Endocervical chlamydial infection in female contacts of patients with nongonococcal urethritis

Eighty-five female contacts of patients with nongonococcal urethritis attending Middle Road Hospital were examined. Chlamydia trachomatis was isolated from the cervix in 39% of them. Forty-five per cent of the chlamydia-positive patients were asymptomatic and 79% of them showed signs of a cervicitis. None of the patients developed complications. Neisseria gonorrhoeae was not isolated from any of the patients. Clinical markers other than cervicitis are not useful for detecting chlamydial infections in female contacts of NGU. Until such time when cheaper, more convenient and accurate methods of laboratory diagnosis of C. trachomatis are put to routine use, it would seem prudent to treat all female contacts of NGU patients after exclusion of other sexually transmitted diseases.     

汕头地区性病门诊患者泌尿生殖道沙眼衣原体感染状况分析

目的了解汕头地区性病门诊患者泌尿生殖道沙眼衣原体的感染情况。方法对在我院性病门诊就诊的2000例患者泌尿生殖道标本进行沙眼衣原体核酸检测（PCR-荧光探针法）,并对检测结果进行分析。结果2000例患者中检出沙眼衣原体阳性308例,阳性率为15．4％。308例泌尿生殖道沙眼衣原体感染患者中男性占69．2％（213例）,女性占30．8％（95例）,男女两组感染率相比具有显著的统计学差异（P〈0．05）,各年龄段沙眼衣原体以30-39岁年龄段感染率最高,为37．9％,其次为20-29岁、40-49岁年龄段,分别占29．2％和21．8％。沙眼衣原体阳性患者职业分布以工人、商业职业组所占的比例最高,分别为38．6％和34．4％。不同临床诊断就诊患者都有一定比例的沙眼衣原体检出率,其中以淋菌性尿道炎就诊患者检出率最高,为47．6％,健康体检组衣原体感染者占15．6％（193例）。结论性病门诊患者为泌尿生殖道沙眼衣原体感染高危人群,临床应保持高度的关注,不能只凭临床经验,应重视沙眼衣原体的实验室检测及对无症状人群的筛查。     

Association of genital adenovirus infection with urethritis in men

Adenoviruses were isolated from the urethral swabs of 129 male patients in an STD clinic. After exclusion of patients with Chlamydia trachomatis or Neisseria gonorrhoea infections, 85 of the remaining 120 patients had urethritis, compared with 28 men with urethritis detected in a control group which was closely matched for age, sex, and date of specimen collection. This statistically significant difference suggests that genital adenovirus infection may be a cause of urethritis in some male patients.     

The prevalence of Chlamydia trachomatis in a young, sexually-active population

A prospective study was carried out to determine the prevalence of Chlamydia trachomatis among 1000 sexually-active women at the Family Planning Association Clinic in Melbourne. This organism was isolated from the cervices of 5.1% of screened women. The women were surveyed about their sexual and gynaecological history, and symptoms of discharge or pain. It was found that women who gave positive results for the presence of Chlamydia were younger, and had commenced intercourse at an earlier age. Risk factors of multiple sexual partners, cervical ectopy and symptoms of urethritis were identified. We recommend that women who have more than one sexual partner should ask their partners to use condoms or, failing this, undergo annual screening for Chlamydia by immunofluorescent staining.     

Chlamydia trachomatis infection in women with ectopic pregnancy

Chlamydia trachomatis infection, presumably sexually transmitted, has been implicated in the spread of tubal infertility and ectopic pregnancy. In searching evidence of Chlamydia trachomatis infection as a possible cause of tubal ectopic pregnancy, we enrolled 40 consecutive pathologically proven tubal ectopic women and 37 normal early intrauterine pregnant women from our OPD and ward from Jan. 1989 to July 1989. All cases underwent a structured interview giving particular attention to past reproductive history, contraception history and past history of STD. The levels of serum antibody IgG to Chlamydia trachomatis in all cases were determined. Seven ectopic women with wearing IUD in situ (group A) and 33 ectopic women with no identical factor (group B) were compared with 37 normal early intrauterine pregnant women (control group). The result showed group B more often had IgG antibody to Chlamydia trachomatis than control group (P = 0.001). Group A had higher antibody to Chlamydia trachomatis than control group but the difference was not statistically significant (P greater than 0.05). We concluded that the above findings add to the evidence that Chlamydia trachomatis infection is a major cause of tubal ectopic pregnancy.     

