泌尿生殖道沙眼衣原体感染的流行病学进展

沙眼衣原体是一种常见的性传播疾病病原体,可通过性传播和垂直传播.泌尿生殖道沙眼衣原体感染率和发病率逐年增加,且在国内外不同地区和人群中的流行趋势及基因型分布有所不同.沙眼衣原体能导致多种泌尿生殖系统疾病,年轻女性、多性伴者、男同性恋者均是沙眼衣原体感染的高危人群.概述近年来泌尿生殖道沙眼衣原体感染流行病学研究,为进一步的研究和预防提供参考.

Abstract：

Chlamydia trachomatis (CT) is a common pathogen spread through sexual and mother-tochild transmission. There has been a year-by-year increase in the infection rate of CT and incidence rate of CTrelated diseases. The prevalence trend and genotype distribution of CT vary with areas and populations at home and abroad. CT can cause various urogenital tract diseases. Young women, people with multiple sexual partners and homosexual men all belong to populations at a high risk for CT infection. This article describes recent epidemiology of genital CT infection so as to provide a reference for further researches in and prevention of CT infection.     

泌尿生殖道沙眼衣原体感染的治疗药物

泌尿生殖道沙眼衣原体感染的治疗药物郭秀军（重庆第三军医大学，第二附属医院皮肤科６３００３７）目前，沙眼衣原体所致的泌尿生殖道感染，早已超过梅毒、淋病，成为许多国家和地区最常见的性传播疾病。该病原体可以导致男性尿道炎、前列腺炎、附睾炎等（１），亦可引起...     

泌尿生殖道支原体衣原体感染的治疗观察

非淋菌性尿道炎近年来在我国呈上升趋势。支原体、衣原体是引起非淋菌性尿道炎、宫颈炎的主要病原体。目前治疗方法很多，但复发率高，这可能与疗程和剂量不规范有关，我们应用阿奇霉素不同给药方法对168例非淋菌性尿道炎患者进行治疗和观察，报道如下。     

沙眼衣原体泌尿生殖道感染动物模型研究的进展

非淋菌性尿道炎 (ＮＧＵ)是一种性传播疾病。目前 ,该病在国内外的发病率急剧上升 ,国外以及我国沿海经济发达地区 ,甚至超过淋病。该病表现多样 ,在男性表现为尿道炎、附睾炎、睾丸炎、前列腺炎 ,在女性表现为阴道炎、尿道炎、宫颈炎、输卵管炎及盆腔炎 ,甚至导致不孕症。ＮＧＵ病原体种类多 ,主要为沙眼衣原体 ,而且沙眼衣原体感染泌尿生殖道的致病机制不甚清楚 ,因此建立有效动物模型对研究沙眼衣原体致病机制、免疫、以及该病原体所致ＮＧＵ治疗、药物疗效及毒性观察、疫苗研究等方面有着重要意义。本文就目前国内外研究沙眼衣原体泌尿…     

多次传代培养提高沙眼衣原体泌尿生殖道感染的检出率

沙眼衣原体(Chlamydia trachomatis,Ct)所致的泌尿生殖系感染是目前世界范围内最为流行的性传播疾病,在某些西方国家已超过淋病占各种性传播疾病的首位~([1]).在我国,近年日益增加的Ct泌尿生殖道感染已受到重视.在Ct感染的诊断上,实验室一般以传统的细胞培养法、分子生物学技术的LCR和PCR法以及免疫学类的EIA、DIF和VIDAS-CHL法进行诊断.由于细胞培养法结果稳定、可靠,是评价其他方法的"金标准",也是世界卫生组织推荐的主要方法之一~([2]).我们研究Ct的传代培养和影响因素,有助于提高Ct的检出率.     

