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

A multiplex polymerase chain reaction (M-PCR) assay for Haemophilus du creyi, Treponema pallidum, and herpes simplex virus (HSV) was compared with clinical and standard laboratory methods for the diagnosis of ge nital ulcer disease (GUD) in 105 patients; 36% were human immunodefici ency virus (HIV)-seropositive. Chancroid (80%), syphilis (8%), and gen ital 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 indeterm inate. M-PCR detected H. ducreyi, T. pallidum, and HSV in 56%, 23%, an d 26% of patients, respectively; (no definitive diagnosis, 6%). The pr oportion 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, detec ted in 47% of specimens from HIV-infected versus 16% from HIV-uninfect ed patients (P < .001), may be emerging as a more frequent cause of GU D.