Background In many countries, sexually transmitted infections (STI) are treated syndromically. Thus, patients diagnosed with genital ulcer disease (GUD) in Zimbabwe receive antimicrobials that cover infections with Treponema pallidum (TP: benzathine penicillin), Haemophilus ducreyi (HD: erythromycin) and herpes simplex virus (HSV: acyclovir). However, periodic surveys into the aetiology of GUD are necessary to inform treatment guidelines.
Methods For this study, we recently completed enrollment of 200 patients with GUD at 6 clinics in Zimbabwe. To date, test procedures have been completed for patients enrolled at Harare clinics (N = 70). Ulcer specimens were obtained for testing using a validated multiplex polymerase chain reaction assay (M-PCR, National Institute of Communicable Diseases, Johannesburg) for TP (primary syphilis), HD (chancroid), HSV (genital herpes) and Chlamydia trachomatis strains associated with lymphogranuloma venereum (CT-LGV). Blood samples were collected for HIV testing by a standard rapid HIV test algorithm (First Response™ followed by Alere HIV 1/2™) and considered positive when reactive on both.
Results To date, M-PCR testing is complete for all 70 patients with GUD recruited from the Harare clinics (38 men and 32 women). Of these, 17 (24.2%) were positive for HSV, 8 (11.4%) were positive for TP, and 1 was positive for CT-LGV. No cases of chancroid were detected. The overall HIV positivity rate was 43.1%. HIV rates were higher among patients with HSV (62.5%, p = 0.07, Chi Square Test) and TP (87.5%, p < 0.01, Fisher’s Exact Test).
Conclusions Genital herpes was the most common cause of GUD in our survey, followed by primary syphilis. The association of HIV infection with HSV and TP suggests high risk for co-transmission; however some HSV ulcerations among HIV-infected patients may be the result of HSV reactivation among immunocompromised patients. Our study methods and data should be relevant for other countries using a syndromic management to STI control.