Bacterial, viral and parasitic aetiology of paediatric diarrhoea in the highlands of Papua New Guinea

Enteropathogens and clinical features associated with diarrhoea were investigated in 1526 children admitted over a 5-year period to the paediatric ward of a hospital in the highlands of Papua New Guinea. Overall, a recognized pathogen was isolated from 39 per cent of the children admitted with diarrhoea. The most commonly isolated agents were rotavirus (23 per cent), Shigella spp. (13 per cent), Campylobacter spp. (12 per cent), Cryptosporidium parvum (10 per cent) and enteropathogenic Escherichia coli (8 per cent). The clearest clinical associations were rotavirus with vomiting, and Shigella with blood and pus in the stool. A control series of children admitted with other complaints was also included, and the odds ratios for diarrhoea for the above five pathogens were 18.2, 9.6, 3.7, 2.2, and 1.6, respectively.

Ammonium lactate 12% lotion versus a liposome-based moisturizing lotion for plantar xerosis. A double-blind comparison study

Two emollients, ammonium lactate 12% lotion and a liposome-based moisturizing lotion, were compared in a double-blind test for efficacy in the treatment of plantar xerosis. A total of 43 out of 57 participants (75%) with bilateral plantar xerosis followed instructions completely and applied the lotions (one to each foot) twice daily for 4 weeks. Each participant was evaluated once a week for 6 weeks (the final 2 weeks for evaluation of post-treatment regression) to determine xerotic grade (degree of dryness) and treatment effectiveness. With both lotions, significant improvement began during the second week of treatment and continued into the fourth week. There were no significant differences between the two lotions in the 6-week patterns of either xerotic grade or treatment effectiveness.

Cardiovascular disease risk factors in 2 distinct ethnic groups: Indian and Pakistani compared with American premenopausal women

BACKGROUND

Although people from the Indian subcontinent have high rates of cardiovascular disease (CVD), studies of such in Indian and Pakistani women living in the United States are lacking.

OBJECTIVE

This study accounted for variability in serum lipid (total cholesterol and triacylglycerol) and lipoprotein [LDL cholesterol, lipoprotein(a), and HDL cholesterol] concentrations in Indian and Pakistani compared with American premenopausal women in the United States. Body composition, regional fat distribution, dietary intake, and energy expenditure were compared between groups.

DESIGN

The 2 groups were 47 Indian and Pakistani and 47 American women. Health was assessed via medical history, physical activity, body composition (via anthropometry and dual-energy X-ray absorptiometry), dietary intake (via 7-d food records), and serum lipids.

RESULTS

Serum total cholesterol, triacylglycerol, LDL cholesterol, lipoprotein(a), the ratio of total to HDL cholesterol, and the ratio of LDL to HDL cholesterol were greater (P <0.03), whereas HDL-cholesterol values were lower (P = 0.011) in Indians and Pakistanis than in Americans. Multiple regression analysis indicated that approximately 18% of the variance in total cholesterol (P = 0.0010) and LDL cholesterol (P = 0.0009) was accounted for by ethnicity, energy expenditure, and the ratio of the sum of central to the sum of peripheral skinfold thicknesses. Ethnicity, sum of central skinfold thicknesses, ratio of polyunsaturated to saturated fat, and monounsaturated fat intake accounted for approximately 43% of the variance in triacylglycerol concentration (P < 0.0001). Monounsaturated fat, percentage body fat, and alcohol intake accounted for approximately 26% of variance in HDL cholesterol. Ethnicity contributed approximately 22% of the 25% overall variance in lipoprotein(a).

CONCLUSIONS

Results suggest that these Indian and Pakistani women are at higher CVD risk than their American counterparts, but that increasing their physical activity is likely to decrease overall and regional adiposity, thereby improving their serum lipid profiles.

