Behets F M, Liomba G, Lule G, Dallabetta G, Hoffman I F, Hamilton H A, Moeng S, Cohen M S
Department of Medicine, University of North Carolina, Chapel Hill 27599.
J Infect Dis. 1995 Feb;171(2):451-5. doi: 10.1093/infdis/171.2.451.
Men with genital ulcer disease (GUD) attending a clinic in Malawi were evaluated and treated with one of five drug regimens. Haemophilus ducreyi was isolated from 204 (26.2%) of 778 patients. Of 677 men, 198 (29.2%) had treponemes detected in ulcer material by direct immunofluorescence or had rapid plasma reagin reactivity of > or = 1:8. Human immunodeficiency virus type 1 (HIV-1) seroprevalence was 58.9% overall and 75.8% among patients reporting a history of GUD (P < .001). By logistic regression analysis, HIV-1 seropositivity was shown to impair ulcer healing (P = .003). Treatment failure rates for culture-proven chancroid were 19% for trimethoprim-sulfamethoxazole, 12.9% and 7.4%, respectively, for low- and high-dose erythromycin regimens, and 8.3% and 0, respectively, for low- and high-dose ciprofloxacin regimens. Herpes antigen was detected by EIA in 6 (23.1%) of 26 nonhealing ulcers. In Malawi, GUD should be managed as a syndrome to assure treatment of both syphilis and chancroid.
在马拉维一家诊所就诊的患有生殖器溃疡疾病（GUD）的男性接受了评估，并采用五种药物治疗方案之一进行治疗。从778名患者中的204名（26.2%）分离出了杜克雷嗜血杆菌。在677名男性中，198名（29.2%）通过直接免疫荧光法在溃疡材料中检测到梅毒螺旋体，或快速血浆反应素反应性≥1:8。总体而言，1型人类免疫缺陷病毒（HIV-1）血清阳性率为58.9%，报告有GUD病史的患者中为75.8%（P<0.001）。通过逻辑回归分析，显示HIV-1血清阳性会损害溃疡愈合（P = 0.003）。经培养证实的软下疳的治疗失败率，甲氧苄啶-磺胺甲恶唑为19%，低剂量和高剂量红霉素治疗方案分别为12.9%和7.4%，低剂量和高剂量环丙沙星治疗方案分别为8.3%和0。在26个未愈合的溃疡中，有6个（23.1%）通过酶免疫测定法检测到疱疹抗原。在马拉维，GUD应作为一种综合征进行管理，以确保梅毒和软下疳都能得到治疗。
