RESUMEN
In 1994, Médecins du Monde opened a free health centre specialized in STD/AIDS in an ill-favored district of Antananarivo, the Malagasy capital of Madagascar. Besides the medical treatment of Sexually Transmitted Diseases (STD) and AIDS, the centre is responsible for the Information, Education and Communication activities (IEC) within and without the centre towards the residents of the 67 hectares district and the high-risk populations (prostitutes, truck-drivers and transvestites). The project aimed at both preventing the spreading of the VIH infection and reducing the incidence of STD. As the Ministry of Health directed, a syndromic method was applied since 1997 regarding STD. Results for 1998 showed the predominance of the association Neisseria gonorrhae-Chlamydiae among the consultants of both sexes. Negative results from 1,218 HIV serological tests carried out seemed confirm the low prevalence of the HIV infection in Madagascar. Yet, the percentage of positive syphilis serology among the tested consultants was lower than that mentioned in previous surveys. Finally, it appears that the syndromic method is of high interest for the countries with limited laboratory capacities.
Asunto(s)
Centros Comunitarios de Salud/organización & administración , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/prevención & control , Servicios Urbanos de Salud/organización & administración , Serodiagnóstico del SIDA , Adulto , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/etiología , Humanos , Incidencia , Recién Nacido , Madagascar/epidemiología , Masculino , Tamizaje Masivo/organización & administración , Áreas de Pobreza , Prevalencia , Factores de Riesgo , Trabajo Sexual , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/etiología , Travestismo , Salud Urbana/estadística & datos numéricosRESUMEN
Ulcer material from consecutive patients attending clinics in Antananarivo, Madagascar, was tested using multiplex polymerase chain reaction (M-PCR) to detect Treponema pallidum, Haemophilus ducreyi, and herpes simplex virus. Sera were tested for syphilis and for IgG and IgM antibodies to Chlamydia trachomatis by microimmunofluorescence testing (MIF). By M-PCR, 33% of 196 patients had chancroid, 29% had syphilitic ulcers, and 10% had genital herpes; 32% of the ulcer specimens were M-PCR negative. Compared with M-PCR, syphilis serology was 72% sensitive and 83% specific. The sensitivity of clinical diagnosis of syphilis, chancroid, and genital herpes was 93%, 53%, and 0% and specificity was 20%, 52%, and 99%, respectively. Less schooling was associated with increased prevalence of syphilitic ulcers (P=.001). Sixteen patients (8%) were clinically diagnosed with lymphogranuloma venereum (LGV); 1 plausible case of LGV was found by MIF. In Madagascar, primary care of genital ulcers should include syndromic treatment for syphilis and chancroid.