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。     

Urinary leukocyte esterase screening test for asymptomatic chlamydial and gonococcal infections in males

We evaluated the ability of the urinary leukocyte esterase test to predict culture-verified chlamydial and gonococcal urethritis among asymptomatic adolescent males. Nine hundred forty-eight sexually active males provided first-catch urine samples for esterase screening, and 76 (8%) tested positive (greater than or equal to 1+). Among 435 boys who agreed to undergo urethral culture, the esterase was positive in 66 (15%), Chlamydia trachomatis was isolated from 39 (9%), and Neisseria gonorrhoeae was isolated from 14 (3%). The sensitivity, specificity, and positive and negative predictive values for the esterase test were 72%, 93%, and 58% and 96%, respectively. Using the esterase test to screen asymptomatic males for urethritis, we identified 38 culture-verified infections that otherwise would have remained undetected. The urinary leukocyte esterase test is a noninvasive and cost-effective screening method to detect urethritis among asymptomatic adolescent males.     

Dipstick leukocyte esterase activity in first-catch urine specimens. A useful screening test for detecting sexually transmitted disease in the adolescent male

Although sexually active female adolescents are often routinely screened for sexually transmitted diseases, indications for culturing adolescent males for sexually transmitted urethral infections are controversial. A study of 54 sexually active males (14 to 22 years old) was undertaken to assess the reliability of using dipstick leukocyte esterase activity in first-catch urine specimens to detect urethritis caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Eighteen males had sexually transmitted diseases: N gonorrhoeae (nine patients), C trachomatis (eight patients), and N gonorrhoeae and C trachomatis (one patient). First-catch urine specimens with a 1+ (mild) or 2+ (moderate) reaction on dipstick testing had a leukocyte (WBC) count of 10 WBCs per high-power field or greater on microscopic analysis, with an 83% sensitivity, 100% specificity, a 100% positive predictive value, and a 92% negative predictive value for the presence of N gonorrhoeae, C trachomatis, or both. Clinical criteria for screening (urethral discharge, dysuria, or exposure to a sexually transmitted infection) plus a dipstick-positive first-catch urine specimen had a 94% sensitivity, 89% specificity, an 81% positive predictive value, and a 97% negative predictive value.     

Urethritis in men at the Genito-Urinary Medicine Clinic Kuala Lumpur Hospital

The clinical features and aetiology of 100 consecutive symptomatic heterosexual male patients with urethritis were studied from March 1994 to August 1994 in the Genito-Urinary Medicine (GUM) Clinic, Kuala Lumpur Hospital. Gonococcal urethritis (GU) was found to be more common (53%) than non-gonococcal urethritis(47%). All patients with GU confirmed microbiologically had clinically evident urethral discharge. Almost half (41%) of the patients with GU developed post-gonococcal urethritis (PGU). The most common organism isolated in PGU was Ureaplasma urealyticum (37%) whilst only 4% had both Chlamydia trachomatis and Ureaplasma urealyticum. Of the 47% of patients with non-gonococcal urethritis (NGU), 50% had no microorganism isolated, 32% had Ureaplasma urealyticum, 7% Chlamydia trachomatis and 11% both Chlamydia trachomatis and Ureaplasma urealyticum.     

