Simple algorithms for the management of genital ulcers: evaluation in a primary health care centre in Kigali, Rwanda

J Bogaerts, Bea Vuylsteke, W Martinez Tello, V Mukantabana, J Akingeneye, Marie Laga, P Piot

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A cross-sectional study was conducted among 395 patients presenting with genital ulcers at a primary health care centre in Kigali, Rwanda. Using clinical data and the results of a rapid plasma reagin (RPR) test, the authors simulated the diagnostic outcome of two simple WHO flowcharts for the management of genital ulcers. These outcomes and a clinical diagnosis were then compared with the laboratory diagnosis based on culture for genital herpes and Haemophilus ducreyi and serology for syphilis. The prevalence of HIV infection was high (73%) but there was no difference between HIV-positive and HIV-negative patients in the clinical presentation and aetiology of genital ulcer disease. The proportion of correctly managed chancroid and/or syphilis cases was 99% using a syndromic approach, 82.1% using a hierarchical algorithm including an RPR test, and 38.3% with a clinical diagnosis. In situations where no laboratory support is available, a simple syndromic approach is preferable to the clinical approach for the management of genital ulcer. If an RPR test can be included in the diagnostic strategy, patients with a reactive RPR test should be treated for both syphilis and chancroid infection
Original languageEnglish
JournalBulletin of the World Health Organization
Issue number6
Pages (from-to)761-767
Publication statusPublished - 1995


  • B780-tropical-medicine
  • Sexually transmitted diseases
  • STD
  • Genital ulcers
  • Ulcers
  • Primary health care
  • Diagnosis
  • Algorithms
  • HIV
  • Viral diseases
  • Chancroid
  • Syphilis
  • Bacterial diseases
  • Herpes
  • Treatment
  • Clinical
  • Rwanda
  • Africa-Central


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