Genital ulcer disease in India: Etiologies and performance of current syndrome guidelines

Parimi Prabhakar, Prakash Narayanan, Gururaj Rao Deshpande, Anjana Das, Graham Neilsen, Sanjay Mehendale, Arun Risbud

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)


BACKGROUND: In India, genital ulcer disease (GUD) syndrome is clinically classified as herpetic or nonherpetic and managed accordingly; laboratory support is unavailable at most health facilities. We undertook a study to determine the etiology of GUDs in men presenting to sexually transmitted infection (STI) clinics and assess the performance of the national algorithm for syndromic management of herpetic and nonherpetic GUDs in India. METHOD: A cross-sectional study was conducted among men with complaints of genital ulcers attending 8 STI clinics in 4 states. Ulcer swabs were collected and tested by the multiplex polymerase chain reaction method to determine the etiology of GUD. RESULTS: Of the 194 men recruited, etiology was confirmed in 121 GUD cases (62%). Herpes simplex virus (48%) was the most common etiological agent identified, followed by Treponema pallidum (23%) and mixed infections (9%). One case of Haemophilus ducreyi was confirmed in this series. The overall sensitivity and specificity of the national syndromic management algorithm for GUD were 68% and 52%, respectively. Using the national algorithm, 52 (42%) cases clinically misclassified as either herpetic (18 cases) or nonherpetic (34 cases) GUD resulting in incorrect treatment. CONCLUSIONS: Our findings suggest a revision of existing national STI treatment guidelines in India to include treatment of syphilis infections of all GUD patients. Periodic studies are required to monitor changing spectrum of GUD etiologies in India.

Original languageEnglish
Pages (from-to)906-910
Number of pages5
JournalSexually Transmitted Diseases
Issue number11
Publication statusPublished - 01-11-2012

All Science Journal Classification (ASJC) codes

  • Dermatology
  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)
  • Infectious Diseases


Dive into the research topics of 'Genital ulcer disease in India: Etiologies and performance of current syndrome guidelines'. Together they form a unique fingerprint.

Cite this