131例STD高危人群泌尿生殖道沙眼衣原体感染状况调查

本文应用ＭｃＣｏｙ细胞培养法结合直接荧光法对１０９名卖淫妇女及２２名嫖宿男性进行了泌尿生殖道沙眼衣原体（ＣＴ）感染状况调查。结果前者感染率为４０．３％，后者感染率为１８．２％，须引起各方面重视。另外也报告了与ＣＴ感染有关的一些情况。     

泌尿生殖道沙眼衣原体持续性复发性感染的分子机制研究

沙眼衣原体感染可以引起多种疾病。而持续性和复发性是沙眼衣原体感染疾病的一个重要特点，了解导致其持续性的原因对于沙眼衣原体疾病的治疗，减少后遗症有重要作用。就近年来的一些相关研究，简要介绍了干扰素γ抑制被感染细胞凋亡，肿瘤坏死因子-α诱导T细胞凋亡，色氨酸合成酶的不同等几方面可能导致其持续性的原因。     

泌尿生殖道衣原体和支原体感染100例检测分析

基本资料　 10 0例均有性乱史 ,绝大部分以淋病后尿道炎就诊。男 70例 ,女30例。年龄 16～ 6 0岁 ,以 2 0～ 40岁最多共 85例。其中工人 15例 ,农民 18例 ,个体 2 3例 ,暗娼 12例 ,待业 8例 ,司机 16例 ,军人 3例 ,服务员 5例。已婚 74例 ,未婚 2 6例。文化程度以中学为多 ,共 80例。检测方法采用“立明”衣原体快速免疫测定法和Ｕｕ培养法。操作按试剂盒使表 1　不同性别阳性ＮＧＵ患者的病原体性别ＣｔＵｕＣｔ+Ｕｕ合计男 11(15 .71) 5 0 (71.43) 9(12 .86 ) 70 (10 0 )女 6 (2 0 .0 0 ) 2 0 (6 6 .6 7) 4 (13.33) 30 (10 0 )合计 17(17.…     

Ciprofloxacin treatment of chlamydial infections of urogenital tracts of women.

Ciprofloxacin was evaluated in chlamydial infections of the urogenital tracts of women treated with a dosage regimen of 500 mg orally twice a day for seven days. Of the 40 women evaluated, 30 were infected with Chlamydia trachomatis only, two were infected with Neisseria gonorrhoeae only, and a further eight had combined gonococcal and chlamydial infections. Ten were found to be harbouring Chlamydia trachomatis in the urethra as well as the cervix. Neisseria gonorrhoeae was eradicated from all patients with or without concomitant chlamydial infection. The overall chlamydial reisolation rates were 14% (5/35) four weeks after treatment and 23% (6/26) 11 weeks after treatment. The organism was not reisolated from the urethra of any of the patients after treatment. Ciprofloxacin was effective against Mycoplasma hominis, but almost completely ineffective against Ureaplasma urealyticum.     

Quinolones as an alternative treatment of chlamydial, mycoplasma and gonococcal urogenital infections.

We report the results of several trials aimed at evaluating the quinolones in urogenital infections. In Chlamydia trachomatis infections, ofloxacin (200 mg b.i.d. for 10 days) gave a cure rate of 98% (n = 66), and fleroxacin (400 mg s.i.d. for 7 days) provided a cure rate of 89% (n = 19). A double-blind study comparing fleroxacin (600 mg s.i.d.) to doxycycline (100 mg b.i.d.) for 7 days showed similar high cure rates for both regimens (100%; n = 23). In Mycoplasma hominis infections, ofloxacin (200 mg b.i.d. for 10 days) yielded a cure rate of 86% (n = 50) for M. hominis and 55% (n = 43) for Ureaplasma urealyticum. Gonococcal infections (n = 122) were all cured by a single dose of 200 mg ofloxacin. Both ofloxacin and fleroxacin were well tolerated and may be recommended for patients with chlamydial or uncomplicated gonococcal infections, although 600 mg fleroxacin showed a higher incidence of adverse events compared to doxycycline.     

Laboratory techniques for the diagnosis of chlamydial infections.

