Variation in clinical practice in genitourinary medicine clinics in the United Kingdom

OBJECTIVES: This study was conducted to examine the variation in clinical practice in genitourinary medicine clinics in the United Kingdom in early 2002. METHODS: Questionnaires were sent to all 234 consultants in charge of genitourinary medicine clinics in the United Kingdom in March-May 2002. The questions concerned clinical practice in respect of asymptomatic patients presenting for an infection screen, and practice in respect of some specific sexually transmitted and other genitourinary infections. RESULTS: The test for infection least likely to be offered to heterosexuals is an HIV test (71% and 70% of clinics routinely offer this to male and female heterosexuals respectively). The practice of permitting "low risk" patients to telephone for their HIV results now extends to 24% of clinics. 34% of clinics do not require patients with non-specific urethritis to attend for follow up. 41% of clinics routinely ask patients treated for Chlamydia trachomatis to return for a follow up chlamydia detection test. 25% of clinics routinely offer two tests of cure to all patients with gonorrhoea. 6% of clinics do not routinely offer syphilis serology to heterosexuals. Other significant variations in clinical practice were documented. CONCLUSIONS: Overall, our findings indicate the need for further evidence to guide clinical practice and a wider knowledge and debate of national guidelines.     

陕西省2014年梅毒血清学检测室间质评效果评价

目的：明确2014年陕西省梅毒血清学检测室间质量评价的效果。方法：梅毒盲样统一采购,分发至341个医疗单位实验室,由各实验室按照梅毒血清学检测规范操作,结果反馈,统一判定。结果：上报质评结果的医疗单位332个,上报率为97.4%。其中梅毒螺旋体抗原血清学检测总体合格率为96.99%,非梅毒螺旋体抗原血清学检测总体合格率为69.88%。结论：陕西性病诊疗医院梅毒实验室检测质量仍有待改进。     

Prevalence of HIV-1 among attenders at sexually transmitted disease clinics: analyses according to country of birth

OBJECTIVES: To determine the importance of world region of birth as a risk factor for HIV-1 infection, the likelihood of having an HIV-1 infection diagnosed and the likelihood of having another coexisting acute sexually transmitted infection (STI) among attenders at genitourinary medicine clinics. SUBJECTS: Specimens from attenders having routine syphilis serology at 15 sexually transmitted disease clinics in England, Wales, and Northern Ireland participating in the unliked anonymous seroprevalence monitoring programme from 1994 to 1996. METHODS: Limited data were collected with specimens that were irreversibly unlinked from the source patients before testing for antibodies to HIV-1. Numbers of specimens, the prevalence of HIV-1, the proportions of infections clinically diagnosed, and the presence of coexisting acute STIs were analysed according to world region of birth, sexual orientation, and injecting drug use. RESULTS: Between 1994 and 1996, 173,075 specimens were collected; 16.9% were from people born outside the United Kingdom. Risk of being HIV-1 positive was significantly higher overall for both men and women born abroad, but this was not the case for those born in south Asia (India, Pakistan, and Bangladesh). Homosexual and bisexual males born abroad were almost twice as likely to be HIV infected as their counterparts born in the United Kingdom. However, homosexual and bisexual men born in the United Kingdom accounted for almost three quarters of the 1174 HIV-1 positive specimens detected. Among 158,728 non-drug injecting heterosexuals the highest prevalence was observed in specimens from those men (4.0%) and women (5.8%) born in sub-Saharan Africa. The 6991 heterosexual men and women born in other European countries were also more likely to provide HIV-1 positive specimens than UK born heterosexuals. However, 39% of the HIV-1 positive specimens in heterosexuals come from clinic attenders born in the United Kingdom. Heterosexual males were generally less likely to have their infection diagnosed than females. There were 182 attendances (mostly from London clinics) non-drug injecting heterosexual men and women who were infected with both HIV-1 and an acute sexually transmitted infection; only 12% of whom had had their HIV-1 infection diagnosed. CONCLUSION: Among most people attending genitourinary medicine clinics, being born abroad is associated with an increased likelihood for HIV-1 infection. HIV-1 infected heterosexuals, of whom 46% are people from sub-Saharan Africa, are unlikely to have their infection clinically diagnosed and thus are unable to obtain appropriate treatment. The presence of HIV-1 infected heterosexual men and women with acute STI represents a potential source of heterosexual HIV transmission both for those born in the United Kingdom and born abroad.     

