女性生殖器溃疡的病因学分析

【目的】了解妇科和性病门诊中以生殖器溃疡为主要表现的疾病的病因。【方法】取生殖器溃疡处分泌物进行涂片、培养、荧光定量PCR、暗视野显微镜和血清学检查 ,同时检测梅毒螺旋体 (TP)、单纯疱疹病毒 (HSV)、人类乳头瘤病毒 (HPV)、杜克雷嗜血杆菌 (HD)及人类免疫缺陷病毒 (HIV)。【结果】在 181例病人中 ,梅毒 48例 ,生殖器疱疹 32例 ,尖锐湿疣 9例 ,分别占 2 6 5 2 % ( 48/ 181)、17 6 8% ( 32 / 181)和4 97% ( 9/ 181) ,其中梅毒合并生殖器疱疹 6例 ,占 3 31% ( 6 / 181) ,合并尖锐湿疣 1例 ,占 0 5 5 % ( 1/ 181) ,合并HIV感染 1例 ,占 0 5 5 % ( 1/181) ;生殖器疱疹合并尖锐湿疣 4例 ,占 2 2 1% ( 4/ 181) ;念珠菌 6例 ,占 3 31% ( 6 / 181) ,合并梅毒 2例 ,占 1 10 % ( 2 / 181) ;细菌 7例 ,占3 87% ( 7/ 181) ,合并梅毒 4例 ,占 2 2 1% ( 4/ 181) ;未发现软下疳。 79例未检出病原体 ,占 43 6 5 % ( 79/ 181)。【结论】在妇科和性病门诊中 ,女性生殖器溃疡性疾病的病因以梅毒和生殖器疱疹为主 ,其次是尖锐湿疣 ,且存在混合性感染。     

生殖器溃疡与艾滋病相关性研究进展

性传播疾病引起的生殖器溃疡与艾滋病具有密切的关系,其可相互影响、相互促进.大量的流行病学研究证实,与正常人相比,梅毒、生殖器疱疹和软下疳等以生殖器溃疡为特征的性病病人感染艾滋病的危险性更高.由于生殖器溃疡性疾病的病因复杂,因此对有生殖器溃疡表现的性传播疾病进行诊治,是一个较为复杂的问题.正确诊治有生殖器溃疡表现的性传播疾病,可直接降低艾滋病的传播风险.     

151例生殖器溃疡的病因学分析

目的了解门诊病人中生殖器溃疡发病的主要病因。方法对患者详细询问病史、药敏史和性接触史，并取生殖器溃疡分泌物进行直接涂片、细菌和真菌培养、HPV、HSV-荧光定量PCR和血清学检查（梅毒和HIV）。结果在151例门诊溃疡病人中，梅毒35例（23．17％），生殖器疱疹28例（18．54％），尖锐湿疣（CA）16例（10．59％），软下疳1例（0．66％），念珠菌7例（4．66％），细菌9例（5．96％）；其中．梅毒合并生殖器疱疹7例（4．63％），合并CA2例（1．32％），合并HIV感染者3例（1．98％）；生殖器疱疹合并CA5例（3．71％）；念珠菌感染者7例（4．64％），合并梅毒者1例（0．67％）；细菌感染者9例中合并梅毒者3例（1．98％）。73例（48．34％）未检出病原体患者中接触性皮炎和湿疹27例（17．88％）；固定型药疹24例（15．98％）；急性女阴溃疡4例（2．64％）；白塞病3例（1．98％）；坏疽性龟头炎2例（1．32％）；Reiter病2例（1．32％）；病因未明者10例（6-62％）。结论在该院皮肤科门诊中，生殖器溃疡性疾病以梅毒、生殖器疱疹、药疹和湿疹为主。其次为尖锐湿疣，且性病感染中混合感染现象常见，HIV感染呈上升趋势。     

