Orroth K K, Korenromp E L, White R G, Changalucha J, de Vlas S J, Gray R H, Hughes P, Kamali A, Ojwiya A, Serwadda D, Wawer M J, Hayes R J, Grosskurth H
London School of Hygiene and Tropical Medicine, London, UK.
Sex Transm Infect. 2003 Apr;79(2):98-105. doi: 10.1136/sti.79.2.98.
To assess bias in estimates of STD prevalence in population based surveys resulting from diagnostic error and selection bias. To evaluate the effects of such biases on STD prevalence estimates from three community randomised trials of STD treatment for HIV prevention in Masaka and Rakai, Uganda and Mwanza, Tanzania.
Age and sex stratified prevalences of gonorrhoea, chlamydia, syphilis, HSV-2 infection, and trichomoniasis observed at baseline in the three trials were adjusted for sensitivity and specificity of diagnostic tests and for sample selection criteria.
STD prevalences were underestimated in all three populations because of diagnostic errors and selection bias. After adjustment, gonorrhoea prevalence was higher in men and women in Mwanza (2.8% and 2.3%) compared to Rakai (1.1% and 1.9%) and Masaka (0.9% and 1.8%). Chlamydia prevalence was higher in women in Mwanza (13.0%) compared to Rakai (3.2%) and Masaka (1.6%) but similar in men (2.3% in Mwanza, 2.7% in Rakai, and 2.2% in Masaka). Prevalence of trichomoniasis was higher in women in Mwanza compared to women in Rakai (41.9% versus 30.8%). Herpes simplex virus type 2 (HSV-2) seroprevalence and prevalence of serological syphilis (TPHA+/RPR+) were similar in the three populations but the prevalence of high titre syphilis (TPHA+/RPR >/=1:8) in men and women was higher in Mwanza (5.6% and 6.3%) than in Rakai (2.3% and 1.4%) and Masaka (1.2% and 0.7%).
Limited sensitivity of diagnostic and screening tests led to underestimation of STD prevalence in all three trials but especially in Mwanza. Adjusted prevalences of curable STD were higher in Mwanza than in Rakai and Masaka.
评估基于人群的调查中因诊断错误和选择偏倚导致的性传播感染（STD）患病率估计值的偏差。评估此类偏差对乌干达马萨卡和拉凯以及坦桑尼亚姆万扎三项用于预防艾滋病毒的性传播感染治疗社区随机试验中性传播感染患病率估计值的影响。
对三项试验基线时观察到的淋病、衣原体感染、梅毒、单纯疱疹病毒2型（HSV - 2）感染和滴虫病按年龄和性别分层的患病率，根据诊断测试的敏感性和特异性以及样本选择标准进行调整。
由于诊断错误和选择偏倚，所有三个人群的性传播感染患病率均被低估。调整后，姆万扎男性和女性的淋病患病率（分别为2.8%和2.3%）高于拉凯（分别为1.1%和1.9%）和马萨卡（分别为0.9%和1.8%）。姆万扎女性的衣原体感染患病率（13.0%）高于拉凯（3.2%）和马萨卡（1.6%），但男性患病率相似（姆万扎为2.3%，拉凯为2.7%，马萨卡为2.2%）。姆万扎女性的滴虫病患病率高于拉凯女性（41.9%对30.8%）。单纯疱疹病毒2型（HSV - 2）血清阳性率和血清学梅毒（TPHA + /RPR +）患病率在三个人群中相似，但姆万扎男性和女性的高滴度梅毒（TPHA + /RPR≥1:8）患病率（分别为5.6%和6.3%）高于拉凯（分别为2.3%和1.4%）和马萨卡（分别为1.2%和0.7%）。
诊断和筛查测试的敏感性有限导致所有三项试验中性传播感染患病率被低估，尤其是在姆万扎。姆万扎可治愈性传播感染的调整患病率高于拉凯和马萨卡。
