Background and Objectives. Genital ulcer diseases represent a diagnostic dilemma, especially in India, where few STI clinics have access to reliable laboratory facility. The changing STI trends require that a correct diagnosis be made in order to institute appropriate treatment and formulate control policies. The objective of this study was to determine recent trends in aetiology of genital ulcers, by using accurate diagnostic tools. Methods. Specimens from 90 ulcer patients were processed for dark field microscopy, stained smears, culture for H. ducreyi, and real-time PCR. Blood samples were collected for serological tests. Results. Prevalence of GUD was 7.45 with mean age at initial sexual experience as 19.2 years. Use of condom with regular and nonregular partners was 19.5% and 42.1%, respectively. Sexual orientation was heterosexual (92.2%) or homosexual (2.2%). There were 8 cases positive for HIV (8.9%). Herpes simplex virus ulcers were the commonest, followed by syphilis and chancroid. There were no cases of donovanosis and LGV. Conclusions. A valuable contribution of this study was in validating clinical and syndromic diagnoses of genital ulcers with an accurate aetiological diagnosis. Such reliable data will aid treatment and better define control measures of common agents and help eliminate diseases amenable to elimination, like donovanosis. 1. Introduction Genital ulcer diseases (GUDs) often represent a diagnostic dilemma, especially in developing countries, like India, where few sexually transmitted infection (STI) clinics have access to reliable laboratory facility. The changing trends in STIs make it imperative that a correct diagnosis be made in order to institute appropriate treatment and formulate policies for control. The annual global incidence of GUD exceeds 20 million cases [1]. In 1960s and 1970s, bacterial GUDs were the commonest. By 1980s, with the advent of HIV, the viral GUDs took over [2]. Thus, over time the trends in microorganisms causing GUD have undergone considerable change across the developed world, with bacterial aetiologies giving way to viral causes. Genital herpes has become the most common STD among clinic attendees [3] and the leading cause of genital ulcers worldwide [4]. For viral GUDs, prevention and counseling are more important rather than early diagnosis and treatment, as is the case with bacterial GUDs [2]. Often, in GUDs, it is seen that more than one aetiological agent may be found, if careful evaluation is conducted [5]. An accurate diagnosis of a GUD is often not possible when based solely on history
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