早期梅毒误诊30例临床及病理分析

目的 :了解梅毒误诊情况及原因 ,探讨组织病理学检查在梅毒诊断中的意义。方法 :对首诊误诊的 3 0例早期梅毒进行了临床分析 ,其中 1 0例做了组织病理学检查。结果 :一期梅毒男性易误诊为软下疳、生殖器疱疹、疥疮结节等 ,女性易误诊为女阴溃疡、软下疳等 ;二期梅毒斑疹及斑丘疹鳞屑性丘疹易误诊为过敏性皮炎、玫瑰糠疹等 ;鳞屑性丘疹易误诊为银屑病 ;扁平湿疣易误诊为尖锐湿疣等。结论 :病理检查对硬下疳、扁平湿疣、鳞屑性丘疹皮疹诊断有一定意义 ,而斑疹呈非特异性改变     

生殖器溃疡患者杜克雷氏链杆菌、梅毒螺旋体及人类单纯疱疹病毒2型抗体血清学检测及其与HIV感染的关系

目的：检测女性生殖器溃疡患者血清杜克雷氏链杆菌抗体、梅毒螺旋体血清学、人类单纯疱疹病毒2型抗体，并探讨其与人类免疫缺陷病毒(HIV)感染之间的关系。方法：将102例女性生殖器溃疡患者作为研究对象。采用酶联免疫吸附法(ELISA)测定血清HIV抗体，并以蛋白印迹试验(western blot)进行确认；采用快速血浆反应试验(RPR)筛查梅毒，对螺旋体感染患者进一步进行梅毒螺旋体红细胞凝集试验(TPHA)；采用Westem blot测定人类单纯疱疹2型特异糖蛋白抗体；采用酶免法(EIA)测定抗杜克雷氏链杆菌抗体IgA及IgG。结果：杜克雷氏链杆菌IgG或／及IgA阳性共计30例(30．61％)；梅毒RPR或／及TPHA阳性51例(52．04％)；单纯疱疹2型特异糖蛋白抗体阳性17例(17．35％)。98例患者中，HIV抗体阳性47例(47．96％)。30例软下疳患者中19例HIV抗体阳性(63．33％)，51例梅毒病例中21例(41.18％)呈HIV感染，17例单纯疱疹病毒2型特异糖蛋白抗体阳性者中7例(41．18％)HIV抗体阳性；三者之间HIV抗体阳性率无显著差异，但均有易感倾向。结论：杜克雷氏链杆菌、梅素螺旋体及单纯疱疹2型感染所致的女性生殖器溃疡与HIV感染有密切联系。     

广州地区生殖器溃疡性疾病与HIV感染的相关性研究

[目的]了解性病门诊生殖器溃疡性疾病(GUD)的HIV感染状况及其与HIV感染的关系.[方法]取GUD患者溃疡处分泌物进行暗视野显微镜检查、多重聚合酶链反应,同时取上述患者和非溃疡性性传播疾病(STD)患者尿道或宫颈或阴道分泌物进行淋球菌、沙眼衣原体、支原体、单纯疱疹病毒、人类乳头瘤病毒、念珠菌、滴虫及加特纳菌等检测;检测所有STD患者血清的HIV抗体及梅毒血清学试验.[结果]在8962例病人中,就诊时生殖器有溃疡的STD与生殖器无溃疡的STD病人中HIV感染率分别为1.75%(5/285)和1.53%(133/8677),两者无统计学意义(χ2=0.09,P>0.05;OR=1.15,95%CI=0.47～2.81);梅毒、生殖器疱疹和其他STD病人的HIV感染率分别为2.81%(22/784)、0.74%(6/814)和1.49%(110/7364),梅毒病人的HIV感染率明显高于生殖器疱疹和其他STD病人的HIV感染率,有统计学意义(2.81%vs0.74%,χ2=9.92,P<0.005,OR=3.89,95%CI=1.67～9.05;2.81%vs1.49%,χ2=7.66,P<0.001,OR=1.90,95%CI=1.21～3.00).[结论]本研究提示本组GUD病人HIV感染率较国外低,梅毒与HIV感染有明显相关性;生殖器疱疹病人与HIV感染的关系尚待进一步研究.     

