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The Etiology of Genital Ulcer Disease and Coinfections With Chlamydia trachomatis and Neisseria gonorrhoeae in Zimbabwe: Results From the Zimbabwe STI Etiology Study
BACKGROUNDIn many countries, sexually transmitted infections (STIs) are treated syndromically. Thus, patients diagnosed as having genital ulcer disease (GUD) in Zimbabwe receive a combination of antimicrobials to treat syphilis, chancroid, lymphogranuloma venereum (LGV), and genital herpes. Periodic...
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Published in: | Sexually transmitted diseases 2018-01, Vol.45 (1), p.61-68 |
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creator | Mungati, More Machiha, Anna Mugurungi, Owen Tshimanga, Mufuta Kilmarx, Peter H Nyakura, Justice Shambira, Gerald Kupara, Vitalis Lewis, David A Gonese, Elizabeth Tippett Barr, Beth A Handsfield, H Hunter Rietmeijer, Cornelis A |
description | BACKGROUNDIn many countries, sexually transmitted infections (STIs) are treated syndromically. Thus, patients diagnosed as having genital ulcer disease (GUD) in Zimbabwe receive a combination of antimicrobials to treat syphilis, chancroid, lymphogranuloma venereum (LGV), and genital herpes. Periodic studies are necessary to assess the current etiology of GUD and assure the appropriateness of current treatment guidelines.
MATERIALS AND METHODSWe selected 6 geographically diverse clinics in Zimbabwe serving high numbers of STI cases to enroll men and women with STI syndromes, including GUD. Sexually transmitted infection history and risk behavioral data were collected by questionnaire and uploaded to a Web-based database. Ulcer specimens were obtained for testing using a validated multiplex polymerase chain reaction (M-PCR) assay for Treponema pallidum (TP; primary syphilis), Haemophilus ducreyi (chancroid), LGV-associated strains of Chlamydia trachomatis, and herpes simplex virus (HSV) types 1 and 2. Blood samples were collected for testing with HIV, treponemal, and nontreponemal serologic assays.
RESULTSAmong 200 GUD patients, 77 (38.5%) were positive for HSV, 32 (16%) were positive for TP, and 2 (1%) were positive for LGV-associated strains of C trachomatis. No H ducreyi infections were detected. No organism was found in 98 (49.5%) of participants. The overall HIV positivity rate was 52.2% for all GUD patients, with higher rates among women compared with men (59.8% vs 45.2%, P < 0.05) and among patients with HSV (68.6% vs 41.8%, P < 0.0001). Among patients with GUD, 54 (27.3%) had gonorrhea and/or chlamydia infection. However, in this latter group, 66.7% of women and 70.0% of men did not have abnormal vaginal or urethral discharge on examination.
CONCLUSIONSHerpes simplex virus is the most common cause of GUD in our survey, followed by T. pallidum. No cases of chancroid were detected. The association of HIV infections with HSV suggests high risk for cotransmission; however, some HSV ulcerations may be due to HSV reactivation among immunocompromised patients. The overall prevalence of gonorrhea and chlamydia was high among patients with GUD and most of them did not meet the criteria for concomitant syndromic management covering these infections. |
doi_str_mv | 10.1097/OLQ.0000000000000694 |
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MATERIALS AND METHODSWe selected 6 geographically diverse clinics in Zimbabwe serving high numbers of STI cases to enroll men and women with STI syndromes, including GUD. Sexually transmitted infection history and risk behavioral data were collected by questionnaire and uploaded to a Web-based database. Ulcer specimens were obtained for testing using a validated multiplex polymerase chain reaction (M-PCR) assay for Treponema pallidum (TP; primary syphilis), Haemophilus ducreyi (chancroid), LGV-associated strains of Chlamydia trachomatis, and herpes simplex virus (HSV) types 1 and 2. Blood samples were collected for testing with HIV, treponemal, and nontreponemal serologic assays.
RESULTSAmong 200 GUD patients, 77 (38.5%) were positive for HSV, 32 (16%) were positive for TP, and 2 (1%) were positive for LGV-associated strains of C trachomatis. No H ducreyi infections were detected. No organism was found in 98 (49.5%) of participants. The overall HIV positivity rate was 52.2% for all GUD patients, with higher rates among women compared with men (59.8% vs 45.2%, P < 0.05) and among patients with HSV (68.6% vs 41.8%, P < 0.0001). Among patients with GUD, 54 (27.3%) had gonorrhea and/or chlamydia infection. However, in this latter group, 66.7% of women and 70.0% of men did not have abnormal vaginal or urethral discharge on examination.
