不孕症女性患者就诊行为分析

本文对上千例不孕症女性患者的就诊行为进行了调查,发现就诊者具有患不孕症年限较长、文化程度较高的特点,并分析了其就诊的信息来源问题.针对患者就诊行为的特殊性,本文提出了一些辅助治疗的积极途径.     

女性不孕患者的心理干预疗法

女性生殖系统的功能主要受神经内分泌系统调控，心理因素可以影响神经内分泌系统和生殖系统的正常运行。我们在积极治疗女性不孕疾病的同时，一定要关注不孕女性在就诊、检查和治疗各个时期的心理变化，及时进行心理干预治疗，以增强对不孕女性患者临床治疗效果。     

STD门诊1076例就诊者情况调查

目的　分析STD门诊就诊者的一般人口学特征、病程、传染来源及STD病史 ,研究就诊人群的STD的流行病学特征。方法　征得同意后 ,与 10 76例STD门诊就诊者进行面对面交谈 ,完成调查表 ,调查表包括就诊者的人口学资料、临床资料及STD病史等。用 χ2 检验分析男女就诊者在上述资料中的差异。结果　男女就诊者在年龄、受教育情况及收入方面有明显差异 ,在低年龄组 ,女性比例较高 ,而在高年龄组 ,情况相反 ;男性在受教育情况及收入方面好于女性。同女性相比 ,男性更可能早期就诊。男性多为临时性伴传染 ( 64 .1% ) ,而女性多为固定性伴或配偶传染 ( 5 4.9% )。结论　应加强干预促使病人及早就诊 ;对就诊病人及其它人群 ,尤其是男性人群进行健康教育 ,宣传安全性行为 ,推广应用避孕套。     

女性不孕症患者生殖免疫抗体检测结果分析

目的:分析女性不孕症患者生殖免疫抗体检测情况,为不孕患者的诊疗方案提供参考。方法:选取在我院不孕不育科和妇产科就诊的不孕女性患者2856例,采用酶联免疫吸附法(ELISA)检测各项生殖免疫抗体指标。结果:原发不孕组共442例(32.74%)患者生殖免疫抗体阳性,继发不孕组共594例(39.44%)患者生殖免疫抗体阳性。继发不孕患者生殖免疫抗体阳性率明显高于原发不孕组(P<0.05)。两组生殖免疫抗体阳性患者中,以单抗体阳性为主(71.95%vs.72.39%)。两组抗体分布统计学检验无显著差异(P>0.05)。结论:生殖免疫抗体阳性是影响不孕的原因之一,其中以单阳性抗体为主,且继发不孕患者阳性率高于原发不孕。     

性病就诊者艾滋病和梅毒检测意愿及其影响因素分析

目的:探讨性病就诊者艾滋病(acquired immunodeficiency syndrome,AIDS)和梅毒(syphilis)检测意愿及其影响因素。方法:随机选择2015年1月至2016年12月重庆市某地区4家性病门诊部就诊的550例性病患者为研究对象,采用中国疾病预防控制中心的《门诊HIV、梅毒检测个案登记表》,对其艾滋病抗体、梅毒检测意愿开展横断面调查,对就诊者检测意愿差异进行比较分析。结果:在咨询之前,研究对象中69. 6%的患者有检测艾滋病抗体的意愿,68. 6%的患者有检测梅毒的意愿;在医务人员提供咨询服务后,检测意愿都有了一定提高,分别达到72. 2%和70. 2%。检测结果显示,397例接受艾滋病抗体的患者中,有2例检出艾滋病抗体阳性,占比0. 5%; 386例接受梅毒检测的患者中,有58例检出梅毒,占比15. 0%。通过多因素回归分析可知,男性、就诊科室为妇产科、复诊是影响患者检测艾滋病抗体意愿的主要因素;就诊科室为妇产科、复诊、高危行为是影响患者检测梅毒意愿的主要因素。结论:在性病就诊者中,女性、妇产科就诊患者、复诊等因素,会降低患者检测艾滋病抗体的意愿,而妇产科就诊患者、复诊、高危行为会降低患者检测梅毒的意愿。在具体实践中,应当对性病就诊者实施艾滋病、梅毒检测促进工作,以提高艾滋病、梅毒潜伏期感染者的发现率,推动HIV抗体感染、梅毒防治工作的可持续开展。     