SEXUALLY TRANSMITTED DISEASES： INCIDENCE AND DISTRIBUTION

The incidence of sexually transmitted diseases(STDs) increased from 26. 04 per 10000O in 1987 to 104. 81 per 100 000 in 1993 in selected areas of the country. Gonorrhea is by far the most common STD but its constituent ratio declined because of a rapid increase of nongonococcal uretheritis and genital warts during most recent years. The incidence of syphilis is relatively low and cases of congenital infection are noted. The wide spread of resistant Neisseria gonorrhaeae infection gives a challenge to the therapeutical and control strategies of STDs. Sexually transmitted Chlamydia trachomatis infections, an important cause of urethritis, cervicitis and pelvic inflammatory disease, is becoming common in uur country. Attention has been drawn on viral hepatitis in their means of transmission by sexually behaviors, and also, on the homosexuals, assumed to be the high risk group to catch STDs. Coordinated national efforts to control STDs in China have been taken.     

Seroepidemiology of Chlamydia trachomatis infection in infertile women in Melbourne

A serological study was undertaken to determine the prevalence of antibody to Chlamydia trachomatis in women and to investigate any possible role of the organism in infertility and pelvic inflammatory disease. Thirty-seven per cent of pregnant women were found to have antibodies to Chl. trachomatis, as were 69% of women with pelvic inflammatory disease. Eighty-five per cent of women who were infertile due to inflammatory tubal damage and 78% who were infertile secondary to ectopic pregnancy had antibody as compared with 56% of women who were infertile for other reasons. Sperm bank donors and children showed low prevalences (16% and 3%, respectively). Exposure to Chl. trachomatis is widespread in sexually active women and appears to have a role in pelvic inflammatory disease and infertility that is due to inflammatory tubal disease.     

Predictors of chlamydial infection and gonorrhea among patients seen by private practitioners.

OBJECTIVE: To identify the predictors of chlamydial infection and gonorrhea among patients tested by general practitioners. DESIGN: Prospective study. SETTING: General private practice, family planning and abortion clinic, adolescent clinic, sexually transmitted disease (STD) clinic and community health clinic in downtown Montreal. PATIENTS: The 2856 patients were included because of symptoms compatible with an STD, a history of sexual contact with a person known or suspected to have chlamydial infection, a history of a nonexclusive sexual relationship or presentation for an abortion. MEASURES: Patient information was obtained by the attending physician on a standard form. Enzyme immunoassay (EIA) for Chlamydia trachomatis and culture for Neisseria gonorrhoeae were performed on cervical (female) or urethral (male) samples. Stepwise logistic regression was used to identify the predictors of infection. RESULTS: The EIA results were positive in 11.1% of the cases and the culture results in 2.3%. Among the males chlamydial infection was independently associated with low age (odds ratio [OR] = 0.88 per year), heterosexuality (OR = 4.99), urethral discharge (OR = 3.74) and the absence of a history of gonorrhea (OR = 0.51). Gonorrhea was associated with urethral discharge (OR = 24.3) and homosexuality (OR = 3.68). Among the females chlamydial infection was associated with low age (OR = 0.79 per year), a history of sexual contact with a person known to have chlamydial infection (OR = 2.30), multiple sexual partners in the previous 12 months (OR = 1.60) and a reason for the test other than screening purposes (OR = 0.60). Gonorrhea was associated with a reason other than screening (OR = 0.24) and low age (OR = 0.74 per year). Among the patients tested for screening purposes age was the only significant predictor of chlamydial infection (OR = 0.79 per year), and the prevalence of gonorrhea was 0.4%. The actual rate of chlamydial infection was 11.8% among the patients younger than 25 years, 5.7% among those 25 to 34 years and 0.6% among those over 34. CONCLUSIONS: Age alone can be used as a criterion to screen for chlamydial infection among asymptomatic patients without a history of sexual contact with a person known or suspected to have such infection and with a history of a nonexclusive relationship. The prevalence in our population justifies screening people up to 34 years of age.     

