单纯疱疹病毒Ⅰ、Ⅱ型感染的临床和实验诊断研究

目的 探讨生殖器疱疹（GH）患者单纯疱疹病毒Ⅰ型、Ⅱ型（HSV-Ⅰ、Ⅱ）抗原检测的临床意义，评价其实验诊断的必要性和实用性。方法应用酶联免疫吸附试验（ELIsA）对有GH皮损或无GH皮损但有泌尿生殖道症状的1859例患者（男1104例，女755例）检测HSV-Ⅰ、Ⅱ抗原，无GH症状者同时检测其他性病病原体。结果 1104例男性患者中，无GH皮损但有尿道症状者498例，检出HSV抗原阳性159例，阳性率31．9％；有GH皮损者606例，检出HSV抗原阳性367例，阳性率60．56％。有和无GH皮损两组HSV抗原阳性率的差异有非常显著的统计学意义（χ^2=88．70，P〈0．001）。755例女性患者中，无GH皮损但阴道分泌物不正常或外阴不适者333例，有GH皮损者422例，HSV抗原阳性率分别为30．63％（102／333）和35．31％（149／422）。有和无GH皮损两组HSV抗原阳性率无显著性差异（χ^2=1．63，P〉0．05）。男、女无GH皮损组分别有90例和36例，除HSV抗原阳性外，还伴有其它性病病原体阳性。结论 应对有GH皮损患者进行HSV抗原检测，但在无GH皮损患者中也可在泌尿生殖道中查到较高的HSV抗原检出率，提示对有泌尿生殖道不适症状者，即使没有皮损，也可发生HSV感染。所以对该类患者除检测常规性病病原体外。还应同时检测HSV，防止漏诊。     

健康体检老年人心电图异常特征分析

目的观察老年人健康体检心电图的特征及相关因素,以明确老年人定期进行心电图检查的重要性。方法随机选取2010年1月-2013年6月参加健康体检的500例老年人,对其进行心电图检测,然后进行统计学分析。结果500例老年人中心电图异常总检出182例,总检出率为36．4％;男性和女性心电图异常检出率分别为39．2％和33．6％,男性检出率明显高于女性,差异有统计学意义（P〈0．05）。ST—T异常表现者在心电图异常者中占比最高（44．51％）,其次为传导阻滞（18．68％）及早搏（9．89％）等,且随年龄增大,所占比例呈现上升趋势（P〈0．01）：心电图异常特征与年龄、性别具有相关性。结论老年健康体检时进行心电图检测可以及早发现心电图异常者,老年人进行定期心电图检查对早期发现心血管疾病非常必要。     

慈溪市1994—2001年男青年征兵体检中性病情况分析

目的：调查参加征兵体检的男青年中性病感染情况。方法：对慈溪市1994－2001年参加征兵体检的14241名男青年、按照国家标准进行体格检查和实验室检查，体检合格者于10－20天后进行复检。结果：检出淋病、尖锐湿疣、梅毒和非淋菌性尿道炎共269人，检出率为1．89％。1994－1999年，性病检出率逐年下降，近两年，性病检出率又大幅度上升。结论：有必要加强应征男青年对性、性道德和性病等的认识。     

性传播疾病门诊2268例就诊者病原检测分析

目的了解性传播疾病（性病）门诊就诊者泌尿生殖系统病原体感染情况。方法对2005年6月-2007年5月在淮安市第四人民医院性病门诊就诊的2268例患者泌尿生殖道病原体进行检测。结果2268例患者中，有366例检出病原体，阳性率16．14％（366／2268）。单一病原体感染率为69．13％（253／366），其中检出淋球菌68份（42．5％），沙眼衣原体80份（44．44％），解脲支原体153份（68．91％），梅毒23份（27．7％），生殖器单纯疱疹9份（52．94％），尖锐湿疣27份（24．55％）：混合感染为30．87％（113／366），其中检出沙眼衣原体＋解脲支原体＋淋球菌42份（12．88％），沙眼衣原体＋解脲支原体＋梅毒螺旋体12份（6．25％），HPVF＋HIV1份（1．67％），HPV＋梅毒螺旋体2份（3.77％）。结论门诊就诊者中，中青年患者居多，应重视病原学检查，强化性病防治力度。     

