Although T. vaginalis does not traditionally present with genital ulcers , multivariable analysis showed that genital ulcers were the only predictor of an infection with T. vaginalis in our study. Ulcers could not be due to syphilis, which was not diagnosed in any of the women with T. vaginalis, but we did not test for the Herpes simplex virus, which is also associated with genital ulcers. The association of genital ulcer with T. vaginalis is not unique to our study as it has been reported amongst female sex workers in China .