CDC提出性病年报


  January 13, 2009 — 美国疾病管制局(CDC)的2007年性病(STDs)年报显示,性病有高发病率,特别是妇女和少数民族;在美国,2007年的披衣菌和淋病案例超过140万人,这些疾病蝉连全国最高感染症报告频率。
  
  这些性病可能因为造成不孕或者生育力不佳而异发复杂;举例来说,未治疗的披衣菌和淋病感染可能造成40%的骨盆腔感染症,每年引起多达50,000名妇女不孕。未治疗的披衣菌和淋病感染也可能造成子宫外孕、慢性骨盆痛以及其它并发症。如果及时诊断和治疗,可以预防这些并发症。
  
  诊断与治疗并不困难,但是通常无法侦测无症状的案例,估计有半数以上新的披衣菌和淋病感染未被诊断。CDC因此建议所有26岁以下、有性经验的女性每年进行披衣菌筛检,且该局也支持美国预防服务任务小组对高风险、有性经验妇女的筛检建议。
  
  除了披衣菌和淋病感染增加较多之外,梅毒也持续增加。梅毒一度曾经几乎绝迹,但是在2001年再度出现,且之后每年逐年增加,2006至2007年间大幅增加了15.2%。
  
  CDC性病预防小组主任John M. Douglas, Jr医师在新闻稿中表示,这些疾病的广泛发生率强烈提醒我们,性病在美国仍然是严重的健康威胁,特别是妇女和少数民族。若未治疗,披衣菌和淋病会造成不孕,影响妇女后续生儿育女的机会。只要增加预防工具之使用并且普及到所有需要的人,这种严重后遗症其实是可以避免的!
  
  在2007年,超过110万个披衣菌案例— 较2006年的100万案例增加— 是CDC所有通报类别中数量最多的;2007年时,妇女的案例比率是男性的3倍(每10万名妇女有543.6案例,每10万名男性有190案例)。
  
  2007年有超过350,000个淋病案例,成为第二多的感染症;和披衣菌一样,女性案例较多(每10万名妇女有123.5案例,每10万名男性有113.7案例)。
  
  CDC的报告也指出,在最常见的三种性病中,也存在有种族差异,非裔美国人感染最严重;在2007年,黑人占美国人口的12%,但是淋病案例有70%、披衣菌案例有48%、梅毒案例有46%是黑人。
  
  15至19岁黑人女性的披衣菌比率最高(每10万人有9646.7案例)、淋病也很高(每10万人有2955.7案例),这些疾病会造成潜在的生育伤害。20至24岁黑人妇女的这些疾病流行率次高。
  
  社会经济状态是性方面健康的重要预测因子,在这族群中可能与流行率增加有部份关系,黑人的贫困比率比白人高;少数民族的性病发生率与流行率较高,可能是因为社会经济障碍而无法获得有质量的健康照护与性病预防及治疗服务。
  
  Douglas 医师表示,性病比率的种族差异是国内各种健康状况中差异最大的,我们必须更佳努力让这些社区有所需要的筛检与治疗服务,检查与感染的知识是迈向继续减少这些疾病的重要开端。
  
  梅毒比率在同性恋和双性恋男性中也有差异,2007年的11,466例原发和次发梅毒案例中,男男性行为者(MSM)占了65%,MSM者的梅毒比率增加是造成美国整体比率增加的主因;MSM者中,梅毒有潜在的HIV传染可能,且此病和中风与其它不可逆并发症有关,特别是那些已经感染HIV者;CDC建议所有MSM者应该每年或者更频繁的梅毒筛检。
  
  虽然女性的梅毒比率比男性少(每10万名妇女有1.1例、男性则为6.6例),妇女和婴儿梅毒比率最近增加,然而,之前几年是减少的。自2004年之后,妇女梅毒比率开始增加。 接下来的次年,先天梅毒比率于2007年时增加。这些倾向是个警讯,因为从孕妇垂直传染未治疗的梅毒给婴儿的风险会造成死胎、婴儿死亡、或者存活的婴儿出现严重并发症,因此,CDC要求所有孕妇在怀孕初期必须进行梅毒筛检。
  
  CDC建议多方面扩大预防计画,以减少性病发生,每年将近有1,900万个新的性病案例,其中15至24岁者占了约半数,伴随的风险包括降低生育力、增加罹患HIV之风险、还有其它健康伤害;根据CDC表示,美国健康照护费用中,与性病相关的约有153亿美元。
  
  CDC 建议的性病预防综合计画包括筛检、治疗与行为介入,为了减少健康上的差异,这些更应注重在风险最高的种族和族群。
  
  为了降低披衣菌比率,CDC最近建立国家披衣菌联盟,与「预防合作伙伴」和其它八个主要性病机构合作;虽然自1999年之后,CDC针对梅毒就有类似的联盟合作努力,有些区域和族群获得成功,其它则是继续增加,这需要联邦、州、与地方政府持续优先努力。
  
  作者结论表示,利益组织、公私立机构和社区都是降低性病与相关健康问题的关键。
  
  CDC. 性病监督委员会,2007. Atlanta, GA: 美国健康与人类服务部;2008年12月。

CDC Issues Annual Report on Sexually Transmitted Diseases

By Laurie Barclay, MD
Medscape Medical News

January 13, 2009 — The new annual report of the US Centers for Disease Control and Prevention (CDC) on sexually transmitted diseases (STDs) for 2007 shows a high burden of STDs, especially among women and racial minorities. In the United States, reported cases of chlamydia and gonorrhea exceeded 1.4 million in 2007. These illnesses continued to be the most frequently reported infectious diseases nationwide.