CONCLUSIONSHerpes simplex virus is the most common cause of GUD in our survey, followed by T. pallidum. No cases of chancroid were detected. The association of HIV infections with HSV suggests high risk for cotransmission; however, some HSV ulcerations may be due to HSV reactivation among immunocompromised patients. The overall prevalence of gonorrhea and chlamydia was high among patients with GUD and most of them did not meet the criteria for concomitant syndromic management covering these infections.</description><identifier>ISSN: 0148-5717</identifier><identifier>EISSN: 1537-4521</identifier><identifier>DOI: 10.1097/OLQ.0000000000000694</identifier><identifier>PMID: 29240636</identifier><language>eng</language><publisher>United States: Copyright American Sexually Transmitted Diseases Association</publisher><subject>Activation ; Adolescent ; Adult ; Anti-Infective Agents - therapeutic use ; Antimicrobial agents ; Bacteria ; Bioassays ; Blood tests ; Chancroid ; Chemical analysis ; Chlamydia ; Chlamydia trachomatis ; Coinfection ; Disease management ; Etiology ; Female ; Genital Diseases, Female - etiology ; Genital Diseases, Female - microbiology ; Genital Diseases, Male - etiology ; Genital Diseases, Male - microbiology ; Genital herpes ; Gonorrhea ; Health Surveys ; Herpes viruses ; High risk ; HIV ; Human immunodeficiency virus ; Humans ; Infections ; Internet ; Male ; Materials selection ; Patients ; Polymerase chain reaction ; Questionnaires ; Reproductive Health ; Risk behavior ; Risk taking ; Sexually transmitted diseases ; Sexually Transmitted Diseases - epidemiology ; Sexually Transmitted Diseases - etiology ; Sexually Transmitted Diseases - microbiology ; Skin Ulcer - epidemiology ; Skin Ulcer - etiology ; Skin Ulcer - microbiology ; STD ; Syphilis ; Ulcers ; Viruses ; Young Adult ; Zimbabwe - epidemiology</subject><ispartof>Sexually transmitted diseases, 2018-01, Vol.45 (1), p.61-68</ispartof><rights>Copyright 2018 American Sexually Transmitted Diseases Association</rights><rights>Copyright Lippincott Williams & Wilkins Ovid Technologies Jan 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4854-c87740d1aed2d871e9999de354a904357acb538c205de7f98a63512a15b72f03</citedby><cites>FETCH-LOGICAL-c4854-c87740d1aed2d871e9999de354a904357acb538c205de7f98a63512a15b72f03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925,30999</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29240636$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mungati, More</creatorcontrib><creatorcontrib>Machiha, Anna</creatorcontrib><creatorcontrib>Mugurungi, Owen</creatorcontrib><creatorcontrib>Tshimanga, Mufuta</creatorcontrib><creatorcontrib>Kilmarx, Peter H</creatorcontrib><creatorcontrib>Nyakura, Justice</creatorcontrib><creatorcontrib>Shambira, Gerald</creatorcontrib><creatorcontrib>Kupara, Vitalis</creatorcontrib><creatorcontrib>Lewis, David A</creatorcontrib><creatorcontrib>Gonese, Elizabeth</creatorcontrib><creatorcontrib>Tippett Barr, Beth A</creatorcontrib><creatorcontrib>Handsfield, H Hunter</creatorcontrib><creatorcontrib>Rietmeijer, Cornelis A</creatorcontrib><title>The Etiology of Genital Ulcer Disease and Coinfections With Chlamydia trachomatis and Neisseria gonorrhoeae in Zimbabwe: Results From the Zimbabwe STI Etiology Study</title><title>Sexually transmitted diseases</title><addtitle>Sex Transm Dis</addtitle><description>BACKGROUNDIn many countries, sexually transmitted infections (STIs) are treated syndromically. Thus, patients diagnosed as having genital ulcer disease (GUD) in Zimbabwe receive a combination of antimicrobials to treat syphilis, chancroid, lymphogranuloma venereum (LGV), and genital herpes. Periodic studies are necessary to assess the current etiology of GUD and assure the appropriateness of current treatment guidelines.