Lifestyle and biologic contributors to proximal femur bone mineral density and hip axis length in two distinct ethnic groups of premenopausal women

Although relatively little is known about osteoporotic risk factors in women from the Indian subcontinent, osteoporotic fractures usually occur 10-20 years earlier in Indian men and women compared with their western Caucasian counterparts. The primary purpose of this cross-sectional study was to determine the relative contributions of ethnicity, reproductive history, body size (height, weight) and composition, bone turnover, serum 25(OH)vitamin D(3) [25(OH)D(3)], dietary intake (of calcium, fiber and alcohol) and energy expenditure to femoral bone mineral density (BMD) in Indian and Pakistani (Indian/Pakistani; n = 47) versus American (n = 47) Caucasians. We also contrasted femoral BMD and hip axis length in these two distinct groups of premenopausal females living in the USA. The Indian/Pakistani (0.875 +/- 0.096) women had lower (p = 0.0014) femoral BMD (g/cm(2)) than their American (0.937 +/- 0.088) counterparts, placing them at greater osteoporotic risk. However, the shorter (p = 0.0002) hip axis length (cm) of the Indian/Pakistani (10.54 +/- 0.57) versus American (11.11 +/- 0.78) Caucasians might attenuate hip fracture risk in the former group. Significant contributors to proximal femur BMD were maximum non-pregnant lifetime weight, age at menarche, ratio of summation sigma central-to-peripheral skinfold thicknesses, calcium intake from milk and usual alcohol intake. Although serum 25(OH)D(3) and urinary N-telopeptide concentrations did not contribute to femoral BMD in the regression models, the lower (p<0.0001) serum 25(OH)D(3) (33.1 +/- 16.5 vs 64.0 +/- 22.0 nmol/l) and higher (p = 0.0004) urinary N-telopeptide (45.9 +/- 43.3 vs 18.9 +/- 18.7 nmol BCE/mmol) values in Indian/Pakistani versus American Caucasians, respectively, coupled with their lower BMD, places the Indian/Pakistani women at greater osteoporotic risk. These results suggest that a clinical trial to increase BMD and reduce osteoporotic risk is warranted in this ethnic group of premenopausal women.

Validation of a WHO algorithm with risk assessment for the clinical management of vaginal discharge in Mwanza, Tanzania

OBJECTIVES

(i) To determine the microbial aetiologies of vaginal discharge in STD clinic and antenatal clinic (ANC) attenders; (ii) to evaluate the performance and costs of a new WHO algorithm for the detection of gonococcal and chlamydial infections in women complaining of vaginal discharge and/or genital itching, using a risk assessment.

METHODS

Two groups were enrolled: (i) 395 consecutive female patients attending a hospital outpatient clinic complaining of genital discharge or itching; and (ii) 628 consecutive pregnant women reporting at an urban ANC these symptoms. Patients were interviewed by a nurse, who applied the WHO risk score. They were then referred to the study room for interview concerning the same and other risk factors, examined, and sampled for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), and Candida albicans (CA). Sensitivity, specificity, positive predictive value, overtreatment and correct treatment rates, and cost of drugs per true case treated were estimated.

RESULTS

The prevalence of NG and/or CT infections was 11.4% and 8% at the STD clinic and the ANC respectively. The most prevalent pathogens were CA (38% at both clinics) and TV (25% at the STD clinic and 34% at the ANC). The sensitivity of the WHO algorithm for NG and/or CT was 62% at the STD clinic and 46% at the ANC, and the specificities were 64% and 84% respectively. The operational feasibility of the method was good. The cost of drugs per true case treated in applying the risk assessment approach was $3.5 among nonpregnant women and $5.0 among pregnant women. This compared favourably with respective costs of $8.8 and $25.0 in applying the syndromic management alone.

CONCLUSIONS

The WHO risk assessment algorithm for the diagnosis of NG and/or CT infections among women complaining of genital discharge can considerably reduce overtreatment of NG and/or CT in both pregnant and non-pregnant women, but in this study it failed to identify 38% of non-pregnant and 54% of pregnant women with these infections. The elements of the risk score may need adjustment in different settings.

Risk scores to detect cervical infections in urban antenatal clinic attenders in Mwanza, Tanzania

BACKGROUND

Detection and management of gonococcal and/or chlamydial infections in women is a challenge, particularly in developing countries where laboratory tests are not always available. The World Health Organisation (WHO) has developed a risk assessment approach to identify cervical infections among women complaining of vaginal discharge. We have evaluated this approach as a screening strategy among women attending an urban antenatal clinic (ANC) in Tanzania.

OBJECTIVES

(i) To measure the prevalence of pathogens associated with sexually transmitted diseases (STD) and reproductive tract infections (RTI) in an urban population of ANC attenders in Tanzania; (ii) to examine characteristics of pregnant women associated with cervical infections; and (iii) to evaluate the performance of a WHO risk assessment algorithm and alternative risk scores for the detection of cervical infections in pregnant women.