HIV infection among homosexual/bisexual males attending genitourinary clinics in Scotland

BACKGROUND: Since 1991, unlinked anonymous HIV testing of homosexual/bisexual males attending genitourinary clinics in Edinburgh and Glasgow has been conducted and resulting prevalence data have been published annually. More detailed information which provides an understanding of what proportion of HIV infected men attending genitourinary clinics in central Scotland (i) remain undetected, (ii) acquire sexually transmitted infections following HIV diagnosis, and (iii) possibly become HIV infected either abroad or following sex with someone from abroad, is reported by the authors. METHODS: Unlinked anonymous HIV testing of syphilis serology specimens from homosexual/bisexual males attending genitourinary clinics during 1991-5. RESULTS: Of 3468 specimens tested, 165 (4.8%) were HIV positive. Thirty five per cent (57) of all HIV positive specimens were from men whose infection remained undetected following clinic attendance. Of the 80 attenders who knew themselves to be HIV positive before their clinic visit, 13 had clinical and/or laboratory evidence of a sexually transmitted infection. Men who had a sexual risk associated with America or who were American, had a 2.4-fold greater risk of being HIV infected than those with United Kingdom only connections. CONCLUSION: Increased efforts should be made to ensure that HIV infected men are diagnosed early after infection and do not engage in high risk sexual behaviour, and that all homosexual men are educated about the particular risks of acquiring HIV infection abroad. More effective interventions to prevent indigenous HIV transmissions need to be developed.


     

7800例新生儿TPPA和TRUST检测

目的 探讨非梅毒螺旋体抗原血清学试验和梅毒螺旋体抗原血清学试验检测胎传梅毒的价值及其临床实用性。方法 对门诊及住院7800例新生儿用甲苯胺红不加热血清试验（TRUST）做非特异性抗体定量检测,梅毒螺旋体明胶颗粒凝聚集试验（TPPA）做特异性抗体定性检测。统计分析确诊的胎传梅毒患儿初次梅毒血清学试验结果。比较TPPA和TRUST试验的敏感度和特异性。结果 进行血清学筛查的7800例新生儿中,初次梅毒血清学检测TPPA（+）、TRUST（+）60例,其中胎传梅毒患儿15例;初次梅毒血清学检测TPPA（+）、TRUST（-）47例,其中胎传梅毒患儿5例。TRUST试验检测胎传梅毒的敏感率为75%（5/20）,特异性为99.41%（7734/7780）。TPPA试验检测胎传梅毒的敏感率为100%（20/20）,特异性为98.88%（7693/7780）。结论 TPPA比TRUST更适用于胎传梅毒的筛查。     

Detection of treponemal DNA in the CSF of patients with syphilis and HIV infection using the polymerase chain reaction.

The polymerase chain reaction (PCR) was used to detect Treponema pallidum DNA in the cerebrospinal fluid (CSF) of patients with and without syphilis. The CSF from 10 of 19 patients with positive serological tests for syphilis who were being investigated for late syphilis were treponemal DNA-positive. In contrast, the CSF from only one of 30 patients with no known history of syphilis was DNA-positive. CSF from 28 HIV-positive patients was also tested. Fourteen of these patients had central nervous system (CNS) disease and seven were DNA-positive, whereas none of the 14 without CNS disease were DNA-positive. Five of the seven DNA-positive patients had a history of syphilis. Such a history in an HIV-positive patient who had CNS disease was predictive of finding treponemal DNA in the CSF. The PCR had a sensitivity of 47% and a specificity of 93% for detecting a known history of syphilis and is a potentially useful tool in treponemal diagnosis.     

