       Document 0742
 DOCN  M9440742
 TI    Genital ulcer disease: accuracy of clinical diagnosis and strategies to
       improve control in Durban, South Africa.
 DT    9404
 AU    O'Farrell N; Hoosen AA; Coetzee KD; van den Ende J; City Health STD
       Department, King Edward VIII Hospital, Durban,; South Africa.
 SO    Genitourin Med. 1994 Feb;70(1):7-11. Unique Identifier : AIDSLINE
       MED/94131462
 AB    OBJECTIVE--To investigate the accuracy of clinical diagnosis in genital
       ulcer disease (GUD); to devise management strategies for improving the
       control of GUD and thereby limit the spread of HIV-1 infection.
       DESIGN--Clinical and microbiological assessment of GUD in men and women.
       The index of suspicion, diagnostic accuracy, diagnostic efficiency and
       positive and negative predictive values of a clinical diagnosis were
       investigated. SETTING--City Health Sexually Transmitted Diseases Clinic,
       King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS--100 men
       and 100 women with genital ulcers. RESULTS--The accuracy of a clinical
       diagnosis was, in men: lymphogranuloma venereum (LGV) 66%, donovanosis
       63%, chancroid 42%, genital herpes 39%, primary syphilis 32%, mixed
       infections 8%, and in women; secondary syphilis 94%, donovanosis 83%,
       genital herpes 60%, primary syphilis 58%, chancroid 57%, LGV 40%, mixed
       infections 14%. Overall, diagnostic efficiency was greater in women than
       in men. When compared with other causes of GUD, donovanosis ulcers bled
       to the touch and were larger and not usually associated with inguinal
       lymphadenopathy. In women, extensive vulval condylomata lata were
       readily differentiated from all other causes of GUD. CONCLUSION--A
       clinical diagnosis in genital ulceration was less accurate in men than
       in women. The diagnostic accuracies for donovanosis and secondary
       syphilis were relatively high but for most other conditions were low.
       Differences between clinical and laboratory diagnostic accuracies may
       reflect similarities between the clinical appearances of the various
       causes of GUD, the presence of mixed infections, atypical ulceration due
       to longstanding disease, and insensitive laboratory tests. In this
       community all large ulcers should be treated empirically for syphilis
       and donovanosis. Uncircumcised men with GUD are an important HIV core or
       superspreader group locally, and prevention strategies should include
       counselling and health education in the light of the inaccuracy of
       clinical diagnosis found in this study. The development of rapid
       accurate tests for GUD is urgently required.
 DE    Chancroid/DIAGNOSIS  Female  Genital Diseases, Female/*DIAGNOSIS
       Genital Diseases, Male/*DIAGNOSIS  Granuloma Inguinale/DIAGNOSIS  Herpes
       Genitalis/DIAGNOSIS  Human  Lymphogranuloma Venereum/DIAGNOSIS  Male
       Sensitivity and Specificity  South Africa  Syphilis/DIAGNOSIS
       Ulcer/DIAGNOSIS  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