Yolk-sac inoculation of embryonated eggs was superseded 25 years ago by the use of cell cultures (often McCoy) for the isolation of Chlamydia trachomatis. Centrifugation of specimens onto the cell monolayers was shown to increase sensitivity, but little of late has further improved sensitivity which is at least ten-fold greater than that of eggs. However, culture is slow and labour intensive so that non-cultural techniques without these drawbacks have come to dominate. Direct fluorescent antibody (DFA) tests are rapid and have sensitivities that range from 70% to 100% for men and 68% to 100% for women, and specificities that range from 87% to 99% for men and 82% to 100% for women; if the tests are read by competent observers the values are at the top end of the ranges. The detection rate may be enhanced even further by relatively low-speed centrifugation of specimens before staining. Skilled reading is not a feature of enzyme immunoassays (EIAs) which according to the literature have sensitivities that range from 62% to 97% for men and 64% to 100% for women, and specificities that range from 92% to 100% for men and 89% to 100% for women. However, comparison against poor reference tests is responsible for most of the higher values and the clinician should not be misled into believing that EIAs have excellent sensitivity; the lower values in the ranges are closer to reality. Furthermore, EIAs that are being designed for use by general practitioners should be regarded with the greatest caution since lack of sensitivity means that chlamydia-positive patients will go undetected. The polymerase chain reaction (PCR) is not bedevilled by insensitivity but it is no more sensitive than the most sensitive cell culture or DFA tests. PCR is unsuitable for routine diagnosis but has a place as a research tool. For men, examination of "first-catch" urine samples by the best of the non-cultural procedures provides an acceptable non-invasive approach to diagnosis; for women, the value of examining urine may be less, but needs to be thoroughly tested. However, there is little doubt that a Cytobrush used to obtain cervical specimens holds no practical advantage over a swab. Serological tests are reliant on the provision of paired sera for making a diagnosis; high antibody titres in single sera may be suggestive of an aetiological association in deep-seated chlamydial infections (epididymitis, arthritis, salpingitis, etc), but unequivocal interpretation is unusual, particularly in an individual case, since the distinction between a current and past infection is problematical.     

Comparison of the Amplicor Chlamydia trachomatis test and cell culture for the detection of urogenital chlamydial infections.

OBJECTIVE--To compare the polymerase chain reaction (PCR) Amplicor Chlamydia trachomatis test with the cell culture method, in diagnosing urogenital chlamydial infections. SUBJECTS--439 patients (327 women and 112 men) attending one STD clinic and Family Planning and Gynaecological Clinics in Lisbon, Portugal, between November 1993 and March 1994. METHODS--In women, two endocervical swab samples were collected: one for PCR Amplicor and one for standard culture technique. Men were asked to submit 20 ml of urine (first pass urine) for PCR Amplicor and one urethral specimen was taken for culture. The order of collection of the specimens was rotated every 50 patients. Discrepant results were further analysed by a second PCR with primers directed against the C trachomatis major outer membrane protein (MOMP) and by direct fluorescent antibody (DFA). RESULTS--After analysis of discrepancies, the adjusted sensitivity and specificity of PCR on endocervical specimens were 92.9% and 100% and the positive and negative predictive values were 100% and 99.7% respectively; on the urine samples these values were 100%, 99.1%, 100% and 99.1%, respectively. CONCLUSION--These results indicate that the PCR Amplicor test is a rapid sensitive and specific assay for the detection of C trachomatis in urogenital infections and provides a non-invasive technique for screening chlamydia infection in men.     

Role of the Papanicolaou smear in diagnosis of chlamydial infections

The accuracy of the routine Papanicolaou (Pap) smear in diagnosis of Chlamydia trachomatis infection of the cervix has stimulated controversial reports over the years. In the present study Pap smears from 100 women, evenly divided between culture-positive and culture-negative for C. trachomatis, who had been seen in a single university clinic and cultured in the same laboratory were reviewed by two cytologists. With use of typical inclusions as evidence of chlamydial infection, the sensitivity of the Pap smear was 8.3%. Review of another series of 40 Pap smears that had been reported previously as positive for C. trachomatis showed only 25 with inclusions, an observation suggesting that routine Pap smears are being overread for chlamydial infection. Attempts to improve the sensitivity by immunoperoxidase staining were unsuccessful. Therefore, if strict cytologic criteria are used, C. trachomatis infections may be diagnosed on Pap smears, but the sensitivity will be low.     