五种性病监测中临床诊断与实验室诊断的比对

目的:了解性病门诊疑似性病的患者病原体感染情况。方法:选取韶关地区2012年1-9月份临床诊断为五种性病(淋病、梅毒、尖锐湿疣、生殖器疱疹、衣原体)2460例患者进行了实验室诊断的比对。结果:临床诊断2460例患者中,淋病未确认率为8.24%;梅毒未确认率为12.97%;尖锐湿疣未确认率为90.30%;生殖器疱疹未确认率为67.92%;衣原体未确认率为3.47%。结论:五种性病(淋病、梅毒、尖锐湿疣、生殖器疱疹、衣原体)中未确认率从高至低为尖锐湿疣、生殖器疱疹、梅毒、淋病、衣原体。     

鲁西南地区生殖器溃疡病因学调查

近年来,以生殖器溃疡为主的疾病如硬下疳、生殖器疱疹等的发病率增长迅速[1],梅毒患者感染HIV的危险度是正常人的8. 4-8.5倍,生殖器疱疹是3.3-8.5倍[2].为了提高疾病的诊治率,我们对2007-2009年度来我院就诊以生殖器溃疡为主要特征的性病患者进行调查,现将这些患者的临床和病原学资料介绍如下.     

生殖器溃疡患者合并其他性传播疾病情况分析

对369例生殖器溃疡患者进行临床资料采集和分析,并行生殖器疱疹、梅毒、人免疫缺陷病毒(HIV)、沙眼衣原体、解脲脲原体、淋病双球菌、念珠菌等性传播疾病的病原学检测。结果确诊生殖器疱疹123例(33.3%),梅毒103例(27.9%),沙眼衣原体感染28例(7.6%),沙眼衣原体合并解脲脲原体感染8例(2.2%),淋病双球菌感染22例(6.0%),生殖器念珠菌病23例(6.2%),未发现HIV感染者。提示生殖器溃疡患者易合并其他性传播疾病。     

1990～1999年门诊性病病例分析

分析了 1990～ 1999年 10年间确诊的 84 5 8例性病患者的诊断治疗结果。提示 :1性病以非淋菌性尿道炎(NGU)、淋病 (NG)、尖锐湿疣 (CA)、梅毒 (syphilis)和生殖器疱疹 (GH)为主 ,占总数的 86 .0 7%。 2男性发病高于女性。 3非淋菌性尿道炎、梅毒发展速度较快     

中山市综合医院性病哨点监测效果分析

目的:了解中山市综合医院门诊哨点就诊者性病发生情况和感染流行趋势,为制定中山市性病预防控制规划提供依据。方法:依照《中山市性病监测工作实施方案》,通过对皮肤科、妇科、泌尿科(含男性科)门诊就诊者进行淋病、梅毒、尖锐湿疣、生殖器疱疹、生殖道沙眼衣原体感染等5种性病监测,实验室检测分别采集血、尿道/生殖道拭子样本进行梅毒及生殖器疱疹血清学、淋球菌细菌及沙眼衣原体核酸检测。结果:监测哨点门诊性病1年共发现淋病、梅毒、尖锐湿疣、生殖器疱疹、生殖道沙眼衣原体感染919例,检出率为2.9‰,未发现同患两种以上性病者。结论:综合医院监测哨点门诊就诊者性病检出率较高,存在向一般人群扩散的潜在因素,全市加强性病监测,进一步开展健康教育和行为干预。     

综合性医院性传播疾病感染情况分析

目的 了解延安地区近年来的梅毒、淋病、非淋菌性尿道炎、尖锐湿疣、生殖器疱疹的流行现状和变化特点,为该地区性传播疾病的预防和控制提供依据。方法 通过对2011-01-01～2015-12-31延安大学附属医院皮肤性病科确诊的2951例梅毒、淋病、非淋菌性尿道炎、尖锐湿疣、生殖器疱疹患者进行回顾性分析。结果 2951例梅毒、淋病、非淋菌性尿道炎、尖锐湿疣、生殖器疱疹患者中,梅毒所占比例数最高,为944例(31.99%),21～30岁年龄段所占比例最高,为1077例(36.50%),发病职业最高的人群是农民,为1735例(58.79%)。结论 延安地区梅毒、淋病、非淋菌性尿道炎、尖锐湿疣、生殖器疱疹患者均呈上升趋势,所患性病主要为梅毒,感染者主要为中青年农民和待业者,建议针对高危人群制定相应的防范措施。     

Validation of diagnostic algorithms for syndromic management of sexually transmitted diseases