上海市1986～2001年梅毒实验室监测结果分析

目的 分析上海市1986～2001年性病门诊病例和部分社会人群梅毒感染情况，探索梅毒流行规律，发现高危人群，为有关部门开展性病防治工作提供决策依据。方法 收集和整理上海市1986～2001年的性病门诊病例和部分高危人群的血清学检查结果，结合梅毒确诊试验进行统计学处理。结果 1986～2001年共对20355人次做了梅毒确诊试验，包括梅毒暗视野检查、梅毒螺旋体血凝试验和荧光螺旋体抗体吸收试验，共发现梅毒阳性13518人次，年均阳性检出率为58．63％。其中男性检出率51．53％，女性检出率70．65％，女性明显高于男性。从1995年起，上海市每年梅毒阳性检出数呈逐年快速上升趋势，并出现先天梅毒和小儿梅毒增多现象。结论 上海市性病门诊病例中，梅毒检出数和检出率逐年升高，发病形势日趋严峻。     

性病病征处理在山区县的应用

目的：探索性病病征流程图在山区县医疗单位应用的可行性和有效性。方法：使用世界卫生组织(WHO)推荐并结合中国实际修订的3种常用性病病征流程图，按照病征处理要求选取有效病例，并进行处理和观察。结果：累计观察1250例，其中男性尿道分泌物病征476例，女性阴道分泌物异常528例，生殖器溃疡246例，按性病病征流程图给予相应治疗，治愈率分别为83．19％、67．61％、56．91％，总的治愈率为71．44％，有效率97．68％。结论：经中国修订的3种常见性病病征流程图适合在山区县医疗单位应用，但女性阴道分泌物异常病征还有待完善，性病疫情报告也有待于有关部门协调统一。     

2012年天津市性病门诊男性就诊者HIV/梅毒感染现状及影响因素分析

目的了解性病门诊男性就诊者中,艾滋病病毒（HIV）、梅毒（SP）的感染状况及危险因素,为在该人群中开展相关防控措施提供依据。方法对天津市2家性病门诊中符合条件的男性就诊者开展问卷调查,同时抽取血样检测梅毒和HIV抗体。结果800例性病门诊男性就诊者中,HIV抗体阳性16例,阳性率为2．0％。多因素分析表明,最近3个月有同性性行为[比值比（OR）=21．642,95％可信区间（CI）：7．211～64．946]、感染梅毒（OR=3．097,95％CI：1．059～9．055）与HIV感染关系有统计学意义。梅毒阳性129例,阳性率为16．1％。多因素分析表明,最近3个月有商业性行为（OR=6．306,95％CI：3．930～10．118）、最近3个月有同性性行为（OR=5．948,95％CI：3．017～11．725）与梅毒感染关系有统计学意义。结论性病门诊男性就诊者HIV、梅毒感染率较高,危险行为普遍存在,急需采取有效措施来控制性病艾滋病的传播蔓延。     

TT病毒在健康人群和肝病患者中检出的意义

目的 了解新型肝炎病毒-TT病毒的致病性和在健康人群和肝病患中的流行情况。方法 收集180份健康体检患血清和156份不同类型肝病患血清，采用PCR方法检侧TT病毒的DNA。同时检测HAV，HBV，HCV、HEV和HGV感染标志．比较分析TT病毒在健康人群和不同类型肝病患中流行情况及其致病性。结果 健康体检人群和肝病患中，TTV DNA检出率分别为2．2%和4．5％，两组之间无显性差异(P>O.05)，体检人群中，ALT正常和升高的检出率分别为l.7％和12.5%。急性肝炎，慢性肝炎和肝硬化的检出率分别为4．8％，4．3%和和4．7%，ll例阳性患中，3例A1，T正常，8例ALT异常。在8例ALT异常患中，6例为HBV现行感染，1例为HCV现行感染，仅1例为NA-G肝炎患。结论在中国健康体检人群和肝病患中能检出低水平的TT病毒现行感染。但似乎仅引起个别患的转氮酶轻度升高。TT病毒的致病性可能较弱或需要其他因素协同致病。     

