Effectiveness of a Universally Offered Chlamydia and Gonorrhea Screening Intervention in the Pediatric Emergency Department

PurposeAdolescents represent more than half of the newly diagnosed sexually transmitted infections in the U.S. annually. Emergency departments (EDs) may serve as an effective, nontraditional setting to screen for chlamydia/gonorrhea (CT/GC). The objective was to evaluate the effectiveness of a universally offered CT/GC screening program in two pediatric ED settings.MethodsThis was a prospective, delayed start pragmatic study conducted over 18 months in two EDs within the same academic institution among ED adolescents aged 14–21 years with any chief complaint. Using a tablet device, adolescents were confidentially informed of CT/GC screening recommendations and were offered screening. If patients agreed to CT/GC testing, a clinical decision support tool was triggered to inform the provider and order testing. The main and key secondary outcomes were the proportion of CT/GC testing and positive CT/GC test results in each respective ED.ResultsBoth EDs experienced modest but statistically significant increases in CT/GC testing post- versus pre-intervention (main: 11.5% vs. 7.9%; confidence interval [CI]: 2.9–4.2; p < .0001 and satellite: 3.8% vs. 2.6%; 95% CI: .7–1.7; p < .0001). Among those tested, the positivity rate at the main ED did not significantly change post- versus pre-intervention (24.1% vs. 23.2%; 95% CI: ?1.9 to 3.8; p = .71) but significantly decreased at the satellite ED (7.6% vs. 14.8%; 95% CI: ?12.2 to ?2.2; p = .01).ConclusionsA universally offered screening intervention increased the proportion of adolescents who were tested at both EDs and the detection rates for CT/GC at the main ED, but patient acceptance of screening was low.     

Characteristics of rectal chlamydia among men who have sex with men in southern Taiwan, 2020–2022: An emerging threat of rectal lymphogranuloma venereum L2b

BackgroundThe prevalence of rectal chlamydia among men who have sex with men (MSM) without human deficiency virus infection (non-HIV) remains uncertain in Taiwan, and rectal lymphogranuloma venereum (LGV) among MSM has never been reported in the Far East.Material and methodsFrom January 2020 to April 2022, MSM coming for anonymous voluntary counseling and testing, for pre-exposure prophylaxis, and for antiretroviral therapy were enrolled. All participants submitted his fecal samples and completed a QR-code questionnaire. Medical records of those who took regular medical visits for HIV were recorded. Multiplex polymerase chain reaction (PCR) was performed for all fecal samples, and ompA gene sequencing was therefore performed for each Chlamydia-positive fecal sample.ResultsAmong 341 MSM during 2020–2022 in southern Taiwan, 21 (6.2%) had rectal chlamydia infection. Risk factors of rectal chlamydia included co-infection with rectal gonorrhea (adjusted odds ratio [AOR] 6.78, 95% confidence interval [CI] 1.44–31.91, P = 0.015) and multiple sexual partners (AOR 1.373, 95% CI 1.002–1.882, P = 0.048). Further ompA gene sequencing from 19 Chlamydia-positive fecal samples revealed that the prevalent genotypes or genovariants were Da (26.3%) and L2b (26.3%), followed by B (21.1%), J (14.3%), and G (9.5%). All cases of rectal LGV genovariant L2b presented as acute proctitis with diarrhea, anal pain, or discharge and were treated successfully with prolonged treatment of doxycycline.ConclusionsRectal gonorrhea and multiple sexual partners are risk factors for rectal chlamydia. Clinicians in Taiwan should be aware of the emerging threat of rectal LGV among MSM with acute proctitis.     

口服抗生素治疗单纯性淋病的疗效观察

目的　评价口服左旋氧氟沙星、头孢克洛在治疗单纯性淋病中的疗效、不良反应。方法　 138例单纯性淋病病人随机分成三组 :A组用左旋氧氟沙星 2 0 0mg ,2次 /d ,共 1周 ;B组用头孢克洛 0 5 g ,3次 /d ,共 1周 ;C组用头孢曲松 2 5 0mg ,单剂量肌注。 结果　A、B、C三组痊愈率分别为 85 94 %、83 33%、87 5 0 % ,三组间差异无显著意义 (P >0 0 5 ) ;B组未发现不良反应 ,A、C两组临床不良反应发生率分别为3 13%、15 6 3%。C组与A组或B组间不良反应差异有非常显著意义 (P <0 0 1)。结论　口服左旋氧氟沙星、头孢克洛治疗单纯性淋病疗效满意、服药方便、安全 ,同时减少了不良反应的发生 ,值得临床推广应用。     

淋病患者支原体、衣原体感染分析

目的为了解淋病患者解脲脲支原体(Uu)、人支原体(Mh)、肺炎支原体(Mpn)、生殖道支原体(Mg)、穿透支原体(Mpe) 、发酵支原体(Mf)、梨形支原体(Mpi)和沙眼衣原体(Ct)合并感染情况. 方法采用套式聚合酶链反应(nPCR)和聚合酶链反应(PCR)技术,对100例女性淋病患者宫颈分泌物和91例男性淋病患者尿道分泌物做了上述7种支原体和沙眼衣原体的检测. 结果在女性淋病患者中,Uu、Mh、Mpn、Mpe、Mg、Mf、Mpi和Ct的检测率分别为46%、34%、18%、13%、11%、4%、0、13%,在男性淋病患者中,Uu、Mh、Mg、Mpe、Mpn、Mf、Mpi和Ct的检测率分别为48.4%、14.3%、13.2%、13.2%、8.8%、1.1%、0、5.5%. 结论在淋病患者中支原体和沙眼衣原体合并感染严重.     