METHODS

A systematic sample of 660 pregnant women reporting for routine antenatal care at an urban clinic was enrolled. Women were interviewed by a nurse, who applied the WHO risk score. They were referred to a study room for interview about sociodemographic and behavioural factors, examination, and sampling for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Candida albicans, and bacterial vaginosis. Sensitivity, specificity, positive predictive value (PPV), and theoretical cost per true case treated were estimated for the diagnosis of cervical infection with N gonorrhoeae and/or C trachomatis for the WHO and other risk scores.

RESULTS

The prevalence of any vaginal or cervical infection was 68%. Prevalence rates of various pathogens were: C albicans 39%, T vaginalis 16%, bacterial vaginosis 24%, N gonorrhoeae 2.3%, C trachomatis 5.9%, any cervical infection (N gonorrhoeae and/or C trachomatis) 7.4%. The WHO score identified only five of 49 women with N gonorrhoeae and/or C trachomatis (sensitivity 10.2%). The specificity and the PPV were 92% and 9.8% respectively. The theoretical cost per true case treated on the basis of the WHO score was over $18. Several risk factors were associated with cervical infection on univariate analysis, but only six remained significant at the 10% level after multivariate analysis. These were: never use of contraceptives (OR 3.09), more than one partner in the past 3 months (OR 3.32), partner with symptoms of genital discharge syndrome (GDS) (OR 7.55), frothy vaginal discharge (OR 1.88), 5-19 polymorphonucleocytes per high power field on cervical smear (OR 3.28), or more than 20 polymorphonucleocytes per high power field (OR 16.08), and wet preparation showing evidence of T vaginalis infection (OR 1.96). Scores based on these variables failed to attain high sensitivities or PPVs (all below 40%) although the costs per true case treated were cheaper than for the WHO score.

CONCLUSION

Risk assessment for the screening and management of N gonorrhoeae and/or C trachomatis among women presenting at routine antenatal services appears feasible and acceptable, but of limited value in this population because of its low sensitivity. The optimal risk score may vary considerably from one place to another. The quest for simple, cheap, and reliable tests to diagnose N gonorrhoeae and C trachomatis infections still remains a high priority on the international STD technology research agenda.

"How do you feel?" Self-Reported Health as an Indicator of Current Physical and Mental Health Status

Self-reported health can serve as a reliable indicator of an individual's physical health status and future morbidity and mortality. Although patients are commonly asked "How do you feel?" they are rarely asked to rate their health on a continuum of excellent to poor. This question can be helpful in ascertaining the need for further assessment or referral.

Interleukin-6 in the fever and multiorgan crisis of pheochromocytoma

A 31-y-old black man with neurofibromatosis, alcoholism and hypertension was admitted because of abdominal pain, hematemesis and cough. In the hospital he had prolonged fever and developed a multiorgan crisis. Despite thorough investigation, no infectious cause for fever was found. Urinary catecholamines and metabolites were markedly elevated. Computerized tomography revealed a mass abutting the left kidney. A diagnosis of pheochromocytoma was made, and as soon as treatment with phenoxybenzamine and propranolol was begun, the fever resolved. Serum interleukin-6 (IL-6) concentration was initially elevated, decreased after the start of adrenergic blockade, and gradually fell to an undetectable level after surgery. These observations suggest that interleukin-6 might have been causally related to the patient's fever and possibly the multiorgan crisis.

Persistent facial pain following microvascular decompression of the trigeminal nerve

Pain in the face following microvascular decompression (MVD) can be due to persisting trigeminal neuralgia (TGN) or a variety of other facial pain syndromes. If magnetic resonance tomoangiography (MRTA) indicates continuing vascular compression and the patient has true persistent TGN, then the patient can be relieved of pain by repeating the MVD. When the MRTA is negative for continuing compression alternative techniques may be employed; section of the nerve at the pons may be the treatment of choice for true persistent TGN in the absence of neurovascular compression. In some cases the pain is dysaesthetic in nature and not persistent TGN. This is always associated with previous destructive lesions to the nerve, usually radio-frequency thermocoagulation. When this component to the pain is recognized pre-operatively the patient must be warned not to expect relief of this same component of the pain from MVD. When it is not possible to classify the facial pain clinically, improvement does not occur following MVD even when there is clear evidence of vascular compression on MRTA.