MATERIALS AND METHODSWe selected 6 geographically diverse clinics in Zimbabwe serving high numbers of STI cases to enroll men and women with STI syndromes, including GUD. Sexually transmitted infection history and risk behavioral data were collected by questionnaire and uploaded to a Web-based database. Ulcer specimens were obtained for testing using a validated multiplex polymerase chain reaction (M-PCR) assay for Treponema pallidum (TP; primary syphilis), Haemophilus ducreyi (chancroid), LGV-associated strains of Chlamydia trachomatis, and herpes simplex virus (HSV) types 1 and 2. Blood samples were collected for testing with HIV, treponemal, and nontreponemal serologic assays.
RESULTSAmong 200 GUD patients, 77 (38.5%) were positive for HSV, 32 (16%) were positive for TP, and 2 (1%) were positive for LGV-associated strains of C trachomatis. No H ducreyi infections were detected. No organism was found in 98 (49.5%) of participants. The overall HIV positivity rate was 52.2% for all GUD patients, with higher rates among women compared with men (59.8% vs 45.2%, P < 0.05) and among patients with HSV (68.6% vs 41.8%, P < 0.0001). Among patients with GUD, 54 (27.3%) had gonorrhea and/or chlamydia infection. However, in this latter group, 66.7% of women and 70.0% of men did not have abnormal vaginal or urethral discharge on examination.
CONCLUSIONSHerpes simplex virus is the most common cause of GUD in our survey, followed by T. pallidum. No cases of chancroid were detected. The association of HIV infections with HSV suggests high risk for cotransmission; however, some HSV ulcerations may be due to HSV reactivation among immunocompromised patients. The overall prevalence of gonorrhea and chlamydia was high among patients with GUD and most of them did not meet the criteria for concomitant syndromic management covering these infections.</description><subject>Activation</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Anti-Infective Agents - therapeutic use</subject><subject>Antimicrobial agents</subject><subject>Bacteria</subject><subject>Bioassays</subject><subject>Blood tests</subject><subject>Chancroid</subject><subject>Chemical analysis</subject><subject>Chlamydia</subject><subject>Chlamydia trachomatis</subject><subject>Coinfection</subject><subject>Disease management</subject><subject>Etiology</subject><subject>Female</subject><subject>Genital Diseases, Female - etiology</subject><subject>Genital Diseases, Female - microbiology</subject><subject>Genital Diseases, Male - etiology</subject><subject>Genital Diseases, Male - microbiology</subject><subject>Genital herpes</subject><subject>Gonorrhea</subject><subject>Health Surveys</subject><subject>Herpes viruses</subject><subject>High risk</subject><subject>HIV</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infections</subject><subject>Internet</subject><subject>Male</subject><subject>Materials selection</subject><subject>Patients</subject><subject>Polymerase chain reaction</subject><subject>Questionnaires</subject><subject>Reproductive Health</subject><subject>Risk behavior</subject><subject>Risk taking</subject><subject>Sexually transmitted diseases</subject><subject>Sexually Transmitted Diseases - epidemiology</subject><subject>Sexually Transmitted Diseases - etiology</subject><subject>Sexually Transmitted Diseases - microbiology</subject><subject>Skin Ulcer - epidemiology</subject><subject>Skin Ulcer - etiology</subject><subject>Skin Ulcer - microbiology</subject><subject>STD</subject><subject>Syphilis</subject><subject>Ulcers</subject><subject>Viruses</subject><subject>Young Adult</subject><subject>Zimbabwe - epidemiology</subject><issn>0148-5717</issn><issn>1537-4521</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><recordid>eNp9ksFu1DAQhiMEotvCGyBkiQuXFDux45gDElraUmlFBV2ExMXyOpONi2MX2-lqH4j3xGXbUnpgLpY13_z6f80UxQuCDwkW_M3Z4vMhvl-NoI-KGWE1LymryONihgltS8YJ3yv2Y7zA139MnhZ7lagobupmVvxaDoCOkvHWr7fI9-gEnEnKoq9WQ0AfTAQVASnXobk3rgedWRfRN5MGNB-sGredUSgFpQc_qmTiH_YTmBgh5M7aOx_C4EEBMg59N-NKrTbwFn2BONkU0XHwI0rZxW0LnS9P_1o6T1O3fVY86ZWN8PzmPSiWx0fL-cdycXZyOn-_KDVtGS11yznFHVHQVV3LCYhcHdSMKoFpzbjSK1a3usKsA96LVjU1I5UibMWrHtcHxbud7OW0GqHT4HIuKy-DGVXYSq-M_LfjzCDX_koyIWhVsyzw-kYg-J8TxCRHEzVYqxz4KUoiOOdtg3GV0VcP0As_BZfTZaqtCG9ILTJFd5QOPsYA_Z0ZguX1Gch8BvLhGeSxl_eD3A3d7j0D7Q7YeJsgxB922kCQAyibhv9r_wZeQsEV</recordid><startdate>201801</startdate><enddate>201801</enddate><creator>Mungati, More</creator><creator>Machiha, Anna</creator><creator>Mugurungi, Owen</creator><creator>Tshimanga, Mufuta</creator><creator>Kilmarx, Peter H</creator><creator>Nyakura, Justice</creator><creator>Shambira, Gerald</creator><creator>Kupara, Vitalis</creator><creator>Lewis, David