非淋菌性尿道炎的检测(附43例报告)

非淋菌性尿道炎是最常见的性传播疾病,近年来衣原体(CT)及支原体(UU)感染引起的泌尿生殖道感染在世界范围内呈上升趋势。我们采用衣原体检测及支原体培养的方法与PCR检测衣原体,支原体做对比,以判别两种方法的准确性。 临床资料与方法 均为门诊病人,共48例,年龄20～60岁、男性26例,女性22例。男性病人多数     

应用聚合酶链反应检测女性尿道沙眼衣原体

沙眼衣原体(CT)能引起非细菌性尿道炎,是泌尿生殖器感染的重要病原体。随着对衣原体的深入研究,人们开始重视衣原体与非细菌性炎症的关系,但目前从女性尿道未直接检测出衣原体的报道。我们为了观察衣原体感染和非细菌性尿道炎的关系,应用聚合酶链反应(PCR)对女性尿道分泌物进行了CT检测,观察报告如下。     

PCR检测衣原体及其在男性尿道感染中的意义

应用聚酶链反应（ＰＣＲ）检测６０４例临床已确诊的男性泌尿系感染患者沙眼衣原体（ＣＴ）感染情况，发现ＣＴ阳性率为：急性淋菌性尿道炎（ＡＧＵ）占２６．９％（１１７／４３５），淋菌感染后尿道炎（ＰＧＵ）占４８．５％（３２／６６），非淋菌性尿道炎（ＮＧＵ）占３１．１％（３２／１０３）。认为ＰＣＲ技术是临床快速诊断男性ＣＴ尿道炎的有效方法。     

聚合酶链技术在慢性前列腺炎诊治中的应用

目的：探索慢性前列腺炎的病因，提高其诊治水平。方法：应用聚合酶链技术(PCR)对门诊疑诊为慢性前列腺炎患者的前列腺液进行淋球菌(NG)、沙眼衣原体(CT)及解脲支原体(UU)检测。结果：检出单纯淋球菌感染33例，阳性率9．09％；沙眼衣原体感染32例，阳性率5．15％；解脲支原体感染250例，阳性率23．00％，沙眼衣原体与解脲支原体合并感染13例；淋球菌合并解脲支原体感染5例；淋球菌合并沙眼衣原体感染4例；并应用PCR监测治疗效果。结论：PCR检测慢性前列腺炎病原体快速、敏感性高、特异性强，是一种较为理想、值得推广的临床应用技术。     

男性非淋菌性尿道炎患者尿道黏膜细胞内广泛存在衣原体始体与包涵体

目的 探索男性非淋菌性尿道炎患者尿道黏膜细胞内衣原体始体与包涵体检测的意义.方法 取患者尿道粘膜柱状上皮细胞涂片姬姆萨染色镜检.结果 男性非淋菌性尿道炎患者尿道黏膜细胞内广泛存在衣原体始体与包涵体,在衣原体敏感抗生素治疗前后衣原体感染细胞百分比差异有统计学意义(P＜0.01),尿道细胞标本经实时荧光定量聚合酶链反应检测含有衣原体DNA,经免疫组化染色检测含有衣原体抗原抗体免疫复合物.结论 提示衣原体是男性非淋菌性尿道炎患者的主要致病菌,尿道黏膜细胞内存在衣原体包涵体与数个始体是衣原体感染的确凿证据.     

支原体和衣原体感染对男性生殖的影响

生殖道感染与不孕不育密切相关,以非淋菌性尿道炎最为常见,主要是支原体和衣原体感染。支原体和衣原体感染可以直接或间接地损伤男性的精子及生精细胞。此外,感染引发的一系列免疫反应,也与男性不育有一定的关系。临床上对支原体和衣原体的检测方法一直不断改进,新的检测方法可以使临床更特异、更精准地控制其对男性生殖的影响。     

非淋菌性尿道炎

非淋菌性尿道炎(NGU)是一种性传播疾病(STD),在一些欧洲国家最为常见。在英国,NGU也常有报告,其发病数已超过淋菌性尿道炎(GU),大致为2:1。在美国,性活跃的男性最常见的疾病之一是急性尿道炎,每年GU的发病数为一百万,而NGU估计为二百万。近来我们在临床工作中,发现NGU患者明显增多。病原学多种微生物与NGU有关。由于对正常尿道中各种生物状况了解不多,使NGU的病原学研究变得错综复杂。沙眼衣原体(Chlamydia trachomatis)感染占30—50％,尿素支原体(Ure     

