盆腔炎致病因子及管理措施研究

目的：研究东北地区人群盆腔炎（PID）致病因子，同时观察世界卫生组织（WHO）推荐的PID症征处理方法在中国应用的效果。方法：对200例PID病人和155例健康体检的妇女（对照组）分别检测沙眼衣原体（CT），淋病奈瑟氏菌（NG），人型支原体（MH），细菌性阴道病（BV），阴道毛滴虫（TV）和念珠菌（CA），同时按照WHO推荐的PID病征管理措施给予头孢曲松，多西不素，甲硝唑治疗14天，2－3周后随访，进行体格检查并复查NG以判断疗效。结果：PID病人组MH，BV，CT，CA，TV，NG阳性率分别为26．0％，25．5％，16．0％，4．0％，2．5％，正常对照组分别为5．2％，8．4％，0％，5．2％，0．7％，0％，与对照组相比，PID病人组MH，BV，CT阳性率显著高于对照组（P＜0．01），另外200例PID病人混合感染29例（14．5％）；200例PID病人复诊137例（复诊率68．5％），其中治愈（46．7％），好转68例（49．6％），无效5例（3．7％）。结论：我国东北地区PID病人与感染MH，BV，CT相关，按照WHO推荐的PID病征管理措施治疗我国东北地区PID病人是非常有效的，特别适用于缺少实验室条件的基层单位。     

北京某医院皮肤性病门诊HIV阳性女性患者中淋球菌沙眼衣原体及生殖支原体感染状况及危险因素

目的初步了解北京地区艾滋病病毒(HIV)阳性女性患者中淋球菌(NG)、沙眼衣原体(CT)及生殖支原体(Mg)感染状况。方法收集2016年12月至2017年12月期间在本院皮肤性病科门诊就诊的200例HIV阳性女性患者首段尿进行NG/CT/Mg核酸检测,并收集患者人口社会学、性行为状态等资料进行危险因素分析。结果200例HIV阳性女性患者,NG/CT/Mg总阳性率为9.0%(18例),其中NG、CT、Mg阳性率分别为1.0%(2例)、4.0%(8例)、4.5%(9例),有1例患者NG/CT均阳性。以"NG/CT/Mg感染状况(1/3或以上)"为因变量,其余为自变量,Logistic单因素分析显示,婚姻状态、职业状态与NG/CT/Mg感染相关(P0.05),多因素分析显示,职业状态与NG/CT/Mg感染相关(P0.05),有工作者感染NG/CT/Mg的风险是无业或退休者的4.5倍。结论北京地区HIV阳性女性患者Mg阳性率相对较高,临床工作中应重视HIV阳性女性患者泌尿生殖道Mg等病原体的筛查。     

常见性病病原体生殖道感染与女性不孕的相关性研究

目的探讨解脲支原体(UU)、人型支原体(MH)、生殖支原体(MG)、沙眼衣原体(CT)和淋病奈瑟菌(NG)生殖道感染与女性不孕的相关性。方法回顾性分析2015年1月至2018年12月接诊的941例女性不孕患者(不孕组)和500例有正常生育功能的健康体检妇女(对照组)宫颈分泌物UU、MH、MG、CT和NG感染情况。结果不孕组和对照组感染率最高的病原体UU分别为38.3%和18.0%,其次是MH(9.7%和5.2%)、MG(8.8%和2.6%)和CT(9.4%和2.4%),NG(0.9%和0)感染率最低。单一、混合和总病原体感染率不孕组分别为46.3%、9.5%和55.8%,明显高于对照组的16.5%、5.4%和22.0%,差异有统计学意义(P<0.01);病原体UU、MH、MG、CT和NG构成比不孕组分别为57.1%、14.4%、13.2%、14.0%和1.3%,对照组分别为63.8%、18.4%、9.2%、8.5%和0,UU最高均>50%、其次是MH、NG最低。结论病原体感染与女性不孕关系密切,UU是最常见感染病原体。     