Dark ground microscopy and treponemal serological tests in the diagnosis of early syphilis

OBJECTIVES: To evaluate the use of dark ground microscopy (DGM) and treponemal serological tests in the diagnosis of primary (PS) and secondary (SS) syphilis. METHODS: A retrospective case note review of patients with early syphilis who attended our department between January 2001 and December 2002. Data were collected on demographics, results of treponemal serology and DGM. RESULTS: 50 individuals had PS and 36 individuals had SS. DGM was performed in 31/50 (62%) of PS cases and this was positive in 97%. In 17 (34%) cases of PS, treponemal EIA was negative initially. DGM was performed on 13 of these, all of which were positive. Therefore, EIA had a sensitivity of 57% when compared to DGM. In 27 patients where EIA-IgM was performed, this was positive in 22 (81%), of which 12 were EIA negative on initial screening. All SS cases had positive EIA. DGM was performed in 19/36 (52%) of SS cases and was positive in 16/19--that is, a sensitivity of 84% when compared to EIA. The major reason why DGM was not performed in the cases of PS was that herpes was the presumed diagnosis and in SS the rash was attributed to other causes. CONCLUSIONS: DGM is a rapid and sensitive test while EIA takes time for results and is less sensitive in PS. EIA-IgM is a useful adjunct in PS. DGM allows immediate diagnosis, treatment, and partner notification preventing further transmission. Genitourinary medicine clinics should have trained staff to perform DGM on all anogenital ulcers and suspected syphilitic lesions.     

Serological markers for treponemal infection in children in rural Kilimanjaro,Tanzania: evidence of syphilis or non-venereal treponematoses?

OBJECTIVE: To determine the seroprevalence of treponemal infection and possible risk factors among children aged 0-14 in the general population of a rural Tanzanian village. METHODS: The survey was conducted as a part of a cross section study of a total village population on HIV and sexually transmitted disease. Among 1708 registered children aged 0-14, the 553 first attending were tested for treponemal infection with both rapid plasma reagin test (RPR) and Treponema pallidum Haemagglutination test (TPHA). These children belonged to a household cohort--also including their parents, siblings, and other household members--with 1339 members; 1224 (91.4% participated in the survey and 82.1% of these were tested for treponemal infection. RESULTS: The overall prevalence for the TPHA test was 6.4% among girls and 1.1% among boys (odds ratio, OR = 6.5; 95% confidence interval, CI: 1.9-22.3). The sex difference was most pronounced in the age group 10-14; 11.1% among girls versus 1.0% among boys (OR = 12.8; CI: 1.6-101.9). Among the 20 children who were TPHA positive, we found two cases of active, congenital syphilis. There was a lack of association between positive serology in children and positive serology in their parents. CONCLUSION: The highly significant predominance of girls testing positive for TPHA, and the concomitant lack of association between parents' and children's serostatus might point to sexual transmission as being the most common route of transmission of treponemal infection in girls during childhood in this village. The sources of infection for the seropositive girls are possibly found outside the family.     

Is increased surveillance for asymptomatic syphilis in an HIV outpatient department worthwhile?

OBJECTIVES: Syphilis outbreaks have recently been reported in the United Kingdom, some of which have included cohorts of HIV positive individuals. As a result we commenced 3 monthly screening of syphilis serology (STS) for HIV positive patients having routine follow up blood tests. We assessed if there was an increased number of individuals being screened and also whether the screening programme was diagnosing early cases of syphilis. METHODS: Data from a 1 year period following introduction of screening (May 2001) were analysed and compared with data from the same period last year. The case notes of patients with a positive VDRL were reviewed to establish, firstly, whether these represented new diagnoses and, secondly, whether patients were asymptomatic at the time of screening. RESULTS: 2670 patients had at least one CD4 count measured in the period (surrogate for patients having routine bloods). Of these, 2266 patients had STS performed (85%). 38 patients had a positive VDRL. Of these, 20 were confirmed as having early syphilis which was asymptomatic at the time of screening. Six asymptomatic cases were also confirmed with newly positive TPPAs and a negative VDRL. These 26 asymptomatic cases represent 29% of all cases of early syphilis diagnosed in our department and 50% of cases in the HIV positive cohort. CONCLUSION: With intensive surveillance significant numbers of cases of asymptomatic early syphilis are being identified in a group of HIV individuals under routine follow up, at an earlier stage than would otherwise have been the case. This presents an opportunity to intervene not only to prevent clinical illness but also to institute infection control measures.     