性传播疾病中的衣原体感染

性传播的衣原体感染是血清型D至K的沙眼衣原体,在生殖泌尿系统感染中具有重要位置,如目前发病率最高的性传播疾病非特异性尿道炎,其中40％——50％的患者是由于衣原体感染所致。Mc-COY细胞培养分离衣原体以及免疫荧光检测循环血清中的衣原体抗体可以诊断新近或现时衣原体感染患者,但衣原体可以同时侵袭泌尿系统多个器官并可与其它细菌混合感染,表现出各种不同症状,给临床诊断和治疗增加了困难。本文拟对性传播疾病中衣原体感染的临床表现以及治疗原则作一综述。     

帅克里因治疗男性非淋菌性尿道炎76例疗效观察

为研究帅克里因(甲砜霉素胶囊)治疗非淋菌性尿道炎的有效性和安全性。我们于1999年6～12月用帅克里因治疗由沙眼衣原体和／或解脲支原体感染引起的男性非淋菌性尿道炎76例,同时用美满霉素作对照治疗。结果报告如下。     

男性泌尿生殖道非淋球菌奈瑟菌感染的诊断与治疗研究

目的:探讨非淋球菌奈瑟菌感染对男性泌尿生殖道感染诊断与治疗的影响。方法:采集8例急性尿道炎或慢性前列腺炎患者的尿道分泌物、前列腺按摩液或/和精液标本,分别接种淋球菌培养基、血琼脂培养基、沙保氏琼脂培养基和支原体培养基分离淋病奈瑟菌与其他细菌、真菌、支原体以及Gemenez染色检查衣原体。对分离的革兰阴性双球菌分别进行氧化酶、生化反应、药物敏感试验及淋病奈瑟菌核酸荧光聚合酶链反应(PCR)检测与鉴定。根据药物敏感试验结果选择和使用抗菌药物,对患者以静脉注射或/和口服治疗。结果:从8例患者前列腺按摩液或精液内分离的8株革兰阴性双球菌分别鉴定为粘液奈瑟菌3株、灰色奈瑟菌4株、嗜乳糖奈瑟菌1株,各菌株的隐蔽质粒pJD1基因PCR检测均表现与淋病奈瑟菌相似的阳性反应。男性生殖道分离的非淋球菌奈瑟菌具有多重耐药性,对喹诺酮类药物和磷霉素具有显著高的耐药性。静脉或/和口服给予病原菌敏感的头孢菌素或/和米诺环素治疗7d后,病原学复查无菌和患者症状消失。结论:寄生人体上呼吸道的某些正常菌群奈瑟菌也可以感染男性泌尿生殖器官,引起淋病样尿道炎与慢性前列腺炎。仅仅通过形态、氧化酶试验或/和检测隐蔽质粒基因以及其他淋病奈瑟菌非特异性核苷酸序列的PCR方法,可导致淋病的临床和病原学诊断错误。根据病原学检查结果选择药物静脉注射或/和口服,能够有效治愈非淋病奈瑟菌引起的急性尿道炎与慢性前列腺炎等男性生殖器官感染疾病,病原菌耐药性是影响治疗效果的主要因素。     

Diagnosis of gonococcal urethritis and chlamydial urethritis by polymerase chain reaction]

A polymerase chain reaction (PCR) method was compared to standard methods (cultures for Neisseria gonorrhoeae and Chlamydia trachomatis and an enzyme-immunoassay for C. trachomatis) in diagnosis of gonococcal and chlamydial urethritis in 40 male patients with urethritis. Gonococcal urethritis was diagnosed by detection of a 206 bp DNA fragment amplified by PCR with N. gonorrhoeae-specific primers. Chlamydial urethritis was diagnosed by detection of a 242 bp DNA fragment amplified by PCR with C. trachomatis-specific primers. Gonococcal and chlamydial urethritis, gonococcal and non-chlamydial urethritis, non-gonococcal and chlamydial urethritis, and non-gonococcal and non-chlamydial urethritis were diagnosed in 8, 10, 14 and 8 patients, respectively, by the PCR method. In 9 patients with gonococcal and chlamydial urethritis, 10 with gonococcal and non-chlamydial urethritis, 12 with non-gonococcal and chlamydial urethritis, and 9 with non-gonococcal and non-chlamydial urethritis, diagnosed by the standard methods, the coincidence rates of the PCR to the standard methods were 78% (7/9), 90% (9/10), 100% (12/12), and 89% (8/9), respectively. The overall coincidence rate between the PCR and the standard methods in diagnosis of urethritis were high (90%). In addition, N.gonorrhoeae and C.trachomatis could be simultaneously detected from one urethral sample in approximately 6 hours by means of the PCR. Thus, the PCR method could clinically be applied and would offer several advantages to diagnosis of urethritis, compared to the standard methods.     

