Chancroid, primary syphilis, genital herpes, and lymphogranuloma venereum in Antananarivo, Madagascar

Ulcer material from consecutive patients attending clinics in Antananarivo, Madagascar, was tested using multiplex polymerase chain reaction (M-PCR) t o detect Treponema pallidum, Haemophilus ducreyi, and herpes simplex virus. Sera were tested for syphilis and for Ige and Igh I antibodies to Chlamydi a trachomatis by microimmunofluorescence testing (MIF). By M-PCR, 33% of 19 6 patients had chancroid, 29% had syphilitic ulcers, and 10% had genital he rpes; 32% of the ulcer specimens were M-PCR negative. Compared with M-PCR, syphilis serology was 72% sensitive and 83% specific, The sensitivity of cl inical diagnosis of syphilis, chancroid, and genital herpes was 93%, 53%, a nd 0% and specificity was 20%, 52%, and 99%, respectively. Less schooling w as associated with increased prevalence of syphilitic ulcers (P = .001). Si xteen patients (8%) were clinically diagnosed with lymphogranuloma venereum (LGV); 1 plausible case of LGV was found by MIE In Madagascar, primary car e of genital ulcers should include syndromic treatment for syphilis and cha ncroid.