Simple Algorithms for the Management of Genital Ulcers: Evaluation in a Primary Health Care Center in Kigali, Rwanda

By Bogaerts, J.; Vuylsteke, B. et al. | Bulletin of the World Health Organization, November-December 1995 | Go to article overview

Simple Algorithms for the Management of Genital Ulcers: Evaluation in a Primary Health Care Center in Kigali, Rwanda


Bogaerts, J., Vuylsteke, B., Martinez Tello, W., Mukantabana, V., Akingeneye, J., Laga, M., Piot, P., Bulletin of the World Health Organization


Introduction

Prompt diagnosis and treatment of genital ulcer disease (GUD) is important not only to reduce morbidity but also to slow down the spread of human immunodeficiency virus (HIV) (1). In developing countries, where laboratory facilities are scarce, etiological diagnosis of GUD is usually based on clinical criteria only. However, even before the HIV era, it was reported that this approach was not very accurate, even if performed by experienced clinicians (2, 3). To assure prompt and effective treatment of patients with sexually transmitted diseases (STDs) at the primary health care level, WHO has developed simple flowcharts (4), including two designed for the management of GUD.

In Rwanda, which has a population of around 7 million, about 5000 cases of primary syphilis are reported annually to the health authorities, other causes of GUD are reported only sporadically or not at all. In the Centre Medico Social de Bilyogo in Kigali in 1985, the proportions of chancroid, syphilis and genital herpes diagnosed among patients with GUD were 18%, 28%, and 19%, respectively; 59% of these patients were infected with HIV-1 (5).

The first objective of this study was to assess the proportion of genital herpes, syphilis, and chancroid in patients with and without HIV infection who presented with GUD at a primary health care centre in Kigali. The second, was to compare three simple methods for the management of GUD (two WHO algorithms (flowcharts) and a clinical approach) to determine which approach would result in the largest proportion of patients with chancroid and/or syphilis receiving the correct treatment.

Patients and methods

Data collection

During 1990-92, on three working days each week, all consecutive men and women presenting with genital ulcers at the Centre Medico Social de Bilyogo in Kigali were included in the study. This primary health care centre serves the lower socioeconomic levels and is situated in a part of the city where prostitution is widespread.

Demographic and clinical information about the patients were obtained in a standard interview. All patients underwent a physical examination of the external genitalia and the inguinal region before specimens for laboratory analysis were taken; each patient was diagnosed clinically by a physician (JB) before the laboratory results were known. The following criteria were used: invasive ulcers were considered as chancroid; noninvasive ulcers, as primary syphilis; and genital herpes was diagnosed if vesicles were present, or if there was a history of recurrences, or the ulcers were superficial (erosions). Pain and purulence were not used as diagnostic criteria. If the clinical picture did not correspond to one of these criteria, the diagnosis remained undetermined. No attempts were made to identify clinically other causes of GUD or mixed infections. All patients were requested to return for clinical and microbiological evaluation on days 7, 14, 21 and 28 after the initial visit.

Laboratory procedures

Haemophilus ducreyi was isolated by inoculating a swab specimen from the ulcer directly onto two selective media. The first medium consisted of Mueller-Hinton agar base 2 (BioMerieux, Marcy l'Etoile, France) supplemented with 1% Iso Vitalex (BBL Microbiology Systems, Cockeysville, MD, USA), 5% fetal calf serum (Gibco, Paisley, Scotland), 1% haemoglobin (Difco, Detroit, MI, USA) and 3 [mu]g/ml vancomycin. The second medium had a gonococcal agar base (GC-Agar, Difco, Detroit, MI, USA) and the same supplements as the first. Isolates were identified on the basis of typical colony morphology and Gram-stain results. Specimens for isolation of herpes simplex virus (HSV) were obtained with a nontoxic cotton swab which was transported in Hank's balanced salt solution to the Institute of Tropical Medicine, Antwerp, Belgium, where HSV was detected by its cytopathic effect on a monolayer of Vero cells. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Simple Algorithms for the Management of Genital Ulcers: Evaluation in a Primary Health Care Center in Kigali, Rwanda
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.