A</creator><creator>Gonese, Elizabeth</creator><creator>Tippett Barr, Beth A</creator><creator>Handsfield, H Hunter</creator><creator>Rietmeijer, Cornelis A</creator><general>Copyright American Sexually Transmitted Diseases Association</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7QL</scope><scope>7T2</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201801</creationdate><title>The Etiology of Genital Ulcer Disease and Coinfections With Chlamydia trachomatis and Neisseria gonorrhoeae in Zimbabwe: Results From the Zimbabwe STI Etiology Study</title><author>Mungati, More ; Machiha, Anna ; Mugurungi, Owen ; Tshimanga, Mufuta ; Kilmarx, Peter H ; Nyakura, Justice ; Shambira, Gerald ; Kupara, Vitalis ; Lewis, David A ; Gonese, Elizabeth ; Tippett Barr, Beth A ; Handsfield, H Hunter ; Rietmeijer, Cornelis A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4854-c87740d1aed2d871e9999de354a904357acb538c205de7f98a63512a15b72f03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Activation</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Anti-Infective Agents - therapeutic use</topic><topic>Antimicrobial agents</topic><topic>Bacteria</topic><topic>Bioassays</topic><topic>Blood tests</topic><topic>Chancroid</topic><topic>Chemical analysis</topic><topic>Chlamydia</topic><topic>Chlamydia trachomatis</topic><topic>Coinfection</topic><topic>Disease management</topic><topic>Etiology</topic><topic>Female</topic><topic>Genital Diseases, Female - etiology</topic><topic>Genital Diseases, Female - microbiology</topic><topic>Genital Diseases, Male - etiology</topic><topic>Genital Diseases, Male - microbiology</topic><topic>Genital herpes</topic><topic>Gonorrhea</topic><topic>Health Surveys</topic><topic>Herpes viruses</topic><topic>High risk</topic><topic>HIV</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Infections</topic><topic>Internet</topic><topic>Male</topic><topic>Materials selection</topic><topic>Patients</topic><topic>Polymerase chain reaction</topic><topic>Questionnaires</topic><topic>Reproductive Health</topic><topic>Risk behavior</topic><topic>Risk taking</topic><topic>Sexually transmitted diseases</topic><topic>Sexually Transmitted Diseases - epidemiology</topic><topic>Sexually Transmitted Diseases - etiology</topic><topic>Sexually Transmitted Diseases - microbiology</topic><topic>Skin Ulcer - epidemiology</topic><topic>Skin Ulcer - etiology</topic><topic>Skin Ulcer - microbiology</topic><topic>STD</topic><topic>Syphilis</topic><topic>Ulcers</topic><topic>Viruses</topic><topic>Young Adult</topic><topic>Zimbabwe - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mungati, More</creatorcontrib><creatorcontrib>Machiha, Anna</creatorcontrib><creatorcontrib>Mugurungi, Owen</creatorcontrib><creatorcontrib>Tshimanga, Mufuta</creatorcontrib><creatorcontrib>Kilmarx, Peter H</creatorcontrib><creatorcontrib>Nyakura, Justice</creatorcontrib><creatorcontrib>Shambira, Gerald</creatorcontrib><creatorcontrib>Kupara, Vitalis</creatorcontrib><creatorcontrib>Lewis, David A</creatorcontrib><creatorcontrib>Gonese, Elizabeth</creatorcontrib><creatorcontrib>Tippett Barr, Beth A</creatorcontrib><creatorcontrib>Handsfield, H Hunter</creatorcontrib><creatorcontrib>Rietmeijer, Cornelis A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Sexually transmitted diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mungati, More</au><au>Machiha, Anna</au><au>Mugurungi, Owen</au><au>Tshimanga, Mufuta</au><au>Kilmarx, Peter H</au><au>Nyakura, Justice</au><au>Shambira, Gerald</au><au>Kupara, Vitalis</au><au>Lewis, David A</au><au>Gonese, Elizabeth</au><au>Tippett Barr, Beth A</au><au>Handsfield, H Hunter</au><au>Rietmeijer, Cornelis A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Etiology of Genital Ulcer Disease and Coinfections With Chlamydia trachomatis and Neisseria gonorrhoeae in Zimbabwe: Results From the Zimbabwe STI Etiology Study</atitle><jtitle>Sexually transmitted diseases</jtitle><addtitle>Sex Transm Dis</addtitle><date>2018-01</date><risdate>2018</risdate><volume>45</volume><issue>1</issue><spage>61</spage><epage>68</epage><pages>61-68</pages><issn>0148-5717</issn><eissn>1537-4521</eissn><abstract>BACKGROUNDIn many countries, sexually transmitted infections (STIs) are treated syndromically. Thus, patients diagnosed as having genital ulcer disease (GUD) in Zimbabwe receive a combination of antimicrobials to treat syphilis, chancroid, lymphogranuloma venereum (LGV), and genital herpes. Periodic studies are necessary to assess the current etiology of GUD and assure the appropriateness of current treatment guidelines.