1010例性病门诊患者泌尿生殖道病原体感染分析

目的了解深圳地区性病门诊患者感染泌尿生殖道沙眼衣原体(Chlamydia trachomatis,CT)、淋球菌(Neisseria gonorrhoeae,NG)和支原体的情况,以及支原体的耐药情况。方法对2010年深圳慢性病防治中心性病门诊的1 010例患者的泌尿生殖道标本,进行CT、NG核酸检测以及支原体培养、药敏试验。结果 1 010例患者中,CT阳性295例(29.2%),NG阳性103例(10.2%),解脲支原体(Ureaplasma urealyticum,UU)或/和人型支原体(Mycoplasma hominis,MH)阳性428例(42.4%)。其中CT和NG感染率男性高于女性,支原体感染情况则是女性高于男性。NG感染者中合并CT感染的比例(38.8%)高于CT感染者中合并NG的比例(13.6%);CT感染者中合并UU/MH感染的比例(47.1%)高于NG感染者中合并UU/MH感染的比例(30.1%)。对428例支原体药敏结果进行分析,UU耐药率最高的是环丙沙星(68.0%),MH及UU+MH混合感染耐药率最高的均是红霉素,分别为72.7%和90.4%。而UU、MH及UU+MH敏感率最高的均是交沙霉素,敏感率分别达98.3%、95.5%、91.3%,其次为强力霉素和美满霉素。结论深圳地区CT、NG和支原体的感染率均处在较高的水平,不同病原体混合感染的情况有所不同,感染存在性别差异。支原体感染以UU为主,交沙霉素、强力霉素和美满霉素可作为治疗支原体感染的首选药物。     

性病及泌尿外科门诊男性就诊者生殖道沙眼衣原体和淋球菌感染状况及相关因素

目的了解深圳市宝安区性病及泌尿外科门诊男性就诊者生殖道沙眼衣原体(CT)及淋球菌(NG)感染现状及相关因素。方法 2018年4-5月,对辖区4所医院性病及泌尿外科门诊符合纳入标准的男性就诊者进行问卷调查及尿液标本生殖道沙眼衣原体及淋球菌核酸检测。结果共调查804人,CT及NG阳性率分别为10.6%(85人)、5.0%(40人);其中性病门诊CT及NG阳性率分别为8.9%(35/393)、1.8%(7/393),泌尿外科门诊CT及NG阳性率分别为12.2%(50/411)、8.0%(33/411)。NG感染是CT感染的相关因素[调整比值比(aOR)=3.54,95%可信区间(CI):1.70～7.37,P=0.001];NG感染的相关因素包括泌尿外科门诊就诊(aOR=2.14,95%CI:1.41～3.25;P 0.001)、无业/待业者(aOR=4.34,95%CI:1.47～12.80,P=0.008)及CT感染(aOR=3.16,95%CI:1.48～6.73,P=0.003)。结论宝安区性病及泌尿外科门诊男性就诊人群CT感染率高,同时泌尿外科门诊NG感染率高;CT及NG感染存在交互作用,无业/待业是NG感染的相关因素。     

昆明市暗娼人群中HIV梅毒 淋球菌和生殖道沙眼衣原体感染的调查

目的了解昆明市暗娼人群中艾滋病病毒(HIV)、梅毒、淋球菌和生殖道沙眼衣原体的感染情况及流行病学特征。方法 2017年11月至2018年2月对昆明市区的暗娼进行了现场问卷调查,并采集血液和阴道拭子送云南省疾病预防控制中心进行检测。结果共调查423名暗娼,平均年龄31.2岁,初、高中文化占70.4%(298名),性病知识平均知晓率为86.8%,安全套使用率为80.4%,艾滋病病毒检测及时率为55.1%。共检出生殖道沙眼衣原体(CT)56例(13.2%),淋球菌(NG)11例(2.6%),梅毒13例(3.1%),未检出HIV。CT、NG混合感染5例,CT、梅毒混合感染2例,CT、NG、梅毒三重感染1例。15～20岁年龄组、彝族和未婚暗娼人群生殖道沙眼衣原体的感染率显著偏高(P 0.05)。结论昆明市暗娼人群有较高的性病知识知晓率和安全套使用率,性病感染以生殖道沙眼衣原体为主,梅毒和淋球菌的感染率较低,感染者主要分布在低年龄组、未婚、彝族的暗娼人群中。     

