性病门诊以生殖器溃疡为主要表现的疾病病因初探

目的 了解在性病门诊中，以生殖器溃疡为主要表现的疾病的病因。方法 在实验室建立了同时检测梅毒、生殖器疱疹和软下疳的复合ＰＣＲ方法。同时进行暗视野显微镜检查和梅毒血清学检查。结果 复合ＰＣＲ检测梅素与暗视野显微镜检查和梅毒血清学检查有较好的一一致性。在总计１６５例患者中，梅毒５１例，生殖器疱疹５２例，分别占３０．９％和３１．５％，未发现软下疳病例。６２例（３７．６％）未检出者中，梅毒５１例，生殖器疱     

生殖器溃疡性疾病的病因分析

为了解以生殖器溃疡为主要表现的疾病的病因及其与HIV感染的关系，根据病史、临床表现，结合暗视野显微镜检查、梅毒血清学试验，PCR检测HSV-DNA，HIV抗体检测等进行诊断。186例生殖器溃疡性疾病中，梅毒46例(24．7％)；生殖器疱疹62例(33．3％)；梅毒和生殖器疱疹混合感染2例(1％)；拟诊软下疳3例(1．6％)；58例未能明确诊断，占31．2％；HIV感染1例。显示生殖器溃疡性疾病中，以生殖器疱疹和梅毒居多，软下疳少见，已出现合并HIV感染者。     

以生殖器溃疡为特征性病患者的临床和性行为情况研究

目的:了解我国以生殖器溃疡为特征的性病患者的临床、病原学和性行为情况。方法:按统一标准在南京、大连、深圳性病专科门诊部收集有生殖器溃疡的初诊病例作临床和实验室诊断及性行为特征调查。结果:在有生殖器溃疡的380例性病患者中,检出梅毒患者153例占40.26%,生殖器疱疹患者167例占43.95%,未发现软下疳和性病性淋巴肉芽肿(LGV)患者。患者中未婚者占25.4%,近3个月内有2个以上性伴的占25.28%,有口-阴接触者占23.56%,在有皮损时有性交者占44.16%,多数患者未采取安全措施,在有措施者中采用安全套的仅占46.56%。结论:目前在我国以生殖器溃疡为特征的性病以梅毒和生殖器疱疹为主,未发现经实验室确诊的软下疳和L G V病例。开展性健康教育尤其是对青少年的性健康教育仍然是一项迫切而艰巨的任务。     

美国疾病控制中心最新性传播疾病诊断标准与治疗方法介绍

介绍美国疾病控制中心2002年性传播疾病中以生殖器溃疡为特征的梅毒、软下疳、生殖器疱疹、性病性琳巴肉芽肿和腹股沟肉芽肿的诊断标准及治疗方案，以供临在医生在STD诊治中参考。     

以生殖器溃疡为特征的性病患者临床和病原学检查

目的 了解以生殖器溃疡为特征的性传播疾病的病种构成及病例的临床特征。方法 按统一标准在南京、大连、深圳性病专科门诊部收集有生殖器溃疡的初诊病例作临床和实验室诊断,统计各病所占比例及临床特征。结果 在有生殖器溃疡的380例性病患者中,检出梅毒患者153例,占40.26%,生殖器疱疹患者167例,占43.95%,未发现软下疳和性病性淋巴肉芽肿患者。溃疡发生的部位在男性以冠状沟为多,占48.67%,女性以大阴唇为多,占50.70%。结论 我国以生殖器溃疡为特征的性病患者以梅毒和生殖器疱疹为主,未发现经实验室确诊的软下疳和性病性淋巴肉芽肿病例。     

性病病征处理的研究进展

对不同性病病征的病征处理方案的有效性评价结果表明,病征处理能有效地治疗男性淋球菌和沙眼衣原体感染、男女性梅毒和生殖器疱疹。但阴道分泌物病征处理流程图对处理宫颈淋球菌和沙眼衣原体感染的敏感性、特异性和阳性预期值较低,将其应用于淋球菌和沙眼衣原体感染率较高的高危人群及有症状者更为有效。     

性病病征处理的研究进展

对不同性病病征的病征处理方案的有效性评价结果表明,病征处理能有效地治疗男性淋球菌和沙眼衣原体感染、男女性梅毒和生殖器疱疹。但阴道分泌物症征处理流程图对处理宫颈淋球菌和沙眼衣原体感染的敏感性、特异性和阳性预期值较低,将其应用于淋球菌和沙眼衣原体感染率较高的高危人群及有症状者更为有效。     

