Genital ulcer disease in patients attending a public sexually transmitted disease clinic in Singapore: an epidemiologic study

Genital ulcer disease forms about 10% of all sexually transmitted diseases (STDs) in Singapore. In this retrospective study of 531 cases of genital ulcer disease presenting at the Department of STD Control, 91.6% were due to venereal causes and 8.4% were due to non-venereal causes. The venereal causes of genital ulcers were found to be genital herpes (71.5%), chancroid (15.8%), primary syphilis (3.4%) and lymphogranuloma venereum (1%). The non-venereal causes were mainly trauma, drug eruptions or were non-specific in nature. The peak incidence in both sexes occurred in the 20-39 year age group. Males outnumbered females by a ratio of 5.8:1. The ethnic distribution showed an under-representation of Malays relative to the racial makeup of the general population, reflecting perhaps a protective effect conferred by circumcision from genital ulcer diseases or a lower health-risk sexual behaviour in this ethnic group. The accuracy of initial clinical diagnosis was low indicating the need for laboratory investigations to establish accurate aetiologic diagnosis. Commercial sex workers were the main source of infection in males, highlighting the continued need to educate, screen and effectively treat this high risk group.