Modelling the cost per ulcer treated of incorporating episodic treatment for HSV-2 into the syndromic algorithm for genital ulcer disease.
Background: The proportion of genital ulcer disease (GUD) due to herpes simplex virus type-2 (HSV-2) has increased in sub-Saharan Africa. The most recent 2003 WHO syndromic GUD algorithm includes antiviral treatment for HSV-2 for anyone with \"typical\" symptoms/signs, and suggests that all GUD patients receive treatment for HSV-2 in settings where HSV-2 GUD aetiology is greater than 30%. The previous algorithm (1994) only targeted Haemophilus ducreyi (HD) and Treponema pallidum (TP). Methods: A static deterministic model was used to compare the cost per ulcer treated of using the 1994 and 2003 algorithms amongst individuals presenting with GUD, with sensitivity analyses for different economic and epidemiological scenarios. Results: Except when the proportion of ulcers due to HD/TP (defined as ulcer prevalence) is high (>40%), and HSV-2 ulcer prevalence is low (
Sexually Transmitted Infections (2008) 84 (3) pp. 243-248 [doi:10.1136/sti.2007.027136].