性传播性尿道炎后慢性前列腺炎(附86例报告)

目的　探讨性传播性尿道炎后慢性前列腺炎患者的病因学特点。　方法　对 86例性传播性尿道炎后慢性前列腺炎患者进行前列腺按摩液 (EPS)的病原体检测并分析结果。　结果　EPS细菌培养阳性 5 7例 ,阳性率 6 6 .3% ,其中以淋球菌为主要致病菌 33例 (38.4 % )。前列腺液PCR检测淋球菌阳性 37例 (43.0 % ) ,沙眼衣原体阳性 2 2例 (2 5 .6 % ) ,解脲脲原体阳性 19例(2 2 .0 % )。PCR检测出复合病原体者 12例 (13.9% )。　结论　性传播性尿道炎后慢性前列腺炎的致病菌以淋球菌、衣原体和解脲脲原体为主 ,治疗前行EPS病原学检测有重要意义     

性传播性尿道炎的诊断与治疗：附62例报告

为探讨一种对性传播性尿道炎有效的诊断和治疗方法，采用病原体培养和聚合酶链反应（PCR）检测62例性传播性尿道炎，结果病原体培养淋球菌（NG）阳性9例，解脲文原体（UU）阳性30例，两者均阳性5例，均阴性18例；沙眼衣原体（CT）阳性25例，UU阳性17例，两者均阳性20例，其中合并NG阳性17例。病原体培养与PCR显示NG和UU双阳性分别为13例和34例，双明性分别为47例和25例，两种方法不一致考分别为2例和3例。PCR对NG和UU的敏感度分别98．3％和97．2％，特异性分别为97.9％和92．6％。所有患者均口服阿奇霉素500mg，每3d1次，总剂量1．5g。结果治愈50例，显效6例，无效6例，有效率为90．3％。提示PCR对CT、UU及NG感染是一种敏感、特异、快捷和无创伤的检测技术，可作为性传播性尿道炎复查常规检测手段。阿奇霉素对治疗性传播世尿道炎具有疗效好、副作用少、服用方便等优点，值得推广应用。     

Clinical observation of non-gonococcal urethritis

Sixty-one male urethritis cases, 28 gonococcal urethritis and 33 nongonococcal urethritis (NGU), were out-patients at the Department of Urology, Asahi General Hospital, during the 4 months, Oct. 1, 1984-Jan. 31, 1985. Thirteen of the 33 NGU patients (39.4%) were infected with C. trachomatis (CT). The efficacy of Doxycycline and the route of infection was studied in the cases of CT-positive CT-negative-NGU. CT infection from prostitutes was not so frequent as in the other pathogen infection of NGU. The efficacy of Doxycycline (100 mg b.i.d. for 2 weeks) against CT infection was excellent in the disappearance of subjective complaints and that of white blood cells in the urethral discharge in the CT positive-NGU group (13/13), in comparison with CT negative-NGU group (7/18). The efficacy of Doxycycline against CT was also confirmed from the follow-up study by the isolation of CT and by detection of CT antigen from urethral swabs using FITC conjugated monoclonal antibody against CT antigen.     

甘肃省张掖市2 356例患者泌尿生殖道衣原体、支原体感染的调查与药敏分析

目的：了解甘肃省张掖市2000-2004年间2356例可疑非淋菌性尿道炎（NGU）患者泌尿生殖道分泌物衣原体、支原体感染及药敏状况。方法：应用衣原体试剂盒（胶体金法）定性检测衣原体抗原、支原体培养及药敏选用支原体药敏试剂盒,并对10种抗生素对支原体的敏感性进行了分析。结果：2356例可疑NGU患者检出衣原体阳性者384例（16．29％）,支原体阳性者324例（13．29％）,混合感染者57例（2．42％）。支原体敏感的药物是多西环素、交沙霉素、米诺环素,耐药的是环丙沙星、氧氟沙星、克林霉素。结论：张掖地区NGU患者的病原体仍然主要是衣原体、支原体,多西环素、交沙霉素、米诺环素可作为支原体感染的首选药物,同时,NGU的病原学检测和药敏试验对其防治尤为重要。     