Lessons from the syphilis outbreak in homosexual men in east London

OBJECTIVES: To describe the epidemiology, presentation, and diagnosis of early syphilis in 103 homosexual men in east London. METHODS: A retrospective study using data from KC60 returns, the Health Protection Agency (HPA) enhanced surveillance forms and case notes. RESULTS: 40 cases of primary (PS), 40 of secondary (SS) and 23 of early latent syphilis were identified, 33% co-infected with HIV. 41% had concurrent sexually transmitted infections (STIs). Pain featured in 35% of PS and itch in 13% of rashes. Dark ground microscopy (DGM), performed in 44 of the symptomatic cases, was positive in 37 (84%) allowing early management. Initial syphilis serology was negative in 15/40 (37%) cases of PS. 51% and 49% opted for parenteral and oral treatment, respectively. In 53/103 (51%) cases oral sex was the only risk factor. 86% of infections were UK acquired. Only 4% of contacts were seen. CONCLUSION: This outbreak, reflecting the resurgence of syphilis across the United Kingdom, highlights several important points. Painful chancres and itchy rash are common presentations. DGM is a highly sensitive diagnostic tool. Initial negative serological screening tests are common in PS and sero-surveillance for 3 months is recommended. The high prevalence of concomitant STIs indicates ongoing unprotected sexual intercourse. Oral sex is a significant risk factor and is a distinctly "unsafe" practice. Conventional partner notification is ineffective. Other methods of screening of the at-risk homosexual population are warranted. Continued education is required to reduce STI acquisition in homosexual men.     

Syphilis serology and HIV infection in Harare, Zimbabwe

OBJECTIVE: To determine the reliability of serological tests in detecting syphilis in a factory worker cohort and examine the impact of concurrent HIV infection on serological tests for syphilis. METHOD: Reactions to non-treponemal and treponemal antigens were tested using sera from a cohort of 3401 factory workers in Harare, Zimbabwe. The participants consented to regular testing for syphilis, by VDRL, and HIV using two ELISAs. All sera from men who were VDRL positive, and a random sample of VDRL negative sera, were tested by RPR, TPHA, and where appropriate FTA-Abs. From the results, men were defined as having no syphilis, active syphilis, incident syphilis, historic syphilis, or giving biological false positive reactions. RESULTS: 709 sera were examined from 580 men. There were 78 cases of active syphilis in the cohort, giving a prevalence of 2.3%, and the seroincidence was 0.25 per 100 person years of follow up. The prevalence of HIV in the cohort was 19.8%. There was a strong association between syphilis, whether active, incident or historic, and HIV seropositivity. With both HIV positive and negative sera the negative predictive values of VDRL and RPR were > 99.9% while the positive predictive value for VDRL (30%) was lower than for RPR (39%). Biological false positive reactions were detected in 0.5% of the cohort, with in most cases a transient rise in VDRL titres up to < 1/16. Higher false positive titres occurred in five men, each of whom was HIV positive. CONCLUSIONS: The VDRL is reliable in detecting possible cases of syphilis even in a community with a high prevalence of heterosexually transmitted HIV. There is need, however, for confirmatory tests. The prevalence of syphilis in this cohort is very low in comparison with other countries in southern Africa, but is consistent with recent data from Harare. Despite a strong association between syphilis and HIV it was clear that syphilis could not be counted as a major factor fueling the HIV epidemic in Zimbabwe.     

Diagnosis of neurosyphilis: appraisal of clinical caseload.