生殖道支原体属及衣原体属感染对女性不孕及性功能的影响分析

目的:检测分析生殖道支原体属及衣原体属感染对女性不孕及性功能的影响。方法:选取自2014年10月至2016年10月间在我院就诊的女性不孕不育患者140例为研究对象。检测所有研究对象的宫颈分泌物支原体属、衣原体属感染情况,并调查统计所有研究对象的性功能情况,分析支原体属、衣原体属感染情况与不孕及性功能障碍的关系。结果:对照组、原发性不孕组、继发性不孕组研究对象支原体感染、衣原体感染及混合感染情况相比较差异均具有统计学意义(P0.05),不孕与性功能障碍呈现相关性,支原体属及衣原体属感染与性功能障碍呈现相关性(P0.05)。结论:女性生殖道支原体属及衣原体属感染与不孕及性功能障碍均呈现出密切的相关性。     

社区卫生服务中心与性病专科医院阴道分泌物异常就诊者求医行为比较

目的:比较社区卫生服务中心和性病专科医院的阴道分泌物异常就诊者求医行为和首诊选择医疗机构的原因。方法:选择2005年5~11月山东省济南市清河社区卫生服务中心妇产科门诊和2005年7~9月山东省皮肤病性病防治研究所性病门诊初次就诊的阴道分泌物异常就诊者。采用半封闭式问卷。问卷内容包括人口学特征、STD/HIV知识和求医行为、既往性病和性行为史、安全套使用等。结果:阴道分泌物异常就诊者首次求医时间平均为14.20天,53.5%在7天内。社区门诊就诊者7天内首诊的比例高于性病专科(66.4%,40.4%,P<0.001)。21.1%社区门诊和49.0%性病专科就诊者本次就诊前曾求诊于其它医疗机构。对就诊医疗机构的信任是首诊求医的最主要原因。结论:在社区内应宣传生理健康相关知识和提高妇女对症状的认识水平,提高性病医疗机构的服务质量有助于促进有症状患者早求医。     

性生活与不孕不育症

WHO预测不孕不育症将被列入21世纪人类三大疾病（心脑血管、肿瘤、不孕不育症）之一^[1]。不孕不育症人群在逐渐加大的同时，年龄也趋向年轻化。在众多导致不孕不育的病因中，不可忽视的一点因素就是性生活。正是由于不良性生活现象的存在，导致不孕不育症的发生。因此，在治疗不孕不育症的同时，应该对不孕不育症夫妇进行有效的心理疏导、生育知识的普及和性医学方面的治疗，这样可以大大提高不孕不育症的治愈率^[2]。     

中西医结合诊疗不孕不育症的探讨

不孕不育症是临床上的常见病、多发病,本文系统地探讨了中西医结合诊断和治疗不孕不育症的方法。     

宫腔镜治疗宫腔疾病所致女性不孕患者临床研究

目的:探讨宫腔镜治疗宫腔疾病所致女性不孕患者的临床疗效。方法:将2014年3月至2016年3月我院收治的90例宫腔疾病所致女性不孕患者随机分为观察组和对照组,对照组采用腹腔镜治疗,观察组采用宫腔镜治疗,比较两组临床指标、治疗前后性激素水平及妊娠结局。结果:观察组手术时间、术中出血量、住院天数均显著少于对照组,差异比较有统计学意义(P<0.05);两组治疗前后LH、FSH、E_2、P水平无显著性变化,且观察组治疗后上述指标水平较对照组治疗后差异无统计学意义(P>0.05);观察组早产率明显低于对照组,足月分娩率高于对照组,差异有统计学意义(P<0.05)。结论:宫腔镜治疗宫腔疾病所致女性不孕患者有助于改善患者妊娠结局,促进病情康复,且不影响卵巢功能,可在临床上推广。     

Lower genital tract infections in infertile Nigerian women compared with controls.