Clinical study of male urethritis in Oogaki Municipal Hospital

We studied 181 patients diagnosed with male urethritis at Oogaki Municipal Hospital from April 2002 to March 2004. Twenty-two out of 92 patients diagnosed with gonococcal urethritis (GU) and 52 out of 89 patients diagnosed with non-gonococcal urethritis (NGU) were positive for Chlamidia trichomatis by polymerase chain reaction (PCR). Most patients of male urethritis were in their twenties. Of GU patients, 39 (67%) were infected from commercial sex workers (CSWs). Of NGU patients, 12 (30%) were infected from CSWs, 24 (40%) from girl friends and 4 (10%) from their Twenty-eight (48%) out of GU patients were infected through oral sex. spouse. Eighty-three GU patients were treated with SPCM (2 g, one shot). Fifty-five patients could be evaluated for the efficacy of treatment. Elimination rate of Neisseria gonorrhoeae was 100% and 14 out of 18 patients with persisting urethritis had C. trichomatis. Eighty-two NGU patients were treated with minocycline, tosufloxacin, levofloxacin, gatiflixacin or clarithromycine. Sixty-six patients could be evaluated for the efficacy of treatment. Forty-one patients were diagnosed with non-gonococcal chlamydial urethritis (NGCU) and 25 patients were diagnosed with non-gonococcal, non-chlamydial urethritis (NGNCU). The clinical curative rate of NGCU and NGNCU was 93% (38/41) and 80% (20/25), respectively.     

淋菌性尿道炎合并砂眼衣原体感染的诊断和治疗

１９９３年８月－１９９４年６月，用微量酶联免疫分析方法自３２６例淋病患者检出１０２例砂眼衣原体感染者，阳性率３０．７％，其中男性５４例，阳性率２７．５％；女性４８例，阳性率３６．２％。对淋病合并ＣＴ感染较高的原因，症状，诊断和治疗进行了讨论。     

Usefulness of oral wash specimens for detecting Chlamydia trachomatis from high-risk groups in Japan

Orogenital sex is recognized as a route for the transmission of Chlamydia trachomatis (CT) which thus causes male chlamydial urethritis. Patients with a pharyngeal CT infection have no gross lesions, but CT was tested by pharyngeal swabs. In this study, the usefulness of oral wash specimens for detecting CT was compared to that of swab specimens. In addition, oral wash specimens were also used to screen for CT pharyngeal infection. Eighteen female commercial sex workers in whom CT was detected from pharyngeal swabs were re-examined using both methods. The positive rate for CT was 44% by swabs and 61% by oral wash specimens. Forty-eight male students with CT-positive urine were also screened for pharyngeal CT infection. The positive rates were 6% by swabs and 10% by oral wash specimens. Our findings therefore indicate that oral wash specimens more effectively detected pharyngeal CT infection than pharyngeal swabs.     

Is urethritis accompanied by seminal vesiculitis?

Objective:   To determine whether urethritis is accompanied by seminal vesiculitis using transrectal ultrasound (TRUS) imaging.
Methods:   Fifty-six male patients (mean age 31.6 ± 8.7 years) with urethritis were included in the study. As a control group, we also considered 34 healthy volunteers (mean age 21.3 ± 1.8 years). The two groups were evaluated by the nucleic acid amplification test and imaging studies using TRUS.
Results:   The nucleic acid amplification test could identify 15 patients (26.8%) with gonococcal urethritis (five had accompanying chlamydial urethritis), 32 (57.1%) with chlamydial urethritis, and nine (16.1%) with nongonococcal and nonchlamydial urethritis. The mean anteroposterior diameter of the bilateral seminal vesicles was significantly longer in the urethritis group than in the controls (12.9 ± 3.3 mm vs 11.0 ± 2.0 mm, P  = 0.004). The incidence of dilatation or cystic changes of seminal vesicles was significantly higher in the urethritis group than in the controls (dilatation: 30% vs 9%, P  = 0.019; cystic change: 39% vs 12%, P  = 0.007). There was no significant difference in the incidence of dilatation or cystic changes of seminal vesicles between gonococcal urethritis and chlamydial urethritis.
Conclusions:   Patients with urethritis are likely to have accompanying seminal vesiculitis. This suggests a close interrelationship among urethritis, seminal vesiculitis and epididymitis.