OBJECTIVES: To review the management of a cohort of patients with positive treponemal serology and psychiatric and/or neurological disorders. METHODS: A retrospective case note review of 172 patients with positive treponemal serology attending the Patrick Clement's Clinic, Central Middlesex Hospital between December 1990 and November 1995 was performed. RESULTS: 101 men and 71 women were new attenders diagnosed with positive treponemal serology. A neurological problem was identified in 27 patients (12 women and 15 men) with psychiatric and/or neurological disorders, of whom 20 (six women and 14 men) underwent investigation of the cerebrospinal fluid (CSF). With the medical history and results of CSF-RPR and FTA tests, white cell count (WCC), and total protein level in the CSF, 10 patients (eight men and two women) were diagnosed with likely neurosyphilis and 17 with neurological disorders not thought to be caused by syphilis. The clinical features in those having neurosyphilis were sensorineural hearing loss (n = 5) and tabes dorsalis (n = 5). In the seven patients diagnosed with neurosyphilis who underwent CSF examination one patient had a reactive CSF-FTA, elevated protein, and elevated WCC; one patient had a reactive CSF-FTA and RPR with elevated protein; the total protein only was elevated in three cases and the WCC elevated in one case. Nine of the 10 patients with neurosyphilis received adequate neurosyphilitic treatment; one patient was lost to follow up. CONCLUSIONS: The management of patients with positive treponemal serology and psychiatric and/or neurological disorders was consistent. Patients with suspected neurosyphilis or patients with neurological signs compatible with neurosyphilis (who did not undergo CSF examination) were treated with adequate neurosyphilitic therapy.     

Epidemiology of HIV among black and minority ethnic men who have sex with men in England and Wales

OBJECTIVES: To examine the epidemiology of HIV among black and minority ethnic (BME) men who have sex with men (MSM) in England and Wales (E&W). METHODS: Ethnicity data from two national HIV/AIDS surveillance systems were reviewed (1997-2002 inclusive), providing information on new HIV diagnoses and those accessing NHS HIV treatment and care services. In addition, undiagnosed HIV prevalence among MSM attending 14 genitourinary medicine (GUM) clinics participating in the Unlinked Anonymous Prevalence Monitoring Programme and having routine syphilis serology was examined by world region of birth. RESULTS: Between 1997 and 2002, 1040 BME MSM were newly diagnosed with HIV in E&W, representing 12% of all new diagnoses reported among MSM. Of the 1040 BME MSM, 27% were black Caribbean, 12% black African, 10% black other, 8% Indian/Pakistani/Bangladeshi, and 44% other/mixed. Where reported (n = 395), 58% of BME MSM were probably infected in the United Kingdom. An estimated 7.4% (approximate 95% CI: 4.4% to 12.5%) of BME MSM aged 16-44 in E&W were living with diagnosed HIV in 2002 compared with 3.2% (approximate 95% CI: 2.6% to 3.9%) of white MSM (p<0.001). Of Caribbean born MSM attending GUM clinics between 1997 and 2002, the proportion with undiagnosed HIV infection was 15.8% (95% CI: 11.7% to 20.8%), while among MSM born in other regions it remained below 6.0%. CONCLUSIONS: Between 1997-2002, BME MSM accounted for just over one in 10 new HIV diagnoses among MSM in E & W; more than half probably acquired their infection in the United Kingdom. In 2002, the proportion of BME MSM living with diagnosed HIV in E&W was significantly higher than white MSM. Undiagnosed HIV prevalence in Caribbean born MSM was high. These data confirm the need to remain alert to the sexual health needs and evolving epidemiology of HIV among BME MSM in E&W.     

生殖器溃疡病征处理修订方案的有效评价

目的 评价经修改的生殖器溃疡病征处理方案的有效性。方法 选择两家性病门诊就诊、具有生殖器溃疡表现的首诊患者，按病征处理原则进行处理。以复合PCR、暗视野显微镜检查及梅毒血清学试验作病原学诊断。结果 在227例患者中，78（34.4%)患有梅毒，43例（18.9%）患有生殖器疱疹，28例（12.3%)同时患梅毒和生殖器疱疹、78例（34.4%)未检出病原体。未发现软下疳。病征诊断对于梅毒和生殖器疱疹的敏感性分别为88.7%，69.0%，特异性95.0%，50.0%，阳性预期值94.0%，38.6%，阴性预期值90.6%，78.0%，在128例随访的患者中，总有效率为89.0%。结论 病征诊断对梅毒的敏感性尚不足，约有10%的梅毒患者被漏诊。对生殖器溃疡的病征处理方案仍需进一步修改和验证。由于在本组患者中未发现软下疳病例，因此在修改后的方案中目前不包含软下疳的治疗可能是可行的。     

