MOLECULAR METHODS FOR THE DIAGNOSIS OF GENITAL ULCER DISEASE IN A SEXUALLY-TRANSMITTED DISEASE CLINIC POPULATION IN NORTHERN THAILAND - PREDOMINANCE OF HERPES-SIMPLEX VIRUS-INFECTION

A multiplex polymerase chain reaction (M-PCR) assay that simultaneousl y detects the three major causes of genital ulcer disease (GUD), Haemo philus ducreyi, Treponema pallidum, and herpes simplex virus, was used to evaluate swab specimens for 38 sequential patients with GUD at a T hai sexually transmitted disease: clinic. Subjects received clinical d iagnoses and syndromic treatment. Swab specimens for H. ducreyi cultur es and M-PCR were obtained. No H. ducreyi cultures were positive. Of 3 8 M-PCR specimens, 31 (81.6%) were positive for HSV, 1 (2.3%) for both HSV and T, pallidum, and none for H. ducreyi or T. pallidum alone; 6 (15.8%) were negative for all 3 pathogens. Clinical diagnoses correspo nded poorly to M-PCR findings; none of 5 suspected cases of chancroid were positive by M-PCR and none of 1 for syphilis, but 21 of 24 suspec ted herpes lesions were confirmed by M-PCR. Human immunodeficiency vir us infection status was known for 24 of 38 subjects; 11 (45.8%) were s eropositive, and all 11 had HSV by M-PCR. HSV appeared to be the most common pathogen overall.