2004～2011年广西天等县淋病、梅毒、AIDS／HIV流行病学特征分析

目的了解广西天等县近年梅毒、淋病、艾滋病和HIV阳性病例流行病学特征,分析其流行规律,为该县制定防治策略提供科学依据。方法收集该县2004～2011年的梅毒、淋病、AIDS／HIV阳性病例疫情资料,采用Excel软件进行统计分析。结果2011年全县总人口33万,2004～2011年8年报告梅毒、淋病、艾滋病和HIV阳性病例共1576例,年均人群发病率为60．46／10万,其中淋病为19．26／10万,梅毒为33．30／10万,AIDS／HIV阳性为7．90／10万,年均人群死亡率为2．46／10万,为该县引起死亡病例的主要传染病。患者中男性高于女性为1．19：1,全县各乡镇各种职业和各年龄组均有患者存在,以农民发病人数为最多占74．94％。梅毒和AIDS／HIV阳性病例近几年呈现较明显的平行上升,两种病例数之比为4．21：1。结论该县淋病、梅毒、AIDS／HIV阳性病例逐年增多,AIDS／HIV阳性病例已从城市向农村、从高危人群向普通人群扩散,并以性传播为主,需进一步加强当地的防治工作。     

头孢地嗪联合氧氟沙星对淋病患者症状改善的影响作用分析

目的:头孢地嗪联合氧氟沙星对淋病患者症状改善的影响作用分析。方法:选取自2014年3月至2015年11月在医院接受治疗的淋病患者118例实施研究。按照数字随机表法将118例患者分成观察组以及对照组各59例,为对照组患者给予头孢地嗪治疗,为观察组患者给予头孢地嗪以及氧氟沙星的联合治疗,对比两组患者的疗效、复发情况、治疗前后细胞因子水平(TNF-α、IL-10及Hs-CRP),以及用药后的不良反应情况。结果:观察组的总有效率是96.61%,与对照组的84.75%相比,差异显著(P0.05)。观察组患者的复发率是0,与对照组的14.81%相比,差异显著(P0.05)。两组治疗后的TNF-α、IL-10及Hs-CRP水平均显著低于各自治疗前,且观察组治疗后的TNF-α、IL-10及Hs-CRP水平均显著低于对照组(P0.05)。观察组患者不良反应的总发生率是6.78%,与对照组的11.86%相比,差异不显著(P0.05)。结论:头孢地嗪与氧氟沙星联合治疗淋病,具有较好的疗效,能够有效改善患者的临床症状,且安全性较高,值得给予推荐。     

深圳市淋病报告发病率影响因素分析

目的：分析影响深圳市淋病报告发病率的因素,并评估其影响程度。方法：用按比例分层随机抽样法从全市144家性病网络直报医疗机构中抽取34家作为调查点,将2009年10月1日至2009年lO月31日期间,首次主动前往调查点皮肤性病科、妇产科、泌尿外科门诊寻求性病诊疗服务的就诊者作为研究对象。评价是否检测淋球菌、实验室淋球菌检测能力和是否漏报等环节对淋病报告发病率的影响。结果：2534名就诊者中性病门诊实验室淋球菌漏检率为7．3％,漏诊率为62．3％,误诊率为18．6％。性病门诊检测阳性结果的漏报率为6．2％。性病门诊报告发病数为实际发病数的37．1％。结论：漏检、漏诊、误诊和漏报等因素对淋病报告发病率造成了不同程度的影响,在不考虑其他影响因素的情况下,淋病报告发病率只反应了真实发病率的37．1％。     

安阳市1995年~2004年淋病流行病学分析

目的了解安阳市1995年~2004年淋病的流行病学情况和发展趋势,为制定科学的性病防治措施提供可靠的依据。方法对安阳市1995~2004年淋病的疫情资料进行流行病学统计分析。结果(1)淋病的发病在1995年~2001年为上升阶段,2002年~2004年呈下降趋势。淋病构成比随年份下降有显著性意义(r=-0.7626,tr=4.4260,p<0.01)(2)男性发病高于女性,男女之比为2.05∶1。淋病的高发年龄段为(20~29)岁和(30~39)岁,分别占淋病总数的42.67%、35.31%。(3)职业分布以农民(34.6%)、工人(30.81%)为主;文化程度以中学、小学文化程度居多,共占86.19%。地区分布与流动人口和医疗机构的数量有关。结论安阳市的淋病发病仍未得到根本控制,防治工作仍需加大力度。     

2005年～2010年连州市女性淋病流行病学分析

目的:了解连州市女性淋病的流行状况,为今后制定女性淋病防治策略提供科学依据。方法:对国家疾病监测信息报告管理系统中女性淋病相关数据用描述性流行病学方法进行分析。结果:2005～2010年连州市共报告女性淋病93例,年发病率介于2.86/10万～12.18/10万之间,年均发病率为7.16/10万。高发年龄为20～29岁组,共报告38例,占报告病例总数的40.86%。职业以农民为主,共报告69例,占报告病例总数的74.19%。地区分布以连州镇报告病例最多,共报告23例,占报告病例总数的24.73%。结论:针对连州市女性淋病疫情情况,建议加强健康教育力度、加强对医务人员专业知识培训及政府各部门各司其职,阻断淋病的蔓延。