Improved treatment services significantly reduce the prevalence of sexually transmitted diseases in rural Tanzania: results of a randomized controlled trial

OBJECTIVE

To evaluate the impact of improved case management for sexually transmitted diseases (STD) at the primary health care level on the incidence and prevalence of STD.

DESIGN

Community-randomized controlled trial.

SETTING

Mwanza region, Tanzania.

SUBJECTS

A random cohort of about 1000 adults aged 15-54 years from each of 12 communities, in six matched pairs. One member of each pair was assigned at random to receive the intervention, and the others served as a comparison community. This cohort was surveyed at baseline and at follow-up 2 years later. About 100 antenatal clinic attenders were also studied in each community on two occasions: the first shortly after the implementation of the intervention, and the second approximately 1 year later.

INTERVENTION

Improved services were established for the management of STD, using the syndromic approach, in rural health units.

RESULTS

A total of 12,534 individuals were enrolled in the cohort study, of whom 8844 (71%) were seen again 2 years later. The prevalence of serological syphilis (rapid plasma reagin titre > or = 1:8, Treponema pallidum haemagglutinin assay positive) was 6.2% in both intervention and comparison communities at baseline. At follow-up it was 5.0% in the intervention community and 7.0% in the comparison community [adjusted relative risk (RR), 0.71; 95% confidence interval (CI), 0.54-0.93; P < 0.02]. The prevalence of urethritis in males did not differ significantly between intervention and comparison groups at follow-up, but the prevalence of symptomatic urethritis was reduced by about 50% (adjusted RR, 0.51; 95% CI, 0.24-1.10; P = 0.08). There was no significant difference between the groups in the incidence of self-reported STD symptoms over the last year of the follow-up period, or in the prevalence of any STD in antenatal clinic attenders.

CONCLUSION

The reduction in HIV incidence previously reported in this intervention study can be attributed to a reduction in the duration, and hence the prevalence of symptomatic STD.

Increasing prevalence of penicillinase-producing Neisseria gonorrhoeae and the emergence of high-level, plasmid-mediated tetracycline resistance among gonococcal isolates in The Gambia

One hundred and three strains of Neisseria gonorrhoeae isolated from a periurban STD clinic in The Gambia were studied for antimicrobial susceptibility, plasmid profile, and serogroup using standard procedures. Seventy-nine (77%) were penicillinase producers (PPNG) and fully resistant to penicillin (MIC > or = 8 mg/l). One isolate showed chromosomally induced resistance to penicillin (MIC 2 mg/l). None of the isolates was sensitive to tetracycline; 16 (16%) showed intermediate resistance (MICs 1-8 mg/l) and 87 (84%) showed high-level plasmid-mediated resistance (TRNG) (MICs > 10 mg/l). This is the first report of TRNG in The Gambia. Only 6 (6%) strains were fully sensitive to trimethoprim-sulphamethoxazole (MIC < 8 mg/l); 78 (76%) showed intermediate level resistance (MICs 8-16 mg/l) and 19 (18%) were fully resistant (MIC > 32 mg/l). Indications of an increase in MIC to ciprofloxacin and ceftriaxone were found in 6 (6%) and 1 (1%) strains, respectively, although all remained fully sensitive (MICs 0.004-0.03 mg/l and 0.001-0.015 mg/l). All PPNG and TRNG strains carried the 3.2 MDa and 25.2 MDa plasmids, respectively. All isolates carried the 2.6 MDa cryptic plasmid and 9 (3 PPNG and 6 non-PPNG) carried the 24.5 MDa conjugative plasmid. Forty-four (43%) strains were typed group W1, 58 (56%) W11/111 and 1 had cross-reacting antigens. Because PPNG are frequently encountered and high-level TRNG is now prevalent, the newer cephalosporins and quinolones must now be considered as first-line drugs for the treatment of gonorrhoea in The Gambia.

STD rapid assessment in Rwandan refugee camps in Tanzania

OBJECTIVE

To obtain baseline information on sexually transmitted diseases (STDs) in the Rwandan refugees camps in Tanzania, prior to establishment of STD services.

SETTING

The largest camps of Rwandan refugees in the Ngara District of Tanzania (estimated population 300,000). The study was carried out in 8 days in August 1994.