OBJECTIVE--To investigate the possibility that infertile Nigerian women have a higher rate of cervical colonisation with pathogenic and facultative organisms than fertile controls. DESIGN--The prevalence of common microorganisms in the vagina and endocervical canals of infertile women was compared with that of pregnant controls. SETTING--The Obafemi Awolowo University Hospital Maternity Centre. SUBJECTS--92 infertile women were compared with 86 pregnant controls. MAIN OUTCOME MEASURES--rates of isolation of Neisseria gonorrhoeae, Candida albicans, Trichomonas vaginalis and other facultative organisms in cases and controls. RESULTS--The rate of isolation of Neisseria gonorrheae was 17.4% among infertile women compared with 10.5% in the group of pregnant women (p > 0.05). There was no significant difference between the groups in the rate of isolation of Candida albicans, Trichomonas vaginalis and other facultative organisms. High rates of isolation of microorganisms were observed in both groups. However, women with secondary infertility had higher rate of carriage of Neisseria gonorrheae, Candida albicans and Staphylococcus aureus as compared with women with primary infertility. Nearly 15% of infertile women had previous episodes of pelvic inflammatory disease and 26% had had induced abortions. A positive history of vaginal discharge was a poor predictor of vagina and endocervical carriage of microorganisms. CONCLUSIONS--High rates of pathogenic organisms exist in the lower genital tract of infertile women and controls. Women with secondary infertility are more likely to have pathogenic organisms than women with primary infertility. A policy of routinely screening women for lower genital tract infections should be pursued in this population because of the high rate of infection.     

Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results.

From 1960 10 1984, 2,501 women underwent diagnostic laparoscopy (index laparoscopy) because of a clinical suspicion of acute pelvic inflammatory disease (PID). Of these women, 1,844 had abnormal laparoscopic findings (patients) and 657 had normal findings (control subjects). The reproductive events after index laparoscopy of 1,732 patients and 601 control subjects were followed. The patients and control subjects were followed for a total of 13,400 and 3,958 woman-years, respectively. During the follow-up period, 1,309 (75.6%) of the patients and 451 (75.0%) of the control subjects attempted to conceive. Of these women, 209 (16.0%) of the patients and 12 (2.7%) of the control subjects failed to conceive. A total of 141 (10.8%) of the patients and 0 (0%) of the control subjects had confirmed tubal factor infertility, 21 (1.6%) of the patients and 3 (0.7%) control subjects had other causes of infertility, and 47 (3.6%) patients and 9 (2.0%) control subjects did not have a complete infertility evaluation. Additional information on tubal morphology (hysterosalpingography, laparoscopy, or laparotomy) in women from couples for whom evaluation was incomplete indicated that 165 (12.2%) patients and 4 (0.9%) of the control subjects had abnormal tubal function or morphology after index laparoscopy. Tubal factor infertility after PID was associated with number and severity of PID episodes. The ectopic pregnancy rate for first pregnancy after index laparoscopy was 9.1% among the patients and 1.4% among control subjects.     

Sexually transmitted diseases and tubal infertility

To evaluate the association of genital herpes, genital warts, gonorrhea, and trichomoniasis with the occurrence of subsequent tubal infertility, 321 women who had tubal infertility were interviewed concerning their history of these sexually transmitted diseases (STD). The responses were compared to those of women who conceived children during the period the infertile women began trying to become pregnant. By a multivariate analysis, the comparisons were controlled for several confounding variables (e.g., use of an intrauterine device, cigarette smoking, number of prior pregnancies, number of sexual partners, and a history of the other STD). The risk of tubal infertility in women who reported at least one episode of gonorrhea after their last pregnancy, relative to that among other women, was 2.8 (95% confidence interval = 1.3-5.7). The relative risk of tubal infertility was also higher among women who reported a history of trichomoniasis (relative risk = 1.4; 95% confidence interval = 1.0-2.5) or genital warts (relative risk = 1.9; 95% confidence interval = 1.0-3.6).     