Objective To validate our revised syndromic algorithms of the management of sexually transmitted diseases and determine their sensitivity,specificity,positive predictive value and cost-effectiveness.Methods Patients with either urethral discharge,vaginal discharge or genital ulcer,were selected during their first visits to three urban sexually transmitted disease clinics in Fujian Province,China,They were managed syndromically according to our revised flowcharts.The etiology of the syndromes was detected by laboratory testing.The data were analyzed using EPI INFO V6.0 software.Results A total of 736 patients were enrolled into the study.In male patients with urethral discharge,the sensitivities for gonococcal and chlamydial infections were 96.7% and 100%,respectively,using the syndromic approach.The total positive predictive value was 73%.In female patients with vaginal discharge,the sensitivity was 90.8%,specificity 46.9%,positive predictive value 50.9%,and negative predictive value 89.3% for the diagnosis of gonorrhea and/or chlamydial infection by syndromic approach.In patients with genital ulcer,the sensitivities were 78.3% and 75.8%,specificities of 83.6% and 42.9%,and positive predictive values of 60.0% and 41.0% for the diagnosis of syphilis and genital herpes, respectively,using the syndromic approach,Cost-effectiveness analysis indicated that the average cost of treatment for a patient with urethral discharge was RMB 46.03 yuan using syndromic management,in comparison with RMB 149.19 yuan by etiological management.Conclusions The syndromic management of urethral discharge was relatively effective and suited clinical application.The specificity and positive predictive value for syndromic management of vaginal discharge are not satisfactory.The revised flowchart of genital ulcer syndrome could be suitable for use in clinical settings.Further validation and revision are needed for syndromic approaches of vaginal discharge and genital ulcer.     

Seroprevalence of syphilis in patients attending a tertiary care hospital in Southern India

ObjectiveTo report our experience with two tests, anti-cardiolipin antibody test [venereal disease reasearch laboratory (VDRL) test] and specific treponemal test (Treponema pallidum hemagglutination assay), used for screening antenatal, high risk cases and cases from sexually transmitted infection in a tertiary care hospital from January 2006 till December 2008.MethodsA total of 14 639 samples received from various patient groups including antenatal cases, patients attending sexually transmitted disease (STD) clinic, blood donors and HIV positive patients were screened.ResultsAmong the 14 639 samples collected, 103 were positive by VDRL test. Of these 89 cases were confirmed by quantitative VDRL test and Treponema pallidum hemagglutination assay. The cumulative seroprevalence over two years was found to be 0.61% in this study. The syphilis seroprevalence reduced from 0.88% in 2006 to 0.40% in 2008. Among the various sub-populations studied, patients attending the sexually transmitted infection clinic showed a seroprevalence of 2.62%. The seroprevalence decreased significantly from 4.00% in 2006 to 1.39% in 2008.ConclusionsOur study showed a statistically significant declining rate of syphilis in STD clinics as well as the overall seroprevalence. These findings could be interpreted as indicators of improved programmes for prevention and management of STDs.     

Risk factors associated with human immunodeficiency virus (HIV) infection among attendees of public sexually transmitted infection clinics in Hong Kong: implications for HIV prevention

OBJECTIVE. To examine the risk factors for human immunodeficiency virus (HIV) transmission among attendees of public sexually transmitted infection clinics in Hong Kong. DESIGN. Retrospective matched case-control study. SETTING. All public sexually transmitted infection clinics in Hong Kong. PATIENTS. All public sexually transmitted infection clinic attendees' records from January 1995 to December 2002 were reviewed. MAIN OUTCOME MEASURES. HIV sero-positivity in corresponding clinic attendees. RESULTS. A total of 196 HIV-positive cases among 149 336 sexually transmitted infection clinic attendees were recruited into the study. Multivariate analysis using conditional logistic regression revealed that HIV infection was associated with the following factors: belonging to non-Chinese ethnic groups (mainly South-East Asian) [odds ratio=9.32; 95% confidence interval, 3.27-26.55], coexisting syphilis (other than primary) [5.67; 1.66-19.36], current non-gonococcal urethritis (2.10; 1.08-4.07), current genital warts (1.94; 1.10-3.43), history of prior sexually transmitted infection (2.19; 1.29-3.72), having casual sex with friends (2.89; 1.07-7.80), and casual sex in Mainland China (1.91; 1.04-3.49). Sexual orientation was also considered to be a potential risk factor, as only those who tested positive reported to be homosexual or bisexual. CONCLUSION. Sexually transmitted disease patients represent an identifiable group who are at high risk of HIV infection. This study found that there were certain factors which increased the risk of HIV infection among patients attending public sexually transmitted infection clinics. Targeted interventions should therefore be offered to such high-risk individuals, so as to prevent and control HIV transmission.     