SUBJECTS AND METHODS

A rapid assessment technique was used to measure STD prevalences among: (i) 100 antenatal clinic attenders (ANC); (ii) 239 men from outpatient clinics (OPD); and (iii) 289 men from the community. Interviews (by questionnaire) and genital examination were performed for all participants; sampling for females included genital swabs for the the diagnosis of Neisseria gonorrhoeae (NG), Candida albicans (CA), Trichomonas vaginalis (TV), bacterial vaginosis (BV) and a blood sample for syphilis serology. Men provided urine samples which were screened for leucocytes using the leucocyte esterase (LE) dipstick; urethral swabs for Gram stain were taken from men with a reactive LE test and from those with symptoms or signs of urethritis. OPD males provided a blood sample for syphilis serology.

RESULTS

All groups reported frequent experience with STDs and engaging in risky sexual behaviour prior to the survey. During the establishment of the camps, sexual activity was reportedly low. Over 50% of ANC attenders were infected with agents causing vaginitis (TV/BV/CA) and 3% were infected with NG. The prevalence of active syphilis was 4%. In the male outpatients, the prevalence of urethritis was 2.6% and of serological syphilis was 6.1%. Among males in the community, the prevalence of urethritis was 2.9% (the majority being asymptomatic infections). We noted frequent over-reporting of STD symptoms, unconfirmed clinically or biologically.

CONCLUSIONS

STD case detection and management should be improved by training health workers in using the WHO syndromic approach, and through IEC campaigns encouraging attendance at clinics. Rapid epidemiological methods provide quick and useful information at low cost in refugee camps.

Hydroxychloroquine in pregnant patients with systemic lupus erythematosus

OBJECTIVE

To determine the safety for both mother and fetus of antimalarial drugs, i.e., chloroquine and hydroxychloroquine, in pregnant patients with lupus who continued antimalarial drugs throughout pregnancy. Stopping antimalarial drugs can precipitate disease flares of systemic lupus erythematosus (SLE), which are known to be detrimental to the outcome of pregnancy in patients with SLE. Stopping antimalarial drugs during pregnancy therefore not only puts the mother's health at risk but can also compromise the outcome of pregnancy.

METHODS

We document 9 pregnancies in 8 patients with lupus, all of whom took hydroxychloroquine (Plaquenil) throughout pregnancy. All 9 pregnancies, which occurred since our first report in 1988, resulted in 9 live births (4 full term and 5 preterm).

RESULTS

No congenital abnormalities occurred and mean followup of 33 months (range 10-72 months) revealed no abnormalities in these children. Temporary discontinuation of hydroxychloroquine for 1 month precipitated a flare of disease in one mother, documented both clinically and serologically.

CONCLUSION

It is safer to continue hydroxychloroquine rather than to discontinue this drug simply because of pregnancy.

Carcinoid tumor of the common bile duct producing gastrin and serotonin

Carcinoid tumors of the biliary tract are rare. We report a 47 year-old man who was unexpectedly found to have a nonobstructing carcinoid tumor of the common bile duct during orthotopic liver transplantation for decompensated cirrhosis. No metastases were noted. Five months after resection of the common bile duct and liver transplantation, the patient had no evidence of residual tumor. The carcinoid was a sclerotic tumor of insular type and was immunoreactive for gastrin and serotonin, but nonfunctional. We review the literature on carcinoids of the extrahepatic bile duct.

Asymptomatic gonorrhoea and chlamydial infection in rural Tanzanian men

OBJECTIVE

To measure the prevalence of urethritis due to Neisseria gonorrhoeae and Chlamydial infection trachomatis in rural Tanzanian men

DESIGN

About 500 men aged 15-54 years were selected from each of 12 rural communities by random cluster sampling; interviewed concerning past or present symptoms of sexually transmitted diseases; and asked to provide a first catch urine specimen, which was tested for pyuria with a leucocyte esterase dipstick test. Subjects with symptoms or with a positive result on testing were examined, and urethral swabs were taken for detection of N gonorrhoeae by gram stain and of C trachomatis by antigen detection immunoassay.

SETTING

Mwanza region, north western Tanzania.

SUBJECTS

5876 men aged 15-54 years.

MAIN OUTCOME MEASURES

Prevalence of urethral symptoms, observed urethral discharge, pyuria, urethritis ( > 4 pus cells per high power field on urethral smear), N gonorrhoeae infection (intracellular gram negative diplococci), and C trachomatis infection (IDEIA antigen detection assay).

