Etiology and Determinants of Sexually Transmitted Infections in Karnataka State, South India
Etiology and Determinants of Sexually Transmitted Infections in Karnataka State, South India
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DOI：
10.1097/olq.0b013e3181bd1007
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发表时间：
2010-03-01
影响因子：
3.1
通讯作者：
Blanchard, James
中科院分区：
文献类型：
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作者：
Becker, Marissa;Stephen, John;Blanchard, James
背景：在许多国家，症状病例管理仍然是 STI（性传播感染）治疗的基石。我们进行这项研究是为了更好地了解印度南部成人性传播感染的病因，并为性传播感染管理指南提供信息。方法：从印度南部卡纳塔克邦的诊所招募有生殖器症状的成年男性和女性。进行了问卷调查、体检并采集血液进行 2 型单纯疱疹病毒 (HSV-2) 和梅毒血清学检查。对有尿道分泌物（UD）的男性和有阴道分泌物的女性进行了淋病奈瑟菌（NG）、沙眼衣原体（CT）和阴道毛滴虫（TV）检测。还对阴道拭子进行了细菌性阴道病和酵母菌感染的检测。患有生殖器溃疡的参与者接受了梅毒螺旋体 (TP)、杜克雷嗜血杆菌 (HD) 和 HSV-2 检测。对所有个体进行人类免疫缺陷病毒（HIV）检测。结果：共有 401 名男性和 412 名女性参与者，HIV 感染率较高（男性 17%；女性 15%）。 HSV-2 与男性和女性的 HIV 显着相关。在患有 UD 的男性中，NG 占 35%，CT 占 10.5%，TV 占 8.5%。在有阴道分泌物的女性中很少检测到 NG 或 CT。然而，大约 40% 的女性被发现患有细菌性阴道病，还检测到大量电视和念珠菌。 HSV-2 是生殖器溃疡病参与者中最常见的病原体，疱疹与非疱疹病变的临床区分没有帮助。结论：印度南部应重新评估当前的 STI 管理指南。应考虑对所有患有 HSV-2 和梅毒的 GUD 患者进行治疗，并在 HSV-2 和 TV 背景流行率较高的地区分别对患有 UD 的男性增加 TV 初始治疗。该人群感染艾滋病毒的风险很高，应接受适当的咨询和检测。
Background: Syndromic case management remains the cornerstone for STI (sexually transmitted infection) treatment in many countries. We undertook this study to better understand the etiology of STIs in adults in south India and to inform STI management guidelines.Methods: Adult males and females presenting with genital complaints were recruited from clinics in Karnataka state, south India. A questionnaire was administered, physical examination performed, and blood collected for herpes simplex virus-type 2 (HSV-2) and syphilis serology. Men with urethral discharge (UD) and women with vaginal discharge were tested for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Trichomonas vaginalis (TV). Vaginal swabs were also tested for bacterial vaginosis and yeast infection. Participants with genital ulcers were tested for Treponema pallidum (TP), Haemophilus ducreyi (HD), and HSV-2. human immunodeficiency virus (HIV) testing was offered to all individuals.Results: There were 401 male and 412 female participants, and rates of HIV infection were high (men, 17%; women, 15%). HSV-2 was significantly associated with HIV in men and women. Among men with the complaint of UD, NG was identified in 35%, CT in 10.5%, and TV in 8.5%. Very little NG or CT was detected among women with vaginal discharge. However, bacterial vaginosis was identified in approximately 40% of women, with significant amounts of TV and Candida also detected. HSV-2 was the most commonly identified pathogen among participants with genital ulcer disease, and the clinical distinction of herpetic versus nonherpetic lesions was not helpful.Conclusions: Current STI management guidelines should be re-evaluated in south India. Consideration should be given to treating all persons with GUD for both HSV-2 and syphilis, and to adding initial treatment for TV for men with UD in areas of high background prevalence of HSV-2 and TV, respectively. This population is at high risk for HIV, and should be counseled and tested appropriately.