Human immunodeficiency virus infection and genital ulcer disease in South Africa: the herpetic connection

BACKGROUND AND OBJECTIVES: While genital ulcers are a risk factor in HIV infection, the association of specific agents of genital ulcer disease (GUD) with HIV infection may vary. GOAL: To determine the etiology of GUD in HIV-infected and HIV-uninfected men attending sexually transmitted disease (STD) clinics in Durban, Johannesburg, and Cape Town, South Africa, and the association of previous and current sexually transmitted infections with HIV infection in men with ulcerative and nonulcerative STDs. STUDY DESIGN: A cross-sectional study of 558 men with genital ulcers and 602 men with urethritis. RESULTS: Patients with GUD were more likely to be infected with HIV than patients with urethritis (39.4% versus 21.4%, P< or =0.001). Herpes simplex virus 2 (HSV-2) was the most common agent identified in ulcer specimens (35.9%), and was detected in a significantly higher proportion of ulcer specimens from HIV-infected patients than in specimens from HIV-uninfected patients (47.4% versus 28.2%, P< or =0.001). Patients infected with HIV-1 were significantly more likely to have HSV-2 infection, as measured by the presence of the antibody to glycoprotein G-2, than patients not infected with HIV (63.1% versus 38.5%, P< or =0.001). Patients infected with HIV-1 were also significantly more likely to have initial HSV-2 infection than HIV-uninfected patients with GUD (50.0% versus 31.6%, P = 0.007). Haemophilus ducreyi was detected in 31.7% of ulcer specimens; prevalence did not vary by HIV-infection status. Treponema pallidum DNA was detected significantly less frequently in ulcer specimens from patients infected with HIV than in specimens from patients not infected with HIV (10.2% versus 26%, P< or =0.001); no association was found between HIV-infection status and fluorescent treponemal antibody absorption test seroreactivity, even when men with M-PCR-positive syphilis lesions were excluded from the analyses. CONCLUSION: The authors found that HSV-2 is a more common etiology of GUD than has been suggested by previous studies conducted in South Africa; serologic evidence of HSV-2 infection and current cases of genital herpes are strongly associated with HIV infection among men who present to STD clinics with GUD or urethritis.     

Increasing detection of asymptomatic syphilis in HIV patients

BACKGROUND/OBJECTIVES: The burden of new syphilis diagnoses in London has mainly been in men who have sex with men (MSM), many of whom are co-infected with HIV. Our HIV unit introduced regular serological screening for syphilis during routine follow up care to detect patients who may be at risk of asymptomatic infection. We assessed if this remained an effective and necessary strategy in the second year since introduction. METHODS: All HIV outpatients with newly positive syphilis serology between 1 May 2002 and 30 April 2003 were identified using a prospectively collected database. Only patients who were asymptomatic at the time of screening were included (cohort B). They were compared to patients in the exact preceding year (cohort A). RESULTS: 2655 patients had at least one CD4 count measured in the period (surrogate marker for patients having routine follow up bloods), of whom 2389 (90%) had syphilis serology performed. 40 individuals were found to have early asymptomatic infection (two were re-infections), compared to 26 patients in cohort A. These 40 patients represented 36% of all patients with infectious syphilis treated within our department and 56% of those who were HIV positive. The event rate in cohort B was 7.3 per 1000 patient years (CI 5.2 to 9.9) compared to 2.8 (CI 1.8 to 4.0) in cohort A. CONCLUSION: Routine screening is effective and has detected increasing numbers of HIV outpatients with early asymptomatic syphilis. Our department will continue this strategy for all HIV patients during their follow up care. We recommend that other units adopt similar initiatives that assist with regional control of the UK syphilis epidemic.     