RESULTS

1618 (28%) subjects reported ever having a urethral discharge. Current discharge was reported by 149 (2.5%) and observed on examination in 207 (3.5%). Gonorrhoea was found in 128 subjects (2.2%) and chlamydial infection in 39 (0.7%). Only 24 of 158 infected subjects complained of urethral discharge at the time of interview (15%).

CONCLUSION

Infection with N gonorrhoeae and C trachomatis is commonly asymptomatic among men in this rural African population. This has important implications for the design of control programmes for sexually transmitted disease.

Asymptomatic carriage of Haemophilus ducreyi confirmed by the polymerase chain reaction

OBJECTIVE

To investigate asymptomatic carriage of Haemophilus ducreyi by using polymerase chain reaction (PCR) on samples from women at high risk of infection.

SUBJECTS

213 commercial sex workers (CSWs) recruited in The Gambia, West Africa.

METHODS

Genital samples (cervical, vaginal and ulcer) were tested for the presence of H ducreyi by PCR with the technique of "one tube nested primer".

RESULTS

12 CSWs were PCR positive for H ducreyi; 8 of these women had genital ulcers on examination.

CONCLUSION

Using a simplified PCR technique for detecting H ducreyi we have shown that 2% of CSWs were carrying the organism without clinical symptoms or signs. This has important implications for sexually transmitted disease control programmes in areas with a high prevalence of chancroid.

A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results

OBJECTIVES

To determine baseline HIV prevalence in a trial of improved sexually transmitted disease (STD) treatment, and to investigate risk factors for HIV. To assess comparability of intervention and comparison communities with respect to HIV/STD prevalence and risk factors. To assess adequacy of sample size.

SETTING

Twelve communities in Mwanza Region, Tanzania: one matched pair of roadside communities, four pairs of rural communities, and one pair of island communities. One community from each pair was randomly allocated to receive the STD intervention following the baseline survey.

METHODS

Approximately 1000 adults aged 15-54 years were randomly sampled from each community. Subjects were interviewed, and HIV and syphilis serology performed. Men with a positive leucocyte esterase dipstick test on urine, or reporting a current STD, were tested for urethral infections.

RESULTS

A total of 12,534 adults were enrolled. Baseline HIV prevalences were 7.7% (roadside), 3.8% (rural) and 1.8% (islands). Associations were observed with marital status, injections, education, travel, history of STD and syphilis serology. Prevalence was higher in circumcised men, but not significantly after adjusting for confounders. Intervention and comparison communities were similar in the prevalence of HIV (3.8 versus 4.4%), active syphilis (8.7 versus 8.2%), and most recorded risk factors. Within-pair variability in HIV prevalence was close to the value assumed for sample size calculations.

CONCLUSIONS

The trial cohort was successfully established. Comparability of intervention and comparison communities at baseline was confirmed for most factors. Matching appears to have achieved a trial of adequate sample size. The apparent lack of a protective effect of male circumcision contrasts with other studies in Africa.

Simplified PCR for detection of Haemophilus ducreyi and diagnosis of chancroid

A simplified PCR was developed for detection of Haemophilus ducreyi in samples from chancroid patients. The strategy included a straightforward chloroform extraction sample preparation method, a one-tube nested PCR to minimize contamination risks, and a colorimetric method for detection of products. Primers were designed from published nucleotide sequences of the 16S rRNA gene of H. ducreyi, with longer outer primers for annealing at a higher temperature and shorter inner primers labelled with biotin and digoxigenin for binding with avidin and colorimetric detection. The PCR technique detected all 35 strains of H. ducreyi tested, from four different geographical regions, and was negative for other, related strains of bacteria and for the common contaminating bacteria tested. Of 25 samples from H. ducreyi culture-positive chancroid patients, 24 were PCR positive and 1 produced a weak reaction. Of 83 samples from clinical cases of chancroid in the Republic of South Africa, 69 were PCR positive. The sensitivity of PCR compared with that of clinical diagnosis was 83%. All 50 negative control samples were negative. Encouraging results were also obtained with a consecutive series of 25 genital ulcer patients in Tanzania, of whom 9 were PCR positive. The adaptations of this simplified PCR strategy, at the sensitivity and specificity levels obtained, mean it will be useful for detection of H. ducreyi in areas where the organism is endemic, particularly where testing by culture is difficult or impossible.