性病病征处理在基层医院应用的可行性和疗效分析

选择男性尿道分泌物、阴道分泌物异常和生殖器疱疹3种病征的门诊初诊病例,进行病征处理;同时进行病原学诊断;并对医患双方进行问卷调查.结果:病征诊断对淋球菌和沙眼衣原感染总的敏感性、特异性和阳性预测值分别为95.34%、62.55%和61.24%,梅毒的敏感性为72.22%,特异性为92.24%,阳性预测值为68.42%;288例男性尿道分泌物的治愈率78.82%,有效率99.65%;阴道分泌物异常治愈率72.60%,有效率99.41%;生殖器溃疡治愈率88.66%,有效率100%,副作用少;医生和患者对病征处理的满意率分别为82.85%和97.99%.提示上述3种病征处理流程图在基层医院应用是可行的.     

生殖器疱疹合并其它性传播感染的临床研究

目的：探讨生殖器疱疹合并其它性传播感染的发生率及其临床特点。方法：对生殖器部位有疱疹性损害或可能由疱疹病毒引起损害的患者进行了临床资料采集和分析，并作了生殖器疱疹、梅毒、尖锐湿疣、生殖器 念珠菌病等性传播感染的病原学检测。结果：在287例入选病例中，确诊生殖器疱疹186例（64．8％），对其中68例（23．7％）患者作了HIV血清抗体检测，未发现HIV感染者。在186例生殖器疱疹病例中，43例（23．1％）合并有其它性传播感染，其中合并尖锐湿疣16例（8．6％）、活动性梅毒及潜伏梅毒13例（7．0％）（包括合并硬下疳6例）、生殖器念珠菌病12例（6．5％）。有合并性传播感染的生殖器疱疹均为HSV－2感染所致。结论：生殖器疱疹易合并其它性传播感染，且可引起其损害形态发生改变。     

97例生殖器溃疡早期梅毒检出率分析

９７例生殖器溃疡早期梅毒检出率分析顾伟鸣，张皓，汤全贵，乐嘉豫生殖器溃疡病（ＧＵＤ）在男性ＳＴＤ门诊中以梅毒、软下疳、性病性淋巴肉芽肿、生殖器疱疹居多。我中心自１９９２年６月～１９９５年３月共发现９７例ＧＵＤ思考，进行暗视野（Ｄ－Ｆ）检查找到梅毒螺旋...     

Is syndromic management better than the current approach for treatment of STDs in China? Evaluation of the cost-effectiveness of syndromic management for male STD patients

BACKGROUND: The syndromic treatment approach has not been evaluated in sexually transmitted disease (STD) clinics in China. GOAL: The goal was to evaluate and compare the validity and cost-effectiveness of syndromic management with current STD management for men in clinics in Hefei, China. STUDY DESIGN: Diagnostic accuracy, treatment appropriateness, costs, and effectiveness of current clinical procedures and syndromic management were compared for 406 men attending four STD clinics. RESULTS: A modified World Health Organization (WHO) syndromic algorithm for urethral discharge yielded 100% sensitivity and a 69% positive predictive value (PPV). A syndromic algorithm for genital ulcers correctly treated all syphilis patients, with a 25% PPV. The average cost (in US dollars) per correct treatment by the current approach was 323.48 dollars for urethritis and 85.65 dollars for syphilis. For the syndromic approach, the average cost per correct treatment was 3.15 dollars for urethritis and 13.54 dollars for syphilis. CONCLUSION: Syndromic management can provide better treatment for men with STDs at significantly lower cost in resource-poor settings such as China.     