健康人群和肝病患者中检测TTV的意义

目的了解新型肝炎病毒－ＴＴＶ的致病性和在健康人群和肝病患者中的流行情况．方法收集１８０份健康体检患者血清和１５６份不同类型肝病患者血清,采用ＰＣＲ方法检测ＴＴＶ的ＤＮＡ．同时检测ＨＡＶ,ＨＢＶ,ＨＣＶ,ＨＥＶ和ＨＧＶ感染标志,比较分析ＴＴＶ在健康人群和不同类型肝病患者中流行情况及其致病性．结果健康体检人群和肝病患者中,ＴＴＶＤＮＡ检出率分别为２２％和４５％,两组间无显著性差异（Ｐ＞００５）．体检人群中,ＡＬＴ正常和升高者的检出率分别为１７％和１４３％．急性肝炎,慢性肝炎和肝硬变者的检出率分别为４８％,４３％和４７％．１１例阳性患者中,３例ＡＬＴ正常,８例ＡＬＴ异常．在８例ＡＬＴ异常患者中,６例为ＨＢＶ现行感染,１例为ＨＣＶ现行感染,仅１例为ＮＡ－Ｇ肝炎患者．结论在中国健康体检人群和肝病患者中能检出低水平的ＴＴＶ现行感染．但似乎仅引起个别患者的转氨酶轻度升高．ＴＴＶ的致病性可能较弱或需要其他因素协同致病．     

济南、北京性病患者特征及首诊状况分析

对山东省皮防所性病患者２７８例、北京性防所性病患者３９０例进行了首诊状况调查分析，结果表明，两地患者文化程度、婚姻状况、性行为特征无显著差异；性病患者首诊时济南有１４．３９％、北京１５．９０％选择非正规途径就医；患病后平均就诊时间济南３０天、北京１５天（Ｐ＝０．０００１），平均就诊次数济南３次、北京１次（Ｐ＝０．０００１）。提示有必要对患者进行求医行为的健康教育和提高现有医疗服务质量。     

Audit of HIV testing: who, why and when?

The risk factors, referral pattern and presence/absence of genital tract symptoms and/or sexually transmitted infections (STIs) in 189 patients having HIV counselling and/or testing at genitourinary medicine (GUM) clinics are reviewed. Eighty per cent were concerned about heterosexual transmission, 9.5% men who have sex with men (MSM) and 4.8% intravenous drug users (IDUs). Heterosexuals and first-time GUM attenders were more likely to have sought prior advice from their general practitioner (GP). The majority were asymptomatic for genital tract infections, but 83% accepted an STI screen, with 44 STIs being diagnosed. Only one individual who had attended primarily for HIV screening was found to have an STI. About half of individuals presented within the window period, and of those stating that they wished to proceed with deferred testing, half subsequently failed to return, resulting in wasted health adviser appointments.     

Testing rates for sexually transmitted infections among HIV-infected men who have sex with men attending two different HIV services

This study compares the testing rates of bacterial sexually transmitted infections (STIs) among HIV-positive men who have sex with men (MSM) attending two HIV clinics in Melbourne. Data on STI testing over a 12-month period were obtained for all HIV-positive MSM who attended the clinics between January and March 2006. Screening rates for bacterial STIs were significantly higher at a sexual health clinic (n = 254) compared with an infectious diseases clinic (n = 351), whether this was measured according to: at least one STI test being performed for chlamydia, gonorrhoea or syphilis (69% vs. 38%, P < 0.01); serological testing for syphilis alone (67% vs. 34%, P < 0.01); or 'complete' STI screening for pharyngeal gonorrhoea, urethral chlamydia, anal gonorrhoea, anal chlamydia and syphilis (41% vs. 6%, P < 0.01). Substantial differences in STI testing rates among HIV-positive MSM may exist between HIV clinical services depending on the measures in place that promote STI screening.     

