Pépin J, Sobéla F, Deslandes S, Alary M, Wegner K, Khonde N, Kintin F, Kamuragiye A, Sylla M, Zerbo P J, Baganizi E, Koné A, Kane F, Mâsse B, Viens P, Frost E
Centre de santé internationale, Université de Sherbrooke, 3001, 12ème avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada.
Bull World Health Organ. 2001;79(2):118-26.
To determine the etiological role of pathogens other than Neisseria gonorrhoeae and Chlamydia trachomatis in urethral discharge in West African men.
Urethral swabs were obtained from 659 male patients presenting with urethral discharge in 72 primary health care facilities in seven West African countries, and in 339 controls presenting for complaints unrelated to the genitourinary tract. Polymerase chain reaction analysis was used to detect the presence of N. gonorrhoeae, C. trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, and Ureaplasma urealyticum.
N. gonorrhoeae, T. vaginalis, C. trachomatis, and M. genitalium--but not U. urealyticum--were found more frequently in men with urethral discharge than in asymptomatic controls, being present in 61.9%, 13.8%, 13.4% and 10.0%, respectively, of cases of urethral discharge. Multiple infections were common. Among patients with gonococcal infection, T. vaginalis was as frequent a coinfection as C. trachomatis. M. genitalium, T. vaginalis, and C. trachomatis caused a similar clinical syndrome to that associated with gonococcal infection, but with a less severe urethral discharge.
M. genitalium and T. vaginalis are important etiological agents of urethral discharge in West Africa. The frequent occurrence of multiple infections with any combination of four pathogens strongly supports the syndromic approach. The optimal use of metronidazole in flowcharts for the syndromic management of urethral discharge needs to be explored in therapeutic trials.
确定除淋病奈瑟菌和沙眼衣原体之外的病原体在西非男性尿道分泌物中的病因学作用。
从西非7个国家72个初级卫生保健机构中659例有尿道分泌物的男性患者以及339例有与泌尿生殖道无关主诉的对照者中获取尿道拭子。采用聚合酶链反应分析检测淋病奈瑟菌、沙眼衣原体、阴道毛滴虫、生殖支原体和解脲脲原体的存在情况。
有尿道分泌物的男性中，淋病奈瑟菌、阴道毛滴虫、沙眼衣原体和生殖支原体（而非解脲脲原体）的检出率高于无症状对照者，在尿道分泌物病例中分别占61.9%、13.8%、13.4%和10.0%。多重感染很常见。在淋病奈瑟菌感染患者中，阴道毛滴虫与沙眼衣原体的合并感染率相当。生殖支原体、阴道毛滴虫和沙眼衣原体引起的临床综合征与淋病奈瑟菌感染相关的临床综合征相似，但尿道分泌物症状较轻。
生殖支原体和阴道毛滴虫是西非尿道分泌物的重要病原体。四种病原体的任意组合导致的多重感染频繁发生，有力支持了综合征处理方法。在治疗试验中需要探索在尿道分泌物综合征管理流程图中最佳使用甲硝唑的方法。
