Diagnosing genital ulcer disease in a clinic for sexually transmitted diseases in Amsterdam, The Netherlands

The most common etiologic agents of genital ulcer disease (GUD) are herpes simplex virus type 1 (HSV-1), HSV-2, Treponema pallidum, and Haemophilus du creyi. In an outpatient clinic for sexually transmitted diseases in Amsterd am, The Netherlands, specimens from 372 patients with GUD were collected fr om February to November 1996. Sera were collected at the time of the sympto ms and, for most patients, also during follow-up visits. Swabs in viral tra nsport medium were used for HSV culture and for detection of DNA. The most prevalent pathogen found was HSV-2, which was detected by culture in 35% of the patients and by PCR in 48% of the patients. Also, HSV-1 infection was more often detected by PCR (7.8%) than by culture (5.6%). Evidence for an a ctive infection with T. pallidum was found in 1.9% of the patients, using s erological tests. A multiplex PCR for simultaneous T. pallidum and H. ducre yi DNA detection was positive for T. pallidum in 3.3% of the samples and fo r H ducreyi in only 0.9% (3 out of 368) of the samples. The sensitivity of the PCR was superior to that of culture for HSV detection and to that of se rology for T. pallidum detection. Specific H. ducreyi immunoglobulin G anti bodies were detected in sera of 5.2% of the patients, with no concordance b etween serology and PCR. In 37% of the cases, none of the tested microorgan isms was detected. Performance of PCR in addition to conventional technique s significantly improved the diagnosis of GUD.