The features of patients attending walk-in compared with booked clinics for sexually transmitted infections

Few data are available on the comparison of access of patients at risk of sexually transmitted infections (STIs) to different models of genitourinary (GU) medicine services. The aim of this study was to compare the characteristics and STIs results of patients attending walk-in clinics with those of patients attending booked-in clinics in a department of GU medicine. The study was carried out at the Department of GUM at Walsall Manor Hospital. This was a prospective study on consecutive new patients attending first come first served walk-in and booked clinics between 1 January and 1 April 2006. Patients' demography, sexual behaviour and results of screening for STIs were recorded. During the study period, 346 and 234 patients attended walk-in and booked clinics, respectively. Default rate for booked clinics was 27%. Significantly higher proportions of patients attending walk-in clinics were screened for an STI. All patients with HIV (n = 2) or with trichomonal (n = 4) infections attended walk-in clinics. In regression analysis, patients with genitourinary symptoms were more likely to attend walk-in clinics (odds ratio [OR]: 2.371; [95% confidence interval [CI]: 1.545-3.639; P = 0.0005). There was no difference between the prevalence of STIs among patients attending either service model. In conclusion, there was no significant difference between the proportion of patients with or at-risk of STIs who attended booked and walk-in clinics.     

Different trends for different sexually transmissible infections despite increased testing of men who have sex with men

Australian and New South Wales Sexually Transmissible Infections Strategies recommend sexual health clinics actively target particular populations, including men who have sex with men (MSM), who have increasing rates of sexually transmitted infections (STIs). We describe trends in MSM attendances, STI testing and diagnostic yield from 1996 to 2007 at a Sydney public sexual clinic. Aggregate data were extracted from the clinic database. There was a 76% increase in the number of individual MSM attending, more than three-fold increase in the number of STI tests performed and the proportion of MSM tested. The increase in testing was greatest for rectal infections. The positive yield increased for rectal chlamydia and infectious syphilis; remained stable for pharyngeal gonorrhoea; and decreased for urethral gonorrhoea, rectal gonorrhoea and urethral chlamydia. Our results demonstrate successful service reorientation in response to a local STI epidemic. Differing trends suggest evolving transmission dynamics for different STIs in the context of increased testing of asymptomatic MSM.     

Syndromic and laboratory diagnosis of sexually transmitted infection: a comparative study in China

The rate of sexually transmitted infections (STIs) has soared in China. Yet, there is no universal consensus about the accuracy of the syndromic approach to STI management. This study aims to compare the syndromic approach with laboratory tests. A randomly selected sample of market vendors in eastern China (n = 4510) was recruited and assessed for the five most common STIs (Chlamydia trachomatis infection, gonorrhoea, genital herpes [herpes simplex type 2, HSV-2] syphilis and trichomoniasis [female only]). Symptom-based assessments made by physicians were compared with laboratory tests. Laboratory test results were used as the gold standard for the comparisons. The overall sensitivity of physician symptom-based assessment was about 10%; sensitivity was lower for males (1.6%) than for females (17.2%). The sensitivity of physician assessments for those who reported STI symptoms was relatively higher (36.7%) than for those who reported no symptoms (5.1%). More than half (54.37%) of the participants were diagnosed with STI of trichomoniasis. For the other four types of STIs, physicians correctly identified only <10% of the positive cases. The study detected a low sensitivity of STI diagnosis made by physicians in an Eastern city of China. The failure in the detection of asymptomatic patients remains one of the limitations of the syndromic approach.     

Should men with asymptomatic non-specific urethritis be identified and treated?

There is currently a debate as to whether microscopy is necessary in asymptomatic men presenting for a sexual health screen. Arguments favouring microscopy include finding chlamydia in a significant proportion of sexual partners of men with non-specific urethritis (NSU) in studies that included symptomatic men. We aimed to investigate the proportion of partners of men with asymptomatic NSU who were diagnosed with a sexually transmitted infection. A retrospective case-note review was carried out for all men diagnosed with asymptomatic pathogen-negative NSU, and their traced sexual contacts, during a nine-month period. As a result of contact-tracing, we identified 42 partners who attended the clinic. Only one partner (2.4%) tested positive for chlamydia. A further two partners were diagnosed with a viral sexually transmitted infection (STI). The low level of chlamydia and other STIs in partners of asymptomatic men with pathogen-negative NSU does not support the routine use of microscopy to identify these patients.     

