未经治疗的披衣菌感染和淋病在青年人中非常常见

需要诊断和治疗性传播疾病的新策略

  2002年2月15日报导──据《The Journal of the American Medical Association》杂志2月13日一期中报导的一项研究结果显示,在Baltimore每12名青年人中,就有1人患有未经治疗的性传播疾病(STD),主要是淋病和披衣菌感染,而且绝大多数是无症状的。

  在编者附录中,Indianapolis,Indiana大学医学院的MS,J. Dennis Fortenberry医师写道:「很明显,临床医师们可以在性健康危险度评价,STD的筛查和治疗,同侪教育和治疗等工作中作得更好。一些病人和医生感到尴尬,或对性健康危险性的评价较低,这些情况都很普遍,但这都不是推脱这项工作的理由。」

  在对Baltimore 年龄在18到35岁之间常住居民,进行这次有关行为的横断面调查中,美国华盛顿特区the Research Triangle研究所的Charles F. Turner博士,和他的同事们估计全部的未经治疗的淋病和披衣菌感染的患病率,并对人群进行分组。

  在1997年1月到1998年9月之间,共有728名年轻人完成面访调查,有579人提供尿液标本,这些标本足够利用连接链方法,来进行淋病和披衣菌感染的核酸扩增检测(NAAT)。

  估计有5.3%的人患有未经治疗的淋病,有3%的人患有未经治疗的披衣菌感染。每种感染的总患病率为7.9%,但是在黑人妇女中,这个率要高得多,达到15.0%。

  作者写道:「在任意一年中,始终未被发现和接受治疗的患有淋病和披衣菌感染的患者的总和,要超过已经诊断并接受治疗的患者的总数。」

  大多数的未经检出的感染者,出现在无症状的成人中,去除在既往的6个月中接受STD治疗的患者外,只有2.0%的人报告排尿困难,只有4.7%的患者报告在过去的6个月中有尿脓的历史症状。

  作者写道:「在这个人群中,降低性病流行的策略可能包括,在青年人中进行筛查或常规的健康体检,接受检查的人群,应包括既往被认为处于感染可能性较低的人群。」

  因为STDs在青少年和成人之间可以互相传染,Turner建议将研究的规模扩大一倍,包括两个年龄组。Fortenberry同意这个建议,并且建议不管费用如何,是否能保密,和出现假阳性后的有害影响,应在学校内进行披衣菌的尿液检查。

  他写道:「我们对STDs不甚了解,不仅仅是因为我们缺乏性病流行的足够信息,社会上对性和STDs的误解及蔑视,使我们对这个生活中重要问题仍不能明白。在既有的STDs死亡率和消耗之成本下,包括由于人类免疫缺陷病毒感染引起的成本消耗,这些对隐藏在性病神秘面纱的将不再可以了解。」

Untreated Gonorrhea, Chlamydia Common in Young Adults

New Strategies Needed for Diagnosis, Treatment of STDs

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Gary D. Vogin, MD

Feb. 15, 2002 -- About one in 12 young adults in Baltimore have an untreated sexually transmitted disease (STD) caused by gonorrhea or chlamydia, and most are asymptomatic, according to a study reported in the Feb. 13 issue of The Journal of the American Medical Association.

"It is clear that clinicians can do a better job with sexual health risk assessments, STD screening and treatment, and partner notification and treatment," J. Dennis Fortenberry, MD, MS, of the Indiana University School of Medicine in Indianapolis, writes in an accompanying editorial. "Embarrassment on the part of the patient or clinician or poor assessment of sexual health risk are common but not satisfactory reasons for avoiding this task."

In this cross-sectional behavioral survey of Baltimore residents aged 18 to 35, Charles F. Turner, PhD, of the Research Triangle Institute in Washington, D.C., and colleagues estimated the prevalence of untreated gonococcal and chlamydial infections overall and within specific demographic subgroups.

Of 728 young adults who completed an interview between January 1997 and September 1998, 579 also provided a urine specimen adequate for nucleic acid amplification testing (NAAT) of gonococcal and chlamydial infection by ligase chain reaction assay.

Estimates were that 5.3% had an untreated gonococcal infection and 3.0% had an untreated chlamydial infection. Overall prevalence was 7.9% for either infection, but the rate was substantially higher, 15.0%, in black women.

"The combined number of gonococcal and chlamydial infections that persist undiagnosed and untreated in this population exceeds the number of infections that are diagnosed and treated in a given year," the authors write.

Most of the undetected infections occurred in asymptomatic adults. Excluding persons receiving treatment for an STD in the previous six months, only 2.0% of those infected reported dysuria, and only 4.7% reported discharge within the past six months.

"Strategies for reducing the prevalence of infection in this population might include screening or routine testing in health care settings for the entire population of young adults, including persons who formerly would be considered to be at low risk of infection," the authors write.

As teenagers and adults can infect each other with STDs, Turner recommends that replication studies include both age groups. Fortenberry agrees and further suggests urine-based testing for chlamydia in schools, despite issues of cost, confidentiality, and potentially harmful effects of false-positives.

"The veils surrounding STDs are not simply those of inadequate documentation of disease prevalence. Societal willingness to stigmatize sexuality and STDs continues to hide issues that are central aspects of our lives," he writes. "Given the morbidity and costs of STDs, including those due to human immunodeficiency virus infection, these are veils that no longer seem affordable."

© 2002 WebMD Inc. All rights reserved.

    
相关报导
兄弟姐妹数目与肿瘤暗指感染
2007/1/5 下午 01:24:00
PET可快速且正确的侦测出人工血管移植引发的感染症状
2004/7/2 上午 09:17:00
穀胺醯胺可改善烧伤病患的治疗结果
2003/11/5 上午 10:50:00

上一页
   1   2   3   4   5   6   7   8   9   10  




回上一页