The etiology and management of genital ulcers in the Dominican Republic and Peru

BACKGROUND: Clinical diagnosis of genital ulcers is difficult, and diagnostic tests are least available in settings where rates of disease are highest. The World Health Organization (WHO) has developed protocols for the syndromic management of genital ulcers in resource-poor settings. However, because risk factors, patterns and causes of disease, and antimicrobial susceptibilities differ from region to region and over time, they must be adapted to local situations. GOAL: The goal of this study was to determine etiologic factors, evaluate syndromic management, and compare polymerase chain reaction (PCR) testing with other diagnostic alternatives for genital ulcers among patients attending sexually transmitted disease clinics in the Dominican Republic and Peru. STUDY DESIGN: Eighty-one men with genital ulcers in the Dominican Republic and 63 in Peru underwent identical interviews and identical multiplex PCR (M-PCR) tests of genital lesion specimens for etiologic diagnoses. Algorithms for managing genital ulcers were developed. RESULTS: In the Dominican Republic, 5% were M-PCR-positive for, 26% for, and 43% for herpes simplex virus (HSV); in Peru, 10%, 5%, and 43%, respectively, were positive. The WHO algorithm for treating syphilis and chancroid had a sensitivity of 100%, a positive predictive value (PPV) of 24%, and an overtreatment rate of 76%. A modified algorithm for treating only those without vesicular lesions had 88% sensitivity and a 27% PPV, and the overtreatment rate was reduced to 58%. CONCLUSION: HSV caused 43% of genital ulcers in these populations. The modified algorithm had lower sensitivity but a reduced overtreatment rate. M-PCR testing was more sensitive than standard tests and more specific and sensitive than clinical diagnosis.     

Aetiology of genital ulceration in the Gambia.

The aetiology of genital ulceration was studied in 104 unselected patients (94 men, 10 women) attending a sexually transmitted disease (STD) clinic in the Gambia. Chancroid was diagnosed in 54 (52%), syphilis in 23 (22%), lymphogranuloma venereum (LGV) in seven (7%), and herpes in six (6%). In 28 (27%) patients no diagnosis was reached. Ten (10%) patients were found to have both chancroid and syphilis, three (3%) had both LGV and syphilis, and one (1%) had both herpes and syphilis. Trimethoprim 160 mg and sulphamethoxazole 800 mg twice daily for one week was found to be effective in the treatment of chancroid. This regimen with a single intramuscular injection of benzathine penicillin 2.4 MIU is recommended for the treatment of genital ulcers in Gambian health centres without laboratory facilities.     

The clinical diagnosis of genital ulcer disease in men in the tropics

Since the clinical diagnosis of genital ulcers without laboratory confirmation is not reliable in developed countries, we postulated that clinical diagnosis alone would be no more reliable in developing countries. A presumptive clinical diagnosis of chancroid, genital herpes, syphilis, or lymphogranuloma venereum was made for 100 male patients at the Special Treatment Clinic in Nairobi, Kenya. This diagnosis was then compared to the final diagnosis determined by laboratory identification of the pathogen, by culture, or by serologic response. In 64 patients, a final diagnosis of either chancroid, syphilis, or genital herpes was established. The diagnostic accuracy varied from 75% for chancroid to 42% for syphilis and 43% for herpes. The overall diagnostic accuracy was 66%. The predictive values of positive clinical diagnoses were 84% for chancroid, 60% for syphilis, and 75% for herpes. Thus, clinical diagnosis of genital ulcer disease was not sufficiently reliable in this study.     

Increasing prevalence of genital herpes in developing countries: implications for heterosexual HIV transmission and STI control programmes

BACKGROUND: The recognition that sexually transmitted infections (STI) facilitate HIV transmission among heterosexuals has led to a rejuvenated focus on improving STI control as a component of HIV prevention programmes in developing countries. While efforts so far have focused mainly on all STI, there is increasing evidence that genital ulcers facilitate a considerable proportion of HIV transmission among heterosexuals and that this effect has been underestimated. This paper focuses on the epidemiology of genital herpes in developing countries past and present. OBJECTIVES: To review the scientific literature about the epidemiology of genital herpes in developing countries and discuss the implications of the findings for STI control and HIV prevention programmes. SEARCH METHODOLOGY: A Medline search for June 1966 to August 1999 using the keywords, genital herpes, STD and developing countries, and genital ulcers in MeSH and free text. Abstract books from recent international AIDS conferences and other international STD conferences were reviewed. The annual reports of the medical officers of heath for Harare 1982-1998 and Durban 1989-1997 were reviewed to detect trends in genital herpes diagnoses. FINDINGS: Genital herpes, formerly regarded as a minor STI in most developing countries, has now emerged as a leading cause of genital ulceration in many countries where syphilis and chancroid were more prevalent previously. This increased recognition of genital herpes reflects both a change in the pattern of STI epidemiology through a decline in syphilis and chancroid as a response to HIV control programmes and improved techniques for diagnosing herpetic infection. Countries with significant heterosexual HIV epidemics also appear to have rapidly increasing numbers of genital herpes cases. CONCLUSIONS: The emergence of this herpes epidemic must be addressed through innovative strategies that will be viable, sustainable, acceptable, and effective in developing countries. In countries where genital herpes is a significant problem, local adaptation of WHO treatment algorithms should be made. STI service providers should be trained about issues around the transmission of herpes and how best to advise clients about dealing with, and recognising, recurrences. The effectiveness of antiviral treatment for genital herpes should be investigated in core groups at high risk of HIV.     