Design of a community-based study of sexually transmitted infections/HIV and infertility in an urban area of northern Tanzania

OBJECTIVE: The objective of this study was to describe the design of a community-based study of sexually transmitted infections (STIs)/HIV and infertility in northern Tanzania. STUDY DESIGN: Households were selected using a 2-stage sampling design. Eligible women and their partners were interviewed before samples were collected for STIs/HIV detection. Posttest counseling and treatment for STIs and infertility were provided. RESULTS: A total of 2019 women and 794 male partners were interviewed. Over 70% of interviewed women and men provided blood and urine samples. Individuals providing blood and urine samples had high-risk profiles for STIs/HIV when compared with others who did not provide these samples. Although the study results may be affected by selection bias, risk factors for STIs/HIV were similar to those in other studies supporting the generalizability of the findings. CONCLUSIONS: It is feasible to conduct a community-based survey, including collection of biomarkers and measurement of infertility, in this urban setting.     

Detection of the gonococcal antigen with an enzyme immunoassay (Gonozyme). Results of the original and modified test procedure

Urogenital specimens of 2,485 patients were examined by an enzymeimmunoassay for the detection of Neisseria gonorrhoeae antigen (Gonozyme, Abbott). The results of the original test (Gonozyme A) and a modified version (Gonozyme B) were compared to bacterial culture. Three different groups were examined by Gonozyme A: 526 men and 464 women from the clinic for sexually transmitted diseases (STD) and 548 registered prostitutes. Sensitivity in men was 98%, in women from the STD clinic 89%, and in prostitutes 81%. Specificity in men was 99.5%, in women from the STD clinic 94%, and in prostitutes 88%. One of the reasons for the decreased specificity in women could be cross reacting bacteria from the genital secretions of the women. The assay was modified by optimizing the antigonococcal antibody and increased incubation times. These modifications improved the specificity of Gonozyme B by reducing the number of cross reactions with other bacterial antigens. Four different groups were examined by Gonozyme B: 261 men and 220 women from the STD clinic, 121 women from an infertility clinic, and 345 registered prostitutes. Sensitivity in men was 100%, in women from the infertility clinic 100%, in women from the STD clinic 94%, and in prostitutes 77%. Specificity in men was 99%, in women from the infertility clinic 100%, in women from the STD clinic 99%, and in prostitutes 96.5%. Analysis of the Gonozyme-positive/culture-negative test results suggested that most patients (85%) did not have gonorrhoea. In 15% of these specimens it is possible that patients had pretreated gonorrhoea which was only detected by Gonozyme.(ABSTRACT TRUNCATED AT 250 WORDS)     

300例不孕症女性阴道微生态状况分析

目的:了解不孕女性阴道微生态状况,探讨不孕症患者进行阴道菌群微生态评价的临床意义。方法:选取不孕症女性300例取阴道分泌物进行微生态评价,以同期389例生育年龄的体检妇女作为对照。结果:不孕女性阴道假丝酵母菌阳性率7.7%(23例),阴道毛滴虫阳性率0%(0例);Nugent评分:正常89.1%(267例),BV中间型4.7%(14例),BV 6.2%(19例);阴道优势菌以革兰阳性大杆菌为主,占83.2%(249例),革兰阳性球菌0.7%(2例),革兰阴性短杆菌16.1%(49例);微生态失调的发生率34.0%(102例)。结论:不孕女性中BV、VVC的患病率和阴道菌群异常的发生率不高于健康体检女性,原发不孕与继发不孕之间、单纯管性因素不孕与单纯男性因素不孕之间阴道微生态的状况也无显著性差异。     

Risk factors for tubal infertility. Influence of history of prior pelvic inflammatory disease.

