尿液检测无法测出性病


  【24drs.com】根据在圣地牙哥举办的IDWeek 2015会议中发表的一篇新研究,当HIV阳性的男性只有使用尿液筛检时,大多数淋病和披衣菌感染无法测出。
  
  奥马哈内布拉斯加大学医学中心Uriel Sandkovsky医师表示,许多研究显示,有男男性行为者,患有性病的机率高于一般人,而许多生殖器外感染是无症状的;如果你试著要发现无症状的性病,你应该要检测其它解剖部位,而不是用最简单的方法。
  
  Sandkovsky医师等人评估了奥马哈、道格拉斯郡、有男男性行为的149名HIV阳性男性的尿液、咽喉、直肠样本,发现12.1%同时有淋病和披衣菌感染。
  
  检测阳性的18名研究对象中,14人是藉由咽喉、直肠样本确认,只有4人是由尿液检测确认。
  
  Sandkovsky医师报告指出,生殖器外部位的性病检测发生率优于只有尿液检测(11% vs 3%),事实上,当有检测生殖器外部位时,测得淋病或披衣菌的机会比尿液检测高3.67倍。
  
  他表示,只有尿液检测时,会错过所有的淋病感染、错过75%的披衣菌感染;当有检测生殖器外部位时,测得淋病或披衣菌的机会大幅增加。
  
  对于性病检测阳性或者没有性病者,去年一年的平均性伴侣人数都是3人,两组在使用保险套方面的报告也没有差异。
  
  不过,淋病或披衣菌检测阳性的人,在过去一年曾有肛交的比率显著高于这两个疾病都检测阴性者(P= .02)。
  
  在过去6个月曾经使用古柯碱的男性,比没有使用过古柯碱者更容易性病检测阳性(P= .05),曾使用过甲基安非他命的男性也是(P= .004)。研究世代中,淋病比率为2.7%,是该郡总人口在此疾病之比率的17倍,披衣菌比率为10.7%,是该郡总人口在此疾病之比率的18 倍。
  
  华盛顿特区乔治华盛顿大学的Sarah Henn医师表示,当进行性病筛检时,她任职的医院一定会检查三个部位—咽喉、直肠和泌尿生殖道。
  
  她表示,多年来,我们也曾让病患自我检测,根据他们的风险因素,给他们一组有这三种检测器具的检测包,他们自己做拭子取样,然后给我们一个尿液样本。
  
  Henn医师指出,我们不是在判断或污名化某一群人。我们把这个工具包提供给男性和女性,并且告诉他们,如果你发生过口交,做咽喉拭子;如果你发生过肛交,做直肠拭子。他们不用被要求做某项筛检或当面承认一些行为;他们可以根据自己的决定做完整的筛检。
  
  Henn医师表示,在她的诊所治疗的患者大部份是男同志,性病比率与Sandkovsky医师的研究类似,且大部份都是在生殖器外部位发现这些性病。
  
  举例来说,我们看诊的直肠披衣菌感染率在9%至10%上下,在我们的男性患者很少看到泌尿生殖道感染;而任何感染都必须根据性病指引治疗。
  
  她表示,无症状性病显然是男男性行为者的一大问题,因为可能会传染给其它性伴侣。 我们知道,某些人患有淋病或披衣菌,因为刺激或发炎而突破肌肉障壁,继而增加患有其它性病的风险,特别是HIV。
  
  资料来源:http://www.24drs.com/
  
  Native link:Urine Tests Miss Sexually Transmitted Infections

Urine Tests Miss Sexually Transmitted Infections

By Pam Harrison
Medscape Medical News

The majority of gonorrhea and chlamydia infections are missed when only urine is used to screen HIV-positive men, according to new research presented at IDWeek 2015 in San Diego.

"Many studies have shown that men who have sex with men have a higher risk for sexually transmitted infections than the general population, and a lot of these are extragenital infections that are asymptomatic," said Uriel Sandkovsky, MD, from the University of Nebraska Medical Center in Omaha.

"If you are trying to detect asymptomatic STIs, you should be testing other anatomical sites, not just the convenient one," he told Medscape Medical News.

Dr Sandkovsky and his colleagues evaluated urine, throat, and rectum samples from 149 HIV-positive men who have sex with men in Douglas County, Omaha, and found a rate of 12.1% for the combined incidence of gonorrhea and chlamydia.

Of the 18 participants who tested positive, 14 STIs were identified through pharynx or rectum samples, and only four were identified through the urine.

The incidence ratio of STI detection was better for the extragenital sites than for urine alone (11% vs 3%), Dr Sandkovsky reported. In fact, the chance of detecting either gonorrhea or chlamydia was 3.67 higher when extragenital sites were tested than when urine was tested.

Gonorrhea and Chlamydia

"Testing only urine would have missed all gonorrhea infections and 75% of chlamydia infections," he said. "The chances of finding either gonorrhea or chlamydia increase substantially when extragenital sites are tested."

The average number of sexual partners in the previous year was three for men who tested positive for an STI and for those who did not. And there was no difference in the reported use of condoms between the two groups.

However, men who tested positive for either gonorrhea or chlamydia were significantly more likely to have received anal sex in the previous year than men who tested negative for either STI (P= .02).

And men who reported cocaine use (P= .05) in the previous 6 months were significantly more likely to test positive for an STI than those who reported no cocaine use. The same was true for men who reported methamphetamine use (P= .004).

The rate of gonorrhea was 2.7% in the study cohort, which is 17 times higher than the rate for the county overall. And the rate of chlamydia was 10.7%, which is 18 times higher than the rate for the county overall.

Sarah Henn, MD, from George Washington University in Washington, DC, told Medscape Medical News that her institution routinely tests all three sites — the pharynx, the rectum, and the urogenital tract — when screening for STIs.

"For many years, we've also had our patients do self-testing. We give them a kit that has all three tests in it, they do the swabs themselves, based on their risk factors, and they give us a urine sample," she said.

Self-Testing for STIs

"We are not judging or stigmatizing a certain group of people," Dr Henn added. "We give these kits to men and women alike, and tell them, 'If you've had a penis in your mouth, do a throat swab, and if you've had a penis in your rectum, do a rectal swab," she explained. "They don't need to ask to be screened or admit to any behaviors face-to-face; they get the complete screening based on their own decision-making."

Dr Henn said that the rates of STIs seen in her clinics, where they treat mostly gay men, mirror those found by Dr Sandkovsky's team. And most of the STIs are found at extragenital sites.

"For example, we see rates of rectal chlamydia upward of 9% and 10%, and we see very little urogenital tract infections in our men," Dr Henn said, adding that any infection should be treated in accordance with STI guidelines.

"Asymptomatic STIs are a big deal in men who have sex with men, obviously, because of transmission to other partners," she said.

"We know that people who have STIs — gonorrhea or chlamydia — have a breakdown in the mucosal barrier in the form of irritation and inflammation. This increases the risk of getting other sexually transmitted infections, most importantly HIV," she explained.

Dr Sandkovsky and Dr Henn have disclosed no relevant financial relationships.

IDWeek 2015. Abstract120. Presented October8, 2015.

    
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