SIMPLE ALGORITHMS FOR THE MANAGEMENT OF GENITAL ULCERS - EVALUATION IN A PRIMARY HEALTH-CARE CENTER IN KIGALI, RWANDA

A cross-sectional study was conducted among 395 patients presenting wi th genital ulcers at a primary health care centre in Kigali, Rwanda. U sing clinical data and the results of a rapid plasma reagin (RPR) test , we simulated the diagnostic outcome of two simple WHO flowcharts for the management of genital ulcers. These outcomes and a clinical diagn osis were then compared with the laboratory diagnosis based on culture for genital herpes and Haemophilus ducreyi and serology for syphilis. The prevalence of HIV infection was high (73%) but there was no diffe rence between HIV-positive and HIV-negative patients in the clinical p resentation and etiology of genital ulcer disease. The proportion of c orrectly managed chancroid and/or syphilis cases was 99% using a syndr omic approach, 82.1% using a hierarchical algorithm including an RPR t est, and 38.3% with a clinical diagnosis.In situations where no labora tory support is available, a simple syndromic approach is preferable t o the clinical approach for the management of genital ulcer. If an RPR test can be included in the diagnostic strategy, patients with a reac tive RPR test should be treated for both syphilis and chancroid infect ion.