PCR检测性病高危人群中淋球菌、沙眼衣原体、解脲支原体感染情况

用聚合酶链式反应（ＰＣＲ）技术对门诊１１１例性病患者泌尿生殖道淋球菌（ＮＧ）、沙眼衣原体（ＣＴ）、解脲支原体（ＵＵ）感染进行了检测。发现泌尿生殖道ＮＧ感染４７例。ＣＴ感染３５例、解脲支原体（ＵＵ）感染１４例，阳性率分别为４２．３４％、３１．５３％和１２．６１％；ＰＣＲ阳性者共７４例（６６．６７％）；其中二项阳性２０例、三项阳性１例，共占２８．３８％（２１／７４）；三项均阴性３７例（３３．３３％）。结果提示武汉市性病高危人群ＣＴ、ＵＵ感染率较高，二者之和已超过淋病；且混合感染在性传播疾病（ＳＴＤ）患者中也常见。     

非淋菌性尿道炎患者衣原体和支原体的感染状况分析

目的 探讨非淋菌性尿道炎(NGU)患者沙眼衣原体(CT)和解脲支原体(Uu)的感染状况.方法 CT检测采用快速免疫测定法,Uu采用病原体培养法.结果 640例NGU患者CT阳性率为34.15%,Uu 40.85%,二者混合感染率23.44%.男、女性患者CT、Uu检出率差异均有统计学意义(P＜0.05),其中CT感染为男性高于女性,Uu为女性高于男性(P＜0.01).对照组CT检出率3.75%,Uu培养结果均为阴性.结论 NGU患者CT和Uu的感染率较高,对NGU患者应同时检测CT和Uu,将有助于该病的及时防治.     

UU/CT在不同人群女性下生殖道中的检测分析

目的了解在解脲脲原体(UU)和沙眼衣原体(CT)女性下生殖道感染的患者中的感染状况,为临床正确诊断和治疗提供依据。方法对601例拟诊为下生殖道感染的女性患者和306例正常体检的女性进行临床检查,阴道分泌物的pH值检测,假丝酵母菌、滴虫检测,胺试验和线索细胞检查,同时采用荧光定量PCR测定解脲脲原体、淋球菌、沙眼衣原体。结果在601例女性下生殖道感染的患者中,解脲脲原体阳性421例(70.1%),沙眼衣原体感染153例(25.5%),均较对照组(分别为41.2%和7.2%)明显升高,P均<0.05。此外,UU以单独感染的状态为主,也可与其它病原体呈混合感染状态;而CT以混合感染为主。结论解脲脲原体、沙眼衣原体可能是当前女性下生殖道感染的主要致病微生物,有必要进行常规的检查,以便正确使用有效的药物治疗。     

Criteria for selective screening for Chlamydia trachomatis infection in women attending family planning clinics

Clinical and epidemiologic factors associated with Chlamydia trachomatis infection were examined in women attending two family planning clinics in order to develop criteria for selective screening. Chlamydia trachomatis was isolated from the cervix of 98 (9.3%) of 1,059 women. Five demographic, behavioral, and clinical characteristics were independently predictive of chlamydial infection by stepwise multivariate logistic-regression analysis: aged 24 years or less, intercourse with a new partner within the preceding two months, examination results showing purulent or mucopurulent cervical exudate, bleeding induced by swabbing the endocervical mucosa, and use of no contraception or a nonbarrier method. A screening program that tested women with two or more of these risk factors (65% of the total) would encompass all who had a 4.7% or greater predicted risk of chlamydial infection and would detect 90% of all infections. Selective screening of sexually active women for chlamydial infection is advocated as a necessary and cost-effective public health measure.     