Sexually transmitted infections and sexual behaviour among commercial sex workers in a rural district of Malawi

In Thyolo District, Malawi, a study was conducted among commercial sex workers (CSWs) attending mobile clinics in order to; determine the prevalence and pattern of sexually transmitted infections (STIs), describe sexual behaviour among those who have an STI and identify risk factors associated with 'no condom use'. There were 1817 CSWs, of whom 448 (25%) had an STI. Of these, the commonest infections included 237 (53%) cases of abnormal vaginal discharge, 109 (24%) cases of pelvic inflammatory disease and 95 (21%) cases of genital ulcer disease (GUD). Eighty-seven per cent had sex while symptomatic, 17% without condoms. Having unprotected sex was associated with being married, being involved with commercial sex outside a known rest-house or bar, having a GUD, having fewer than two clients/day, alcohol intake and having had no prior medication for STI. The high levels of STIs, particularly GUDs, and unprotected sex underlines the importance of developing targeted interventions for CSWs and their clients.     

Prevalence,incidence and recurrence of sexually transmitted infections in HIV-negative adult women in a rural South African setting

Objective

Sexually transmitted infections (STIs), including syphilis, chlamydia, gonorrhoea and trichomoniasis, are of global public health concern. While STI incidence rates in sub-Saharan Africa are high, longitudinal data on incidence and recurrence of STIs are scarce, particularly in rural areas. We determined the incidence rates of curable STIs in HIV-negative women during 96 weeks in a rural South African setting.

Methods

We prospectively followed participants enrolled in a randomised controlled trial to evaluate the safety and efficacy of a dapivirine-containing vaginal ring for HIV prevention in Limpopo province, South Africa. Participants were included if they were female, aged 18–45, sexually active, not pregnant and HIV-negative. Twelve-weekly laboratory STI testing was performed during 96 weeks of follow-up. Treatment was provided based on vaginal discharge by physical examination or after a laboratory-confirmed STI.

Results

A total of 119 women were included in the study. Prevalence of one or more STIs at baseline was 35.3%. Over 182 person-years at risk (PYAR), a total of 149 incident STIs were diagnosed in 75 (65.2%) women with incidence rates of 45.6 events/PYAR for chlamydia, 27.4 events/100 PYAR for gonorrhoea and 8.2 events/100 PYAR for trichomoniasis. Forty-four women developed ≥2 incident STIs. Risk factors for incident STI were in a relationship ≤3 years (adjusted hazard ratio [aHR]: 1.86; 95% confidece interval [CI]: 1.04–2.65) and having an STI at baseline (aHR: 1.66; 95% CI: 1.17–2.96). Sensitivity and specificity of vaginal discharge for laboratory-confirmed STI were 23.6% and 87.7%, respectively.

Conclusion

This study demonstrates high STI incidence in HIV-negative women in rural South Africa. Sensitivity of vaginal discharge was poor and STI recurrence rates were high, highlighting the shortcomings of syndromic management in the face of asymptomatic STIs in this setting.     

How many sexually transmitted infections (STIs) will we miss?--an algorithm to assess risk factors for STI

A self-administered algorithm for the assessment of symptoms of, and risk factors for, sexually transmitted infection (STI) was developed. The algorithm was applied retrospectively to all cases of STI other than chlamydia diagnosed over a one-year period, to estimate the risk of missing STI diagnoses by its introduction. Three hundred and eighty-nine cases were identified, of whom 81 (21%) were asymptomatic. Seven asymptomatic cases had no identifiable risk factors for infection and might potentially have been offered a postal testing kit for chlamydia rather than a full STI screen. We estimate that 1.8% of STIs diagnosed in the unit might be missed by the introduction of the algorithm.