Lyss Sheryl B, Kamb Mary L, Peterman Thomas A, Moran John S, Newman Daniel R, Bolan Gail, Douglas John M, Iatesta Michael, Malotte C Kevin, Zenilman Jonathan M, Ehret Josephine, Gaydos Charlotte, Newhall Wilbert J
Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-46, Atlanta, Georgia 30333, USA.
Ann Intern Med. 2003