一般妇女人群中STD感染状况调查

目的：了解近年来新疆维吾尔自治区(新疆)一般妇女人群中性传播疾病(STD)感染状况。方法：2001年5月在奎屯市2个农场随机对110名普通农村妇女进行STD感染状况调查，取宫颈分泌物检测解脲支原体(UU)、人型支原体(MH)、沙眼衣原体(CT)、淋球菌(NG)等，并采血做梅毒快速血浆反应素试验(RPR)及检测艾滋病病毒(HIV)。结果：UU、CT、MH、NG的阳性率分别为30．0％、21．8％、5．5％、5．5％；29例(26．4％)有≥2种病原体感染合并存在。在宫颈炎或／和附件炎病人(59例)中，CT或／和UU阳性率为59．3％，极显著高于正常组；所有人HIV检测阴性，RPR l例阳性。结论：应加强在一般妇女人群中STD的筛查和治疗。     

荧光定量PCR检测解脲支原体沙眼衣原体及淋病奈瑟氏菌结果分析

目的研究衡阳地区泌尿生殖道炎症患者解脲支原体(UU)、沙眼衣原体(CT)、淋病奈瑟氏菌(NG)三种性传播疾病病原体的感染状况,探讨这些病原体与性别和年龄的相互关系,为临床诊断预防提供依据。方法采用荧光定量聚合酶链式反应(FQ-PCR)对我院2 182例患者进行UU、CT和NG核酸检测。结果 2 182例患者中,UU、NG及CT阳性率分别为61.94%(1 245/2 010)、24.22%(39/161)、7.82%(77/985),三者之间差异均有统计学意义。混合感染以UU+CT二重感染阳性率最高(9.58%)。女性的UU感染率(63.51%)明显高于男性(36.97%),男性的CT及NG感染率(分别为14.75%和40.00%)明显高于女性(分别为7.36%和13.54%),差异均有统计学意义。0～20岁的CT及NG感染率(分别为25.00%和64.29%)明显高于其他年龄段,差异均有统计学意义;UU阳性率(69.41%)高于其他年龄段,但无统计学差异,而21～40岁是三种病原体感染的主要人群。UU以妇产科门诊阳性率最高,而CT及NG的阳性率以泌尿外科门诊和皮肤科门诊最高,差异均有统计学意义。结论本地区泌尿生殖道患者UU感染率最高并且女性感染率高于男性,而男性的CT及NG感染率高于女性。三种病原体感染主要集中于青壮年,而0～20岁人群感染率高于其他年龄段。三种病原体感染率在科室间同样存在一定的差异。     

性病病征处理在山区县的应用

目的：探索性病病征流程图在山区县医疗单位应用的可行性和有效性。方法：使用世界卫生组织(WHO)推荐并结合中国实际修订的3种常用性病病征流程图，按照病征处理要求选取有效病例，并进行处理和观察。结果：累计观察1250例，其中男性尿道分泌物病征476例，女性阴道分泌物异常528例，生殖器溃疡246例，按性病病征流程图给予相应治疗，治愈率分别为83．19％、67．61％、56．91％，总的治愈率为71．44％，有效率97．68％。结论：经中国修订的3种常见性病病征流程图适合在山区县医疗单位应用，但女性阴道分泌物异常病征还有待完善，性病疫情报告也有待于有关部门协调统一。     

1996～2003年上海市某医院泌尿生殖道分泌物标本性病检测结果分析

目的了解上海市近几年性病门诊就诊者中淋球菌(NG)、沙眼衣原体(CT)和解脲脲原体(UU)的流行趋势和特征，探讨可能的影响因素，为制定和开展有效的防治措施提供参考。方法收集1996～2003年到上海市皮肤病性病医院性病门诊就诊，并进行泌尿生殖道分泌物标本性病检测者的人口学特征和检测结果等资料，进行统计学描述和分析。结果在此期间共有66658人接受检查，其中NG阳性18348例(35．8％)，CT阳性7048例(18．1％)，NG和CT阳性人数和阳性率在1997年和1998年达高峰，之后下降，近年又开始上升。UU阳性6673例(37．4％)，其阳性人数和阳性率则基本上呈逐年上升趋势。混合阳性率最高的是CT和UU(14．2％)，最低的是NG和UU(8。7％)。女性NG阳性者中的CT阳性率(35．7％)和CT阳性者中的NG阳性率(27．2％)，分别高于所有受检者对应的阳性率(20．4％和19．6％)，男性情况相反。结论上海地区性病流行谱正在发生改变，女性UU感染人数明显增多；近年来NG、CT和UU的混合感染率处于较高水平，尤其是低龄女性；NG和CT的混合感染情况应该引起重视。     

Pelvic inflammatory disease in the People's Republic of China: aetiology and management