实时荧光PCR在男性性病尿道炎及男性尿道炎后综合征的应用评价

目的探讨实时荧光PCR技术检测男性性病尿道炎及男性尿道炎后综合征（MPUS）患者的病原体的临床价值。方法用实时荧光PCR法对718例男性性病尿道炎及MPUS患者尿道分泌物或前列腺液同时作淋球菌（NG）、沙眼衣原体（Ct）、解脲支原体（UU）检测。结果52．2％的淋病患者并发Ct、UU感染。非淋菌性尿道炎（NGU）患者Ct、UU阳性率68．2％,Ct阳性率31．1％、UU阳性率42．6％,5．4％患者Ct、UU合并感染。MPUS患者NG、Ct、UU阳性率仅为10．2％。结论实时荧光PCR技术灵敏度高,特异性强,对男性性病尿道炎及MPUS的诊断和治疗具有重要的指导意义。     

非淋菌性尿道炎解脲支原体及沙眼衣原体检测

目的 :探讨非淋菌性尿道炎的病因并指导临床治疗。方法 :解脲支原体采用培养法 ,沙眼衣原体采用酶联免疫吸附测定法。结果 :64例非淋菌性尿道炎中沙眼衣原体、解脲支原体感染率分别为 30 .8% ( 2 0 /65)和 2 1.5% ( 14/ 65) ,二者混合感染率为 6.1% ( 4 / 65)。结论 :沙眼衣原体和解脲支原体感染是非淋菌性尿道炎主要病因     

湖南省衡阳地区STD患者病原体检测

目的 了解衡阳地区性传播疾病(STD)患者病原体感染情况。方法 对2420例可疑STD患者进行检测：淋病奈瑟菌(NG)、解脲脲原体(UU)、人型支原体(MH)采用培养法；沙眼衣原体(CT)、人乳头瘤病毒(HPV)、单纯疱疹病毒(HSV)核酸采用聚合酶链反应(PCR)法；梅毒螺旋体(TP)采用快速血浆反应素环状卡片试验(RPR)和TP-PA法。结果 STD病原体阳性检出率为38．1％(922／2420)。在922例中UU占29．6％，CT20．8％，HPV17．8％，NG17．4％，MH6．3％，HSV4．2％，TP3．9％。结论 衡阳地区STD患者中UU感染率最高，CT和HPV次之，TP感染率最低。     

Chlamydia trachomatis cervical infection: prevalence and determinants among women presenting for routine gynecologic examination.

OBJECTIVE: To determine the prevalence of and risk indicators for Chlamydia trachomatis cervical infection among women presenting for a periodic medical examination. DESIGN: Prevalence study. SETTING: Centre local de services communautaires (CLSC) Saint-Louis du Parc, Montreal. PATIENTS: All women presenting for a routine gynecologic examination from May 1985 to July 1986. Of the 773 (99%) who agreed to participate 56 were excluded because of inadequate diagnostic tests (34), antibiotic intake in the preceding 6 weeks (19) or loss to follow-up after the initial visit (3). OUTCOME MEASURES: Culture was the diagnostic standard, but rapid diagnostic tests were also used. From the identified cases logistic regression analysis was used to evaluate the following risk indicators: age, place of residence, use of oral contraceptives, sexual partners and frequency, history of sexually transmitted disease (STD) and abnormalities found on genital examination. MAIN RESULTS: Fifty-one of the women were found to have C. trachomatis infection, for a prevalence rate of 7.1%; 32 (63%) were completely asymptomatic. Three independent indicators were found: age of 25 years or less (odds ratio [OR] 3.2, 95% confidence limits [CL] 1.8 and 5.9), cervical erythema, contact bleeding or mucopurulent exudate (OR 2.5, 95% CL 1.4 and 4.5) and residency in the CLSC area (OR 2.3, 95% CL 1.1 and 5.1). A history of STD or vaginitis had a significant protective effect in women 30 years of age or more (OR 0.2). CONCLUSIONS: Case-finding for chlamydial infection could be an effective public health measure among women 25 years of age or less and among those with signs of cervicitis when they present for a Papanicolaou test.