In order to explore possible etiologic differences between tubal infertility in women who had been physician-diagnosed as having pelvic inflammatory disease ("overt" PID) and in women who had not ("silent" pelvic inflammatory disease), we made use of self-reported data from a large, population-based, case-control study of infertility in King County, Washington. Responses from 33 infertile women with no history of physician-reported PID and 129 infertile women with such a history were compared to those of 501 fertile women. No cultures or blood for antibody titers were obtained. Logistic regression was used to compute the relative risks for silent and overt PID-related tubal dysfunction associated with various lifestyle and contraceptive habits in an effort to identify practices that potentially affect these outcomes. In general, practices associated with an increased risk of overt tubal disease, such as use of Dalkon Shield and other types of intrauterine devices, were also associated with an increased risk of silent tubal disease, but to a lesser extent. Women who used oral contraceptives for longer than three years had a decreased risk for silent disease (relative risk = 0.5, 95% confidence interval = 0.3-0.8), but their risk for overt disease did not decrease to the same extent (relative risk = 0.9, 95% confidence interval = 0.3-2.5). These results suggest that silent and overt tubal disease share many common lifestyle risk factors.     

Risk factors for laparoscopically confirmed pelvic inflammatory disease: findings from Mumbai (Bombay), India

OBJECTIVES: Sexually transmitted diseases (STDs) are an important cause of pelvic inflammatory disease (PID) but have often not been detected in microbiological studies of Indian women admitted to hospital gynaecology wards or private clinics. In this cross sectional study, women living in the inner city of Mumbai (Bombay) were investigated for socioeconomic, clinical, and microbiological risk factors for PID. METHODS: Microbiological tests and laparoscopic examination were carried out on 2736 women aged < or = 35 years who came to a health facility with suspected acute salpingitis or infertility or for laparoscopic sterilisation. 86 women with a clinical diagnosis of PID were not referred for laparoscopy although their characteristics are described. Associations between various risk factors and PID status were investigated and logistic regression performed on all factors that remained significant. RESULTS: Of women with a laparoscopically confirmed evaluation, 26 women had acute and 48 chronic pelvic infection. Independent risk factors for PID were later age at menarche (> or = 14 years), a history of stillbirth and no previous pregnancy, history of tuberculosis, STD, dilatation and curettage or previous laparoscopy, and presence of Gardnerella vaginalis. CONCLUSIONS: It is concluded that STD related risk factors applied to only a small proportion of PID cases and that other determinants of PID are important, including obstetric complications, invasive surgical procedures such as laparoscopy, and tuberculosis.     

Factors related to infertility in the United States, 1965-1976

Although the overall rate of infertility among American women of reproductive age remained fairly constant between 1965 and 1976, the percentage of young black women who were infertile increased very sharply. In 1976, 18% of black women of reproductive age were infertile, whereas only 9% of white women of the same age were infertile. With use of national data bases, the relationships between sexual activity, complications of pregnancy, sexually transmitted diseases, pelvic inflammatory disease, use of contraception, and infertility were examined. Available evidence shows a strong association between sexually transmitted diseases, pelvic inflammatory disease, and infertility trends. Our projections indicate that sexually transmitted diseases operating through pelvic infections account for much of the race differential in infertility as well as for one-half to one-third of the increase. In 1976 5-8% of 20-29-year-old black women were estimated to suffer infertility attributable to sexually transmitted diseases. Among white women the estimated incidence of infertility caused by sexually transmitted diseases was 0.7-1%.     

Urogenital Chlamydia trachomatis in Gabon: an unrecognised epidemic.

Samples from 218 men with urethritis, 517 women with pelvic pain or pelvic pain and vaginal discharge, 218 women consulting for infertility, and 598 postpartal women were screened for Chlamydia trachomatis by culture and direct immunofluorescence. Chlamydiae were detected in 18% (39/218) of the men, 18% (45/252) of women with vaginal discharge, 14% (38/265) of those with pelvic pain, 10% (21/218) of infertile, and 10% (59/598) of postpartal women. A chlamydial prevalence of 18% (41) was observed in 229 postpartal women aged under 21, whereas only 5% (10) of 360 postpartal women over 21 had C trachomatis. In the other clinical groups, an age related decrease in prevalence was noted in women over 25. The direct immunofluorescence test correlated well with culture. The small difference in isolation between symptomatic and postpartal women indicates that women in this population do not seek medical attention for chlamydial infections and expose themselves to chlamydial salpingitis and infertility.