OBJECTIVES: To study the causes of pelvic inflammatory disease (PID) in Shenyang, Northeastern China, and to assess the efficacy of the syndromic management flowchart for PID recommended by World Health Organization (WHO). METHODS: 200 outpatients with PID attending Gynaecologic Clinic of No. 1 and No. 2 hospital of China Medical University in Shenyang, and 155 control women without symptoms underwent pelvic examination, and were tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma hominis (MH), bacterial vaginosis (BV), Candida albicans (CA) and Trichomonas vaginalis (TV). RESULTS: In PID patients, the prevalence of MH was 26%, of BV 26%, of CT 16%, of CA 11%, of TV 4% and of NG 2.5%. In the control population, prevalences were 5.2%, 8.4%, 0%, 5.2%, 0.7%, 0% respectively. MH, BV and CT were significantly more common in PID patients than in controls (P<0.01). One hundred and thirty-seven of the 200 patients with PID (68.5%) returned for follow-up. Symptoms had resolved completely in 64 (47%), and had improved in 68 (50%). There was no improvement in five (4%). CONCLUSIONS: The management protocol for female lower abdominal pain recommended by WHO is effective in this setting.     

Simple and inexpensive point-of-care tests improve diagnosis of vaginal infections in resource constrained settings

Objective  Bacterial vaginosis (BV) and Trichomonas vaginalis infection (TV) have been associated with adverse birth outcomes and increased risk for HIV. We compare the performance of simple inexpensive point-of-care (POC) tests to laboratory diagnosis and syndromic management of BV and TV in poor settings.
Methods  Between November 2005 and March 2006, 898 sexually active women attending two reproductive health clinics in Mysore, India were recruited into a cohort study investigating the relationship between vaginal flora and HSV-2 infection. Participants were interviewed and screened for reproductive tract infections. Laboratory tests included serology for HSV-2; cultures for TV, Candida sp., and Neisseria gonorrhoeae ; Gram stains; and two POC tests: vaginal pH; and Whiff test.
Results  Of the 898 participants, 411 [45.7%, 95% confidence interval (95% CI): 42.4–49.0%] had any laboratory diagnosed vaginal infection. BV was detected in 165 women (19.1%, 95%CI: 16.5–21.9%) using Nugent score. TV was detected in 76 women (8.5%, 95%CI: 6.7–10.4%) using culture. Among the entire study population, POC correctly detected 82% of laboratory diagnosed BV cases, and 83% of laboratory diagnosed TV infections. Among women with complaints of vulval itching, burning, abnormal vaginal discharge, and/or sores (445/898), POC correctly detected 83% (60 of 72 cases) of laboratory diagnosed BV cases vs. 40% (29 of 72 cases) correctly managed using the syndromic approach ( P  <   0.001). Similarly, POC would have detected 82% (37 of 45 cases) of TV cases vs. 51% (23 of 45 cases) correctly managed using the syndromic approach ( P  =   0.001).
Conclusions  In the absence of laboratory diagnostics, POC is not only inexpensive and practical, but also significantly more sensitive than the syndromic management approach, resulting in less overtreatment.     

Performance of a rapid molecular test to detect Chlamydia trachomatis and Neisseria gonorrhoeae in women with pelvic inflammatory disease

ObjectiveThe aim of this study was to investigate the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in women with pelvic inflammatory disease (PID) and the usefulness and cost-effectiveness of a rapid molecular test for the diagnosis and clinical management of PID.MethodsThis observational study included 75 patients with mild-to-moderate PID (n = 33), severe PID (n = 29) and non-specific lower abdominal pain (NSAP) (n = 13). CT/NG infections were analyzed using a standard and a rapid test. A cost analysis was carried out.ResultsSamples of 19 patients (25.3%) were CT/NG positive. Concordance between rapid and standard tests was 100%. No significant differences were observed in the incidence of CT/NG in mild-to-moderate compared to severe PID. Costs differed according only to disease severity.ConclusionsRapid molecular tests could help with the diagnosis of PID in sexually active women in clinical settings in which a standard technique is not available.     

