Paxton L A, Sewankambo N, Gray R, Serwadda D, McNairn D, Li C, Wawer M J
Center for Population and Family Health, Columbia University School of Public Health, New York 10032, USA.
Sex Transm Infect. 1998 Dec;74(6):421-5. doi: 10.1136/sti.74.6.421.
To document the prevalence of asymptomatic non-ulcerative genital tract infections (GTI) in a rural African cohort.
The study population consisted of all adults aged 15-59 residing in 56 rural communities of Rakai District, southwest Uganda, enrolled in the Rakai STD Control for AIDS Prevention Study. Participants were interviewed about the occurrence of vaginal or urethral discharge and frequent or painful urination in the previous 6 months. Respondents were asked to provide blood and a first catch urine sample. Serum was tested for HIV-1. Urine was tested with ligase chain reaction (LCR) for N gonorrhoeae and C trachomatis. Women provided two self administered vaginal swabs; one for T vaginalis culture and the other for a Gram stained slide for bacterial vaginosis (BV) diagnosis.
A total of 12,827 men and women were enrolled. Among 5140 men providing specimens, 0.9% had gonorrhoea and 2.1% had chlamydia. Among 6356 women, 1.5% had gonorrhoea, 2.4% had chlamydia, 23.8% were infected with trichomonas and 50.9% had BV.53% of men and 66% of women with gonorrhoea did not report genital discharge or dysuria at anytime within the previous 6 months. 92% of men and 76% of women with chlamydia and over 80% of women with trichomonas or BV were asymptomatic. The sensitivities of dysuria or urethral discharge for detection of infection with either gonorrhoea or chlamydia among men were only 21.4% and 9.8% respectively; similarly, among women the sensitivity of dysuria was 21.0% while that of vaginal discharge was 11.6%. For trichomonas or BV the sensitivity of dysuria was 11.7% and that of vaginal discharge was 10.5%.
The prevalence of non-ulcerative GTIs is very high in this rural African population and the majority are asymptomatic. Reliance on reported symptoms alone would have missed 80% of men and 72% of women with either gonorrhoea or chlamydia, and over 80% of women with trichomonas or BV. To achieve STD control in this and similar populations public health programmes must target asymptomatic infections.
记录非洲农村人群中无症状非溃疡性生殖道感染（GTI）的患病率。
研究人群包括居住在乌干达西南部拉凯区56个农村社区、年龄在15 - 59岁的所有成年人，他们参与了拉凯艾滋病预防性传播疾病控制研究。就参与者在过去6个月内是否出现阴道或尿道分泌物以及尿频或尿痛情况进行访谈。要求受访者提供血液和首次晨尿样本。检测血清中的HIV - 1。尿液用连接酶链反应（LCR）检测淋病奈瑟菌和沙眼衣原体。女性提供两份自行采集的阴道拭子；一份用于阴道毛滴虫培养，另一份用于革兰氏染色涂片以诊断细菌性阴道病（BV）。
共纳入12827名男性和女性。在提供样本的5140名男性中，0.9%患有淋病，2.1%患有衣原体感染。在6356名女性中，1.5%患有淋病，2.4%患有衣原体感染，23.8%感染阴道毛滴虫，50.9%患有BV。53%的淋病男性和66%的淋病女性在过去6个月内任何时候都未报告有生殖器分泌物或排尿困难。92%的衣原体感染男性和76%的衣原体感染女性以及超过80%的阴道毛滴虫或BV感染女性无症状。男性中尿痛或尿道分泌物对淋病或衣原体感染检测的敏感性分别仅为21.4%和9.8%；同样，女性中尿痛的敏感性为21.0%，而阴道分泌物的敏感性为11.6%。对于阴道毛滴虫或BV，尿痛的敏感性为11.7%，阴道分泌物的敏感性为10.5%。
在这个非洲农村人群中，非溃疡性GTIs的患病率非常高，且大多数无症状。仅依靠报告的症状会漏诊80%的淋病或衣原体感染男性和72%的此类感染女性，以及超过80%的阴道毛滴虫或BV感染女性。为了在这一人群及类似人群中实现性传播疾病的控制，公共卫生项目必须针对无症状感染。
