江苏省部分城市男男性接触者性传播疾病流行情况调查

【摘要】 目的 探讨江苏省部分城市男男性接触者（MSM）人群性传播疾病（STD）的流行情况。 方法 用横断面调查。选择在江苏省部分城市MSM酒吧活动的人群，填写调查问卷并自愿选择STD检测。对MSM人群性传播疾病病原体相关因素分析用单因素分析和Logistic回归分析。结果 388人接受问卷调查、体检并提供检测标本，仅有同性性行为者占45.6％。尿液及尿拭子实验室检测：淋球菌阳性率1.3％（5/388），沙眼衣原体9.4％（36/385），生殖支原体17.2％（66/384）。血清学检查人类免疫缺陷病毒（HIV）抗体阳性率1.0% （4/388），梅毒螺旋体明胶凝集试验（TPPA）阳性率18.8％（73/388），快速血浆反应素试验（RPR）阳性率12.1％（47/388），2型单纯疱疹病毒（HSV-2）IgG抗体阳性率9.8％（38/388），乙型肝炎病毒表面抗原（HBsAg）、 丙型肝炎病毒（HCV）抗体、戊型肝炎病毒（HEV）抗体的阳性率分别为9.8％（38/388）、1.0%（4/388）和2.1％（8/388）。尿拭子涂片中性粒细胞计数是沙眼衣原体感染的独立相关因素［调整比值比（AOR）：5.30，95% CI：2.04 ~ 13.77，P < 0.01］。生殖支原体感染与年龄（AOR：2.84，95% CI：1.17 ~ 6.87，P < 0.05）、尿拭子涂片中性粒细胞计数（AOR：2.37，95% CI：1.01 ~ 5.57，P < 0.05）、尿道不适症状（AOR：2.43，95% CI：1.18 ~ 5.02，P < 0.05）的相关性具有统计学意义。梅毒感染（RPR与TPPA检测同时阳性）与年龄（AOR：2.46，95% CI：1.05 ~ 5.75，P < 0.05）、HSV-2抗体（AOR：3.70，95% CI：1.62 ~ 8.44，P < 0.01）有显著相关性。结论 MSM人群中具有较高的STD患病率，沙眼衣原体和生殖支原体是MSM人群尿道炎的主要病原体。 【关键词】 同性恋，男性； 性传播疾病； 性行为

Prevalence of sexually transmitted diseases among men who have sex with men in some cities of Jiangsu province

LIU Pai, CAO Ning-xiao, SHI Mei-qin, ZHANG Jin-ping, JIANG Juan, SUN Jian-fang. Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China Corresponding authors: JIANG Juan, Email: drjjiang@vip.163.com; SUN Jian-fang, Email: fangmin5758@aliyun.com 【Abstract】 Objective To estimate the prevalence of sexually transmitted diseases（STDs） among men who have sex with men（MSM） in some cities of Jiangsu province. Methods A cross-sectional questionnaire survey was carried out among MSM attending gay bars in some cities of Jiangsu province. Participants underwent screening for STDs in accordance with their personal wishes. Urethral swabs, first void urine and blood samples were collected at these survey sites and delivered to the STD research laboratory for testing. Univariate analysis and multivariate logistic regression analysis were performed to assess factors associated with STDs. Results A total of 388 subjects completed the questionnaire and underwent physical examination and STD screening. Of these subjects, 45.6% had only homosexual behavior. Examination of urine or urethral swab specimens showed that the prevalence rate was 1.3％ （5/388）, 9.4％ （36/385）, 17.2％ （66/384） and 28.1％ （109/388） for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and Ureaplasma urealyticum infection respectively. Serological tests revealed that the positivity rate was 1.0% （4/388） for anti-human immunodeficiency virus （HIV） antibody, 18.8％（73/388） for Treponema pallidum particle agglutination assay （TPPA）, 12.1％（47/388） for rapid plasma reagin （RPR） test, 9.8％ （38/388） for human herpes simplex virus （HSV）-2-IgG, 9.8％ （38/388） for hepatitis B surface antigen, 1.0% （4/388） for anti-hepatitis C virus antibody and 2.1％ （8/388） for anti-hepatitis E virus antibody. Multivariate analysis indicated that Chlamydia trachomatis infection was independently and significantly associated with polymorphonuclear leucocyte （PMNL） counts in urethral swab smears （adjusted odds ratio （AOR）: 5.30, 95% CI: 2.04 － 13.77, P < 0.01）, Mycoplasma genitalium infection was significantly associated with age （AOR: 2.84, 95% CI: 1.17 － 6.87, P < 0.05）, PMNL counts in urethral swab smears （AOR: 2.37, 95% CI: 1.01 － 5.57, P < 0.05） and urethral discomfort in the past three months （AOR: 2.43, 95% CI: 1.18 － 5.02, P < 0.05）, and syphilis （defined as a positive TPPA and RPR test） was associated with age （AOR: 2.46, 95% CI: 1.05 － 5.75, P < 0.05） and seropositivity for anti-HSV-2 antibodies （AOR: 3.70, 95% CI: 1.62－8.44, P < 0.01）. Conclusions There is a high prevalence of STDs among MSM attending gay bars in some cities of Jiangsu province, with Chlamydia trachomatis and Mycoplasma genitalium as the most common pathogens of urethritis. 【Key words】 Homosexuality, male; Sexually transmitted diseases; Sexual behavior