生殖器溃疡病征处理流程图的评价与临床应用

目的 评价世界卫生组织(WHO)推荐的生殖器溃疡病征处理流程图，在中国推行的可行性和实用性。方法 以146例生殖器溃疡患者为研究对象，用病征处理和病原学检测方法检测，并进行特异性、敏感性评价。结果 146例生殖器溃疡患者中，病征处理符合梅毒诊断的38例中，36例符合病原学诊断。而病征处理符合生殖器疱疹诊断的108例中，仅37例符合病原学诊断。结论 WHO的生殖器溃疡病征处理流程图较适用于梅毒处理，对生殖器疱疹处理应除外其它因素，谨慎使用。     

Strategies for diagnosis of bacterial vaginosis in a resource-poor setting

This study evaluated Amsel's criteria, the FemExam card and pH plus amine methods for the diagnosis of bacterial vaginosis (BV) in a resource-poor setting. Two hundred Azerbaijani women participated in a study about reproductive health that included a gynaecological examination and an interviewer-administered survey. Using the WHO syndromic diagnosis algorithm, nearly all women (99%) had abnormal vaginal discharge. The prevalence of BV by Gram stain was 35%; using pH plus amine, the FemExam card and Amsel's criteria, prevalence ranged from 29% to 49%. No behavioural or demographic characteristics were associated with BV as diagnosed by Gram stain. The sensitivity ranged from 0.59 to 0.74 and specificity from 0.65 to 0.92 using the three methods. The pH plus amine test is better than syndromic management protocols, and although it is not the most sensitive or specific of the three methods it will be easiest to implement in resource-poor settings.     

What proportion of episodes of gonorrhoea and chlamydia becomes symptomatic?

The effectiveness of syndromic treatment as an STD control strategy depends on the proportion of episodes which become symptomatic; few studies have measured this directly. We estimated these proportions for gonorrhoea (NG) and chlamydia (CT), synthesizing data on the point prevalence of self-reported discharge and dysuria among infected cases in rural Uganda, the durations of symptoms, incubation period and asymptomatic episodes, and the effect of treatment on symptom duration. Estimated proportions of episodes that become symptomatic were 45% for males with NG, 11% for males with CT, 14% for females with NG and 6% for females with CT. This was on average 1.5-fold higher than symptom prevalence at cross-section among infected cases in this population. Estimates were sensitive to assumptions on the relative durations of asymptomatic and symptomatic episodes, but were invariably inconsistent with previous direct estimates based on a US cohort study. These results show that the probability of recognizing symptoms in NG and CT episodes varies between settings. In populations with low treatment rates like Uganda, these probabilities can be very low. Here, health education should have priority in STD management programmes.     

Prevalence and risk behaviours for Chlamydia trachomatis and Neisseria gonorrhoeae infection among female sex workers in an HIV/AIDS high-risk area

The objectives of this study were to estimate the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection among female sex workers (FSWs) in an HIV/AIDS high-risk area in China and to examine risk factors associated with CT or NG infection. A cross-sectional study of 568 FSWs was conducted in Kaiyuan City, Yunnan Province, PR China. The prevalence rates of HIV, CT and NG in the study participants were 11.1%, 17.4% and 8.3%, respectively. More than one-fifth (21.3%) of participants tested positive for either CT or NG. This study identifies a relatively high prevalence of CT or NG infection among FSWs in Kaiyuan. Notably, HIV infection was found to be associated with NG infection and study participants who tested positive for NG had a higher rate of CT infection. Further studies are warranted to examine the prevalence and spread of CT and NG in China, and their potential impact on the HIV epidemic.     

Leydig cell hyperplasia and the maintenance of bone volume: bone histomorphometry and testicular histopathology in 29 male leprosy autopsy cases

This study was conducted to determine if osteoporosis in male leprosy patients is caused by testicular atrophy. Bone volume (BV/TV), trabecular number (TbN), trabecular thickness (TbTh), and trabecular separation (TbSp) were measured in two areas in decalcified paraffin sections of lumbar bones from 29 male leprosy and 6 male nonleprosy autopsy cases. We found significant differences in the average BV/TV measurements among the 7 patients with nodular Leydig cell hyperplasia (BV/TV 12.24%) and the 22 patients without hyperplasia (BV/TV 7.35%) and 6 patients without leprosy (BV/TV 12.98%). Bone volume was maintained in patients with nodular Leydig cell hyperplasia, and we determined no clinical factor other than the Leydig cell hyperplasia that reflected the bone volume. The osteoporosis of male leprosy patients was attributed to secondary gonadal dysfunction due to testicular atrophy, and Leydig cell hyperplasia appears to preserve bone volume.