, Antwerp, Belgium

The authors thank the patients who participated in the study. The authors also thank David Rutagwera for coordinating the laboratory work with Chisanga Mulombwa’s assistance, the research assistants, and the management and staff at the KS research Laboratory at the University Teaching Hospital in Lusaka. The authors are also grateful to Tania Crucitti for reviewing the article and for the valuable comments.

Supported by the University of Bergen, Bergen, Norway.

The authors declare no conflicts of interest.

Design and plan of the study were contributed by M.M. and I.F.S. Fieldwork was conducted by M.M. Analysis, write up, and approval of the final version were all provided by M.M., I.F.S., and A.B.

Correspondence: Mpundu Makasa, MD, Centre for International Health, University of Bergen, PO Box 7804, N0-5020 Bergen, Norway. E-mail:

Received for publication February 7, 2012, and accepted July 20, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association