Genital ulcer disease in men in Durban, South Africa

Abstract

Objective: To study the microbial aetiology of genital ulcer disease (GUD) in men.

Design: Microbiological and clinical assessment of genital ulcers in men.

Setting: City Health sexually transmitted diseases clinic, King Edward VIII Hospital, Durban, South Africa.

Participants: 100 Zulu men with genital ulcers who had not received antibiotics in the previous four weeks.

Results: Syphilis was diagnosed in 42%, chancroid in 22%, donovanosis (granuloma inguinale) in 11%, genital herpes in 10% and lymphogranuloma venereum (LGV) in 6%. No pathogens were identified in 24%. Mixed infections were detected in 14 men, in whom 13 had syphilis. Five men had HIV-1 antibodies. Neisseria gonorrhoeae was isolated from the ulcers and urethra in seven men and from the urethra alone in five. Scabies was diagnosed clinically in eight.

Conclusions: All the major causes of GUD are prevalent in Zulu men in Durban. Primary syphilis was the commonest and was invariably present in mixed infections. Donovanosis was under-reported and was associated with a long delay before presentation. In this population, genital ulcers other than superficial lesions should be treated with anti-syphilitic therapy and oral antibiotics effective against chancroid and donovanosis.