A comparison of cost-effectiveness of three protocols for diagnosis and treatment of gonococcal and chlamydial infections in women in Africa

BACKGROUND: The cost-effectiveness of different STD diagnosis and treatment approaches has not been evaluated previously. GOALS: The goals of the study were to compare the cost-effectiveness of "gold standard" care (GS), syndromic management (SM), and mass treatment (MT) protocols for the treatment of cervical gonococcal and chlamydial infections in a hypothetical model of 1 million women in Africa. STUDY DESIGN: A decision tree model was constructed for each of the protocols. Sensitivity analyses were conducted and 10,000 Monte Carlo simulations were run to test the robustness of the cost-effectiveness estimates to changes in underlying assumptions. RESULTS: MT with doxycycline for chlamydia was the most cost-effective protocol in terms of cost per cure. SM protocol had the lowest total programmatic costs. For the GS protocol, using azithromycin for chlamydial infections was found to be more cost-effective than using doxycycline. For both the GS and SM protocols, the total cost of the program was most sensitive to the percentage of women seeking STD treatment and the prevalence of non-STD vaginal discharge, whereas the cost of MT was almost exclusively determined by coverage rates. CONCLUSIONS: No single protocol carries with it all the desired conditions of an optimal cost-effective program. The treatment-seeking behavior, STD prevalence, and coverage of each locale must be evaluated to determine the most cost-effective and highest impact program. MT was found to be the most cost-effective protocol in terms of cost per woman treated when compared with the SM and GS protocols for STDs in women.     

Hand eczema guidelines based on the Danish guidelines for the diagnosis and treatment of hand eczema

Background. Classification of hand eczema has traditionally been based both on aetiology and clinical appearance. For 20% of cases, the aetiology is unknown. Objectives. To suggest a classification based on well‐defined aetiology as well as on predefined clinical patterns and on the dynamics of hand eczema. Methods. Literature studies and discussions among members of the Danish Contact Dermatitis Group. Results. Criteria are given for the aetiological diagnoses of allergic contact dermatitis of the hands, irritant contact dermatitis of the hands, protein contact dermatitis of the hands, atopic hand eczema and aetiologically unclassifiable hand eczema. Six different clinical patterns are described and illustrated. Suggestions for general treatment principles are given. Conclusion. Operational guidelines for the diagnosis and treatment of hand eczema are described.     

欧洲、澳大利亚、英国生殖支原体感染诊疗指南介绍

【摘要】 生殖支原体可导致非淋菌性尿道炎、宫颈炎等泌尿生殖道感染甚至附睾炎、盆腔炎、早产等并发症。由于近年来生殖支原体感染率的升高以及多种常用治疗药物耐药的普遍出现,2016年欧洲、2017年澳大利亚性健康联盟、2018年英国性健康与HIV协会分别颁布了生殖支原体感染的诊疗指南,就其感染的临床表现、诊断、患者与性伴的治疗、随访等方面给出了建议,对我国生殖支原体感染的诊治有重要的指导意义。     

Clinical guidelines for the diagnosis and treatment of dermatitis herpetiformis

Dermatitis herpetiformis is an autoimmune blistering disease that appears as a cutaneous manifestation of gluten intolerance. It is one of a group of disorders that have gluten sensitivity in common, including celiac disease and gluten ataxia. Patients with dermatitis herpetiformis present with a pruritic papulovesicular rash on extensor surfaces and on the buttocks. Immunological studies demonstrate the presence of specific immunoglobulin (Ig) A anti-endomysial and anti-transglutaminase antibodies. The finding of granular deposits of IgA along the dermal-epidermal junction is pathognomonic of dermatitis herpetiformis. Treatment of dermatitis herpetiformis is based on a life-long, strict gluten-free diet, which improves all clinical aspects of gluten sensitivity, and dapsone, a drug that is only effective for the skin manifestations.