保定市225名暗娼性传播疾病感染情况调查

目的了解保定市中低档娱乐场所暗娼性传播疾病感染状况,为针对暗娼开展干预工作提供科学依据。方法随机抽取62家中低档娱乐场所225名暗娼进行一对一匿名从业基本情况、高危性行为信息和是否接受过干预服务等问卷调查,并采血进行HIV和梅毒抗体的检测,同时采集宫颈分泌物进行相关性病病原体检测。结果接受检查的225名暗娼中,有90名至少感染一种性病病原体,检出率为40.00%,HIV未检出。在国家要求监测的5种性病中,本文均进行了调查,其感染率分别为：淋病7.56%、梅毒3.56%、生殖道沙眼衣原体感染18.67%、尖锐湿疣11.56%、生殖器疱疹0.00%。结论中低档场所的暗娼性传播疾病感染严重。对暗娼进行有针对性的健康教育及性病等相关知识宣传、干预是有效遏制性病艾滋病在该人群中传播的根本措施。     

A microbiological study of genital ulcers in Kuala Lumpur.

The microbial aetiology of genital ulcers was studied in 249 patients (241 men and 8 women) attending a Sexually Transmitted Disease Clinic in Kuala Lumpur, Malaysia. Herpes simplex virus type 2 was isolated in 48 (19.2%) patients, Haemophilus ducreyi from 22 (8.8%), Neisseria gonorrhoeae from seven (2.8%) and Chlamydia trachomatis from four (1.6%). Syphilis was diagnosed in 18 (7.2%) patients on the basis of dark field microscopy. Two (0.8%) patients were found to have both chancroid and syphilis and one (0.5%) had both gonorrhoea and syphilis. No organism was isolated in the remaining 151 (61.5%) patients. Overall, the accuracy of clinical diagnosis was 58% for single infection, 67% for herpes, 63% for syphilis, 47% for chancroid and 0% for lymphogranuloma venereum. Therefore, our study confirms the need for laboratory tests to diagnose accurately the aetiology of genital ulcer disease.     

性传播疾病160例临床分析

本文分析了我科门诊于1988年1月～12月间160例性传播疾病(STD)的临床资料.发病率占同期门诊患者的0.64％,男103例,女57例;年龄分布2～57岁,其中21～30岁者占56.88％.全组中从事流动职业者占70％.多数病例通过性行为引起直接传播,也有少数病例通过间接接触而传播.病种有尖锐湿疣78例,阴虱53例,淋病22例,生殖器庖疹6例,生殖器疱疹6例,梅毒1例.作者强调做为社会问题引起有关部门的高度重视,采取有效防治措施以控制性传播疾病的流行和蔓延.     

A study on the comparison between clinical and microbiological diagnoses of sexually transmitted diseases

The efficacy of microbiological diagnosis in sexually transmitted diseases (STDs) has been evaluated in comparison with the clinical diagnosis. Amongst the clinical diagnoses of single STDs, syphilis, genital warts, gonorrhoea and herpes genitalis were the predominant ones. Syphilis was the most predominant infection in both the single and mixed STD infections in Chennai. Clinical diagnoses of trichomoniasis, genital chlamydiasis and genital herpes were more accurate and correlated well with laboratory investigations. On the other hand, clinical diagnoses of gonorrhoea, candidiasis and syphilis were less accurate. More over many of these cases, clinically diagnosed as single, infection, were also positive for other STDs in the laboratory investigations. Double infections were clinically diagnosed only in 7 cases as against 11 cases in microbiological tests and one triple infection diagnosed in microbiological tests was diagnosed only as single disease clinically. Therefore, the laboratory/microbiological investigations have been emphasised to have better accuracy of diagnosis of STDs.