These STDs may be complicated by loss or impairment of fertility. For example, pelvic inflammatory disease may result from nearly 40% of all untreated chlamydia and gonorrhea infections, causing infertility in up to 50,000 women annually. Ectopic pregnancy, chronic pelvic pain, and other complications may also result from untreated chlamydia or gonorrhea. These complications may be preventable if the disease is diagnosed and treated in a timely manner.

Diagnosis and treatment are not difficult, but asymptomatic cases often go undetected, and estimates suggest that more than half of all new infections with chlamydia and gonorrhea remain undiagnosed. The CDC therefore recommends that all sexually active women younger than 26 years be screened annually for chlamydia, and the agency supports the recommendations of the US Preventive Services Task Force for gonorrhea screening in high-risk, sexually active women.

Potentially of even greater concern than the increase in chlamydia and gonorrhea is the continued increase in syphilis. Although once nearly eliminated, syphilis resurfaced in 2001 and has increased in prevalence each year since, with a dramatic 15.2% increase from 2006 to 2007.

"The widespread occurrence of these diseases should serve as a stark reminder that STDs remain a serious health threat in the United States, especially for women and racial and ethnic minorities," John M. Douglas, Jr, MD, director of CDC's Division of STD Prevention, said in a news release. "Left untreated, chlamydia and gonorrhea can cause infertility, affecting a woman's chance to bear children later in life. Such a severe consequence is entirely avoidable, if as a nation we work together to increase the use of proven prevention tools and make them widely available to those who need them."

In 2007, more than 1.1 million chlamydia cases were reported — an increase from about 1 million in 2006 — the largest number of cases ever reported to CDC for any condition. The rate among women was 3-fold that of men in 2007 (543.6 cases per 100,000 women vs 190 cases per 100,000 men).

There were more than 350,000 cases of gonorrhea reported in 2007, making it the second most commonly reported infectious disease. As with chlamydia, more cases were reported in women (123.5 per 100,000 women vs 113.7 per 100,000 men).

The CDC report also highlights continued racial disparities in prevalence of the 3 most common reportable STDs, with African Americans most heavily affected. In 2007, blacks represented 12% of the US population but accounted for 70% of reported gonorrhea cases, 48% of all chlamydia cases, and 46% of all syphilis cases.

Black women aged 15 to 19 years had the highest rates of chlamydia (9646.7 per 100,000 population) and gonorrhea (2955.7 per 100,000 population), which is especially concerning because of the potential reproductive harms associated with these diseases. Prevalence rates for these diseases was second highest among black women aged 20 to 24 years.

Socioeconomic status, which is an important predictor of sexual health, may be partly responsible for increased prevalence in this population, with higher poverty rates reported among blacks than among whites. The higher prevalence and incidence of STDs among racial and ethnic minorities may stem from socioeconomic barriers to quality healthcare and to services for STD prevention and treatment.

"The racial disparities in rates of STDs are among the worst health disparities in the nation for any health condition," Dr. Douglas said. "We must intensify efforts to reach these communities with needed screening and treatment services. Testing and the knowledge of infection is a critical first step toward reducing the continued consequences of these diseases."

Disparities in syphilis rates are also evident among gay and bisexual men. Of the 11,466 primary and secondary syphilis cases reported in 2007, men who have sex with men (MSM) accounted for 65%, suggesting that increased transmission of syphilis among MSM is the primary driver of increased overall US rates. In MSM, syphilis can potentiate HIV transmission, and it has been associated with strokes and other irreversible complications, especially in those who are already infected with HIV. Annual or more frequent syphilis screening is recommended by the CDC for all MSM.

Although syphilis rates are still much lower among women than among men (1.1 cases per 100,000 among women vs 6.6 cases among men), women and infants have recently had increasing syphilis rates despite declining rates in prior years. Since 2004, syphilis rates among women have increased. For the second consecutive year, the rate of congenital syphilis increased in 2007. These trends are alarming because of the risk for transmission of untreated syphilis from a pregnant woman to her infant, resulting in stillbirths, infant deaths, or severe complications in surviving children. Therefore, all women in the early stages of pregnancy should be screened for syphilis, according to the CDC.

The CDC recommends expanded prevention programs on many fronts to reduce the health burden of STDs. Of the nearly 19 million new cases of STDs annually, 15- to 24-year-olds account for almost half, with attendant risks including reduced fertility, increased risk for HIV acquisition, and other health harms. Estimated US healthcare costs related to STDs approach $15.3 billion each year, according to the CDC.

CDC recommendations for STD prevention are a comprehensive program including screening, treatment, and behavioral interventions. To reduce health disparities, these measures should particularly target racial and ethnic groups at greatest risk.

In an attempt to lower chlamydia rates, the National Chlamydia Coalition was recently established by the CDC in collaboration with the Partnership for Prevention and 8 other leading STD organizations. Although similar CDC collaborative efforts have been underway for syphilis since 1999, successes in some areas and populations continue to be offset by increases in others, requiring ongoing shifting of priorities at the federal, state, and local levels.

"Organized collaboration among interested, committed public and private organizations and communities is the key to reducing STDs and their related health burdens," the report authors conclude.

CDC. Sexually Transmitted Disease Surveillance, 2007. Atlanta, GA: US Department of Health and Human Services; December 2008.

    
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