性病门诊慢性前列腺炎患者支原体及沙眼衣原体感染情况的研究

目的：探讨性病门诊慢性前列腺炎患者支原体及沙眼衣原体感染情况。方法：对门诊205例慢性前列腺炎患者，应用培养法检测支原体，应用单克隆抗体免疫荧光法检测沙眼衣原体，同时设对照组检测。结果：205例慢性前列腺炎患者中68例（33．17％）感染支原体，43例（20．98％），感染沙眼衣原体，对照组中45例中2例（4．44％）感染支原体（X^2=15．0，P＜0．01），1例（2．22％）感染沙眼衣原体（X^2＝8．0，P＜0．01）。结论：支原体主沙眼衣原体为性病后慢性前列腺炎的主要病原体之一。     

Dilated cardiomyopathy associated with Chlamydia trachomatis infection

A 26-year-old man was admitted to hospital with acute myocarditis complicated by congestive heart failure, and atrial and ventricular arrhythmias. Detailed investigations to determine the aetiological factors involved yielded negative results, except for serological evidence of infection with Chlamydia trachomatis. During the follow-up period, dilated cardiomyopathy developed. To the best of our knowledge a similar case has not been reported previously.     

淋球菌、支原体和沙眼衣原体在急性尿道炎中的感染分布及耐药性分析

目的了解淋球菌、支原体和沙眼衣原体在急性尿道炎中的感染分布和耐药情况。方法用培养法对淋球菌和支原体进行分离鉴定和药敏试验，用头孢硝噻吩法对淋球菌进行口一内酰胺酶检测，用单克隆抗体胶体金标法测定沙眼衣原体。支原体药敏试验用支原体药敏试剂盒检测，淋球菌药敏试验采用中K—B法。结果在389份尿道口分泌物标本中，阳性分离率为94．6％。淋球菌β-内酰胺酶的产生率为29．0％，对青霉素的敏感率为2．9％，对氧氟沙星和环丙沙星的敏感率为6．8％和7．2％，对壮观霉素、头孢菌素和头孢西丁的敏感性均较高。支原体对乙酰螺旋霉素、红霉素、环丙沙星、左氧氟沙星和司巴沙星以及壮观霉素的敏感率均不超过50．0％，而对四环素、强力霉素、罗红霉素、美满霉素、交沙霉素和阿奇霉素的敏感率均超过70．0％。结论急性尿道炎患者主要以淋球菌感染为主，支原体和沙眼衣原体可引起混合感染。监测淋球菌和支原体的耐药性对指导临床合理使用抗生素有重要意义。     

尿道灌注治疗衣原体和脲原体性尿道炎

目的：探讨乳糖红霉素和地塞米松尿道灌注治疗沙眼衣原体（ＣＴ）和（或）解腺原体（ＵＵ）性尿道炎的疗效。方法：筛选出１５０例不并发淋病、附睾炎及前列腺炎，有尿道炎症状，尿道分泌物荧光聚酶链反应检查ＣＴ和（或）ＵＵ阳性病例，随机分为３组，每机分为３组，每组各５０例。服药组，口服福爱力红霉素；灌注组，用１％乳糖红霉素和０．５％地塞米松作尿道灌注；对照组，尿道灌注生理盐水。１０ｄ为１个疗程。结果：经过１～２     

Underrecognition of Cervical Neisseria gonorrhoeae and Chlamydia trachomatis Infections in the Emergency Department

Objectives : 1) To quantify the frequency of underrecognized Neisseria gonorrhoeae and Chlamydia trachomatis cervical infections in women tested in the ED, 2) to describe and compare the characteristics of those treated and not treated during the initial visit, and 3) to quantify the delay interval until treatment was provided. Methods : A 2-year, retrospective consecutive case series was performed from June 1, 1992, to May 31, 1994. There were 148 women with ≥1 discrete occurrence of culture-proven cervical N. gonorrhoeae or C. trachomatis infection studied. All the patients were evaluated in a university-affiliated, tertiary care hospital-based ED with a large rural referral area. The main outcome measures were the proportions of patients with positive cultures both treated and not treated in the ED, the clinical characteristics of each group, and the proportion remaining untreated or experiencing treatment delays of ≥ 2 weeks after attempted phone, mail, and public health follow-up. Results : Of 157 occurrences of positive cultures for N. gonorrhoeae or C. trachomatis, 86 (53%) were treated with a regimen suggested by the CDC prior to ED release. The proportion of women with isolated C. trachomatis infections that were underrecognized and untreated initially was larger than the proportions with isolated N. gonorrhoeae or combined infections (79% vs 27% and 53%, respectively, p < 0.0001). Women with findings suggestive of advanced disease (history of fever or chills, or examination evidence of temperature >38°C, purulent vaginal discharge, or any uterine/salpinx/ovarian tenderness) were more often recognized and treated with appropriate antibiotics initially (p = 0.02 to <0.00001 for all). After phone, mail, and public health follow-up, treatment could not be documented for 25% of the occurrences, in all cases due to an inability to locate the patient. An additional 20% of the women did not receive treatment for 14–60 days. Conclusions : In this population, both N. gonorrhoeae and C. trachomatis cervical infections are frequently underrecognized in the ED, with isolated C. trachomatis infections associated with significantly higher proportions of underrecognition. Many affected women remain untreated for extended intervals, creating public and individual health risks. Improved point of contact detection, follow-up, and treatment policies are needed to limit these risks.     

Chlamydia trachomatis Infection Is Related to Poor Semen Quality in Young Prostatitis Patients

Background

The impact of chronic prostatitis resulting from Chlamydia trachomatis infection on male fertility is controversial.