Study of genital lesions

A total of one hundred patients (75 males and 25 females) age ranged from 17-65 years with genital lesions attending the STD clinic of Bowring and LC Hospitals Bangalore constituted the study group. Based on clinical features, the study groups were classified as syphilis (39), chancroid (30), herpes genitalis (13), condylomato lato (9), LGV (7t condylomata acuminata (5), genital scabies (3), granuloma inguinole (2) and genital candidiasis (1). In 68% microbiological findings confirmed the clinical diagnosis. Of the 100 cases 13% and 2% were positive for HIV antibodies and HbsAg respectively.     

Genital ulcer disease in women in Durban, South Africa.

OBJECTIVE--To study the microbial aetiology of genital ulcer disease (GUD) in women. DESIGN--Microbial and clinical assessment of genital ulcers in women. SETTING--City Health sexually transmitted diseases clinic, King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS--100 Zulu women with genital ulceration who had not received antibiotics in the previous two weeks. RESULTS--Syphilis was diagnosed in 40%, genital herpes in 18%, donovanosis (granuloma inguinale) in 16%, chancroid in 14%, lymphogranuloma venereum in 7% and scabies in 2%. No recognised cause was detected in 18%. Secondary syphilis was diagnosed in 21%, primary syphilis in 16% and mixed primary and secondary syphilis in 3%. Multiple infections were detected in 13 women, of whom 12 had syphilis. Bleeding was observed from the ulcers of 59 during swab collection. Three women had HIV-1 antibodies. Neisseria gonorrhoeae was isolated from the ulcers and endocervix of two women and from the endocervix alone in nine. Generalised scabies was diagnosed in 14. CONCLUSIONS--All the major causes of GUD are prevalent in Zulu women in Durban: secondary syphilis was the commonest diagnosis. Donovanosis, which often presents late with large ulcers, and genital herpes are now significant problems. Mixed infections with coexisting syphilis are common. All women in this population with GUD should be treated for syphilis and receive oral antibiotics effective for chancroid and donovanosis.     

Clinical patterns of sexually transmitted diseases, associated sociodemographic characteristics, and sexual practices in the Farwaniya region of Kuwait

BACKGROUND: Sexually transmitted diseases (STDs) are common worldwide, but there are few studies available on STDs from the Gulf countries, including Kuwait. Our goal was to determine the clinical patterns, sociodemographic factors, and sexual practices of patients with STDs who attended a government hospital in the Farwaniya region of Kuwait. METHODS: All patients seen over a 1-year period (July 2003 to June 2004), who presented with signs and symptoms suggestive of STDs, were included. Sociodemographic details and clinical findings were recorded. The diagnosis of each STD was based mainly on standard World Health Organization (WHO) criteria and available data. Serologic tests for syphilis and human immunodeficiency virus (HIV) were offered to all patients. RESULTS: One thousand and ninety-six patients (1068 male, 28 female) with STDs constituted 2.84% of all new dermatology patients seen; most (866) were in the 21-40-year age group. The STDs were acquired from commercial sex workers in 844 patients (77%). Heterosexual encounter (99.3%) was the most common mode of acquiring STDs. Urethral discharge was noted in 54.1% of patients, followed by genital ulcers (17.8%), papules/growths (16.4%), and urethral/pubic pain without associated discharge/ulcers (5.9%); these were the four most common presenting complaints. Evaluation revealed gonorrhea in 31.5% of patients, nongonococcal urethritis in 23.6%, chlamydia in 4.1%, nonspecific urethritis in 19.5%, concomitant gonorrhea and chlamydia urethritis in 2.7%, genital warts in 13.7%, chancroid in 13.0%, genital herpes in 4.8%, molluscum contagiosum in 2.7%, and lymphogranuloma venereum in 1.4%. CONCLUSIONS: Urethral discharge, gonorrhea, and nonspecific urethritis (presenting with urethral discharge), followed by genital warts, chancroid, and genital herpes (ulcers), were the most common STDs among male patients in the Farwaniya region of Kuwait. Although no case of HIV or syphilis was detected, health authorities and physicians need to remain vigilant.