苍白螺旋体镀银染色检查在一期梅毒诊断中的应用

目的:探讨梅毒螺旋体镀银染色检查在一期梅毒实验诊断中的意义。方法:对37例一期梅毒患者分别采用梅毒螺旋体镀银染色、墨汁负染及暗视野检查3种方法对比检查,同时作快速血浆反应素环状卡片试验(RPR)、梅毒螺旋体血凝试验(TPHA)检测梅毒螺旋体抗体。结果:镀银染色法检查梅毒螺旋体的阳性率高,与墨汁负染法、暗视野检查法的结果比较,其差异有显著性(P<0.05)。镀银染色层次清楚,螺旋体易被着色辨认。结论:梅毒螺旋体镀银染色检查是一期梅毒实验室诊断的有效方法之一。     

北京市2012年男男性行为者HIV及梅毒感染状况调查

【摘要】 目的 了解北京市男男性行为（MSM）人群HIV及梅毒感染状况,探讨两者之间的相关性。 方法 对北京市艾滋病哨点监测MSM人群600例进行HIV及梅毒实验室检测。用ELISA方法对所有研究对象样本进行HIV初筛,初筛阳性者用免疫印迹方法进行确认;梅毒检测采用快速血浆反应素环状卡片试验（RPR）与梅毒螺旋体明胶凝集试验（TPPA）两种方法同时进行,TPPA阳性者即视为梅毒感染者（包括既往感染与现症感染）;符合条件的HIV阳性血清还接受HIV-1 BED捕获酶联法（BED方法）检测并计算HIV在此人群中的发病率;对MSM人群HIV及梅毒感染状况进行统计学相关性分析。 结果 MSM人群600例,HIV阳性49例,阳性率8.17%;HIV新近感染14例,发病率为4.68%。HIV感染者表现出外地户籍比重大、学历层次相对较高的特点。梅毒RPR与TPPA均阳性51例（8.5%）,感染率（含既往感染）为18.5%（111/600）。 结论 北京市哨点监测MSM人群HIV感染率及发病率、梅毒感染率均维持在较高水平;HIV感染与梅毒感染有显著相关性。     

Recent trends in HIV and other STIs in the United Kingdom: data to the end of 2002

Sexual health in the United Kingdom has deteriorated in recent years with further increases in HIV and other sexually transmitted infections (STIs) reported in 2002. This paper describes results from the available surveillance data in the United Kingdom from the Health Protection Agency and its national collaborators. The data sources range from voluntary reports of HIV/AIDS from clinicians, CD4 cell count monitoring, a national census of individuals living with HIV, and the Unlinked Anonymous Programme, to statutory reports of STIs from genitourinary medicine (GUM) clinics and enhanced STI surveillance systems. In 2002, an estimated 49500 adults aged over 15 years were living with HIV in the United Kingdom, of whom 31% were unaware of their infection. Diagnoses of new HIV infections have doubled from 1997 to 2002, mainly driven by heterosexuals who acquired their infection abroad. HIV transmission also continues within the United Kingdom, particularly among homo/bisexual men who, in 2002, accounted for 80% of all newly diagnosed HIV infections acquired in the United Kingdom. New diagnoses of syphilis have increased eightfold, and diagnoses of chlamydia and gonorrhoea have doubled from 1997 to 2002 overall; STI rates disproportionately affect homo/bisexual men and young people. Effective surveillance is essential in the provision of timely information on the changing epidemiology of HIV and other STIs; this information is necessary for the targeting of prevention efforts and through providing baseline information against which progress towards targets can be monitored.     

Serological tests for syphilis in Saudi Arabia.

A total of 6684 sera were initially screened for syphilis by the Venereal Disease Research Laboratory (VDRL) test and the Treponema pallidum haemagglutination assay (TPHA). Reactive sera from either or both these tests were tested for confirmation by the fluorescent treponemal antibody-absorbed (FTA-ABS) test. VDRL biological false positive reactors were detected in 0.5% of the total sera examined, with 0.4% and 0.8%, respectively, obtained in pregnant women and blood donors. Eight sera (0.1%) were found to be positive in the TPHA test alone. An overall positivity of 2.7% for syphilis was detected, with a 0.85% positivity in antenatal patients. Infection with T pallidum seemed to be more common in men than in women (1.6:1) and predominated in the age group 20-39 years. Serological testing of sera from 26 mother and infant pairs allowed one case of congenital syphilis to be detected by FTA-ABS (IgM) and identified VDRL biological false positivity in seven infants.