Objective

To investigate the correlation between C. trachomatis infection and semen quality in young male patients affected by chronic prostatitis resulting from C. trachomatis infection and to evaluate the correlation between anti–C. trachomatis immunoglobulin (Ig) A against heat shock protein 60 (HSP60), heat shock protein 70 (HSP70), and semen parameters.

Design, setting, and participants

All patients with clinical and instrumental diagnosis of chronic prostatitis underwent microbiological cultures for common bacteria, DNA extraction, mucosal and serum antibody evaluation for C. trachomatis, and semen parameter analysis. Western blot analysis of mucosal anti–C. trachomatis IgA was performed.

Interventions

Subjects were split into two groups: Group A consisted of patients with chronic prostatitis resulting from common bacteria (uropathogens), and group B consisted of patients with chronic prostatitis resulting from C. trachomatis infection.

Measurements

The relationship between C. trachomatis infection and semen parameters as well as the correlation among IgA levels, IgA characterisation, and semen analysis were determined.

Results and limitations

We enrolled 1161 patients (mean age: 36.5 yr). Of these, 707 patients were placed in group A, and 454 were placed in group B. Significant statistical differences were reported between groups in terms of sperm concentration (p < 0.001), percentage of motile sperm (p < 0.001), and normal morphologic forms (p < 0.001). Strong correlations between mucosal anti–C. trachomatis IgA and sperm concentration (p < 0.001) and normal morphologic forms (p < 0.001) were reported. Correlations among positivity to HSP60, HSP70, and sperm concentration (p < 0.003) and normal morphologic forms (p < 0.001) were also reported.

Conclusions

This study demonstrated the role of chronic prostatitis resulting from C. trachomatis in male fertility decrease, highlighting probable immunomediated damage to germinal cells because of C. trachomatis infections.     

Genital Chlamydia trachomatis infections

Chlamydia trachomatis infections affect young, sexually active persons. Risk factors include multiple partners and failure to use condoms. The incidence of infection has increased in the past 10 years. Untreated C .  trachomatis infections are responsible for a large proportion of salpingitis, ectopic pregnancy, infertility and, to a lesser extent, epididymitis. Screening is a possible intervention to control the infection, which is often asymptomatic. The emergence of lymphogranuloma venereum proctitis in men who have sex with men, in Europe, and of a variant with a deletion in the cryptic plasmid, in Sweden, are new features of C .  trachomatis infections in the last years. A diagnosis is best made by using nucleic acid amplification tests, because they perform well and do not require invasive procedures for specimen collection. Single-dose therapy has been a significant development for treatment of an uncomplicated infection of the patient and his or her sexual partner.     

沙眼衣原体L2型MOMP基因真核表达载体的构建及序列分析

目的 构建携带沙眼衣原体L2型主要外膜蛋白（MOMP）基因的真核表达载体,为沙眼衣原体的DNA疫苗的研究提供材料。方法 用PCR技术扩增L2型沙眼衣原体MOMP基因片段,再将其定向插入到真核表达载体pcDNA3多克隆位点中,构建成重组表达质粒。并用酶切分析、PCR扩增及部分序列测定等方面对重组质粒进行了鉴定。结果 MOMP基因被正确地克隆到直核表达载体pcDNA3中。测序结果同文献报道的序列一致。结论 真核细胞表达载体pcDNA3－MOMP的成功构建,为进一步开展沙眼衣原体的DNA疫苗的研究奠定了基础。     

沙眼衣原体和支原体所引起非淋菌性尿道炎和宫颈管炎的临床资料分析

目的 对76例临床症状不突出,容易被忽视的沙眼衣原体和支原体引起的非淋菌性尿道炎和宫颈管炎的临床资料进行分析.方法 设计调查表格,由有丰富临床经验的医生对病人进行调查和填写表格;沙眼衣原体实验室诊断采用英国CLEARVIEW试剂盒,支原体由液体培养基培养.采用淋球菌培养方法除外淋球菌感染.结果 男性尿道沙眼衣原体或支原体感染,表现为尿道口稀薄分泌物占74.4%(29/39).女性宫颈管沙眼衣原体或支原体感染,宫颈管口粘液脓性分泌物占64.9%(29/37).结论 沙眼衣原体或支原体引起的男性尿道感染,以尿道稀薄分泌物为特征;引起的女性宫颈管炎,以宫颈管口粘液脓性分泌物为特征.     

酶免疫法对沙眼衣原体诊断价值的Meta分析

目的系统评价酶免疫法诊断沙眼衣原体的准确性。方法计算机检索PubMed（1966～2011．12）、TheCochraneLibrary（2011．12）、EMbase（1974～2011．12）、CNKI（1994—2011．12）、VIP（1989—2011．12）和CBM（1978—2011．12）,并辅助手工检索和其他检索,收集EIA诊断沙眼衣原体的试验研究。由两名评价者依据QUADAS质量评价标准评价纳入研究的质量后,采用MetaAnalyst和RevMan5．0软件进行Meta分析。结果最终共纳入17个研究,9461例受试者。Meta分析结果显示：酶免疫法诊断沙眼衣原体的合并敏感度、特异度、阳性似然比、阴性似然比、诊断比值比和SROC曲线下面积分别为O．847[95％CI（O．571,O．995）]、0．964[95％CI（0．890,0．994）j、25．972195％CI（18．587,36．293）j、0．156[95％CI（0．114,0．212）j、228．875[95％CI（127．136,412．028）]和0．953。结论酶免疫法对诊断沙眼衣原体具有较高的敏感度和特异度,推荐酶免疫法用于沙眼衣原体的初筛及确诊高度疑似病例或症状体征不明显的患者。