MATERIALS AND METHODSWe selected 6 geographically diverse clinics in Zimbabwe serving high numbers of STI cases to enroll men and women with STI syndromes, including GUD. Sexually transmitted infection history and risk behavioral data were collected by questionnaire and uploaded to a Web-based database. Ulcer specimens were obtained for testing using a validated multiplex polymerase chain reaction (M-PCR) assay for Treponema pallidum (TP; primary syphilis), Haemophilus ducreyi (chancroid), LGV-associated strains of Chlamydia trachomatis, and herpes simplex virus (HSV) types 1 and 2. Blood samples were collected for testing with HIV, treponemal, and nontreponemal serologic assays.
RESULTSAmong 200 GUD patients, 77 (38.5%) were positive for HSV, 32 (16%) were positive for TP, and 2 (1%) were positive for LGV-associated strains of C trachomatis. No H ducreyi infections were detected. No organism was found in 98 (49.5%) of participants. The overall HIV positivity rate was 52.2% for all GUD patients, with higher rates among women compared with men (59.8% vs 45.2%, P < 0.05) and among patients with HSV (68.6% vs 41.8%, P < 0.0001). Among patients with GUD, 54 (27.3%) had gonorrhea and/or chlamydia infection. However, in this latter group, 66.7% of women and 70.0% of men did not have abnormal vaginal or urethral discharge on examination.
CONCLUSIONSHerpes simplex virus is the most common cause of GUD in our survey, followed by T. pallidum. No cases of chancroid were detected. The association of HIV infections with HSV suggests high risk for cotransmission; however, some HSV ulcerations may be due to HSV reactivation among immunocompromised patients. The overall prevalence of gonorrhea and chlamydia was high among patients with GUD and most of them did not meet the criteria for concomitant syndromic management covering these infections.</abstract><cop>United States</cop><pub>Copyright American Sexually Transmitted Diseases Association</pub><pmid>29240636</pmid><doi>10.1097/OLQ.0000000000000694</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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language | eng |
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source | Applied Social Sciences Index & Abstracts (ASSIA); JSTOR Archival Journals and Primary Sources Collection |
subjects | Activation Adolescent Adult Anti-Infective Agents - therapeutic use Antimicrobial agents Bacteria Bioassays Blood tests Chancroid Chemical analysis Chlamydia Chlamydia trachomatis Coinfection Disease management Etiology Female Genital Diseases, Female - etiology Genital Diseases, Female - microbiology Genital Diseases, Male - etiology Genital Diseases, Male - microbiology Genital herpes Gonorrhea Health Surveys Herpes viruses High risk HIV Human immunodeficiency virus Humans Infections Internet Male Materials selection Patients Polymerase chain reaction Questionnaires Reproductive Health Risk behavior Risk taking Sexually transmitted diseases Sexually Transmitted Diseases - epidemiology Sexually Transmitted Diseases - etiology Sexually Transmitted Diseases - microbiology Skin Ulcer - epidemiology Skin Ulcer - etiology Skin Ulcer - microbiology STD Syphilis Ulcers Viruses Young Adult Zimbabwe - epidemiology |
title | The Etiology of Genital Ulcer Disease and Coinfections With Chlamydia trachomatis and Neisseria gonorrhoeae in Zimbabwe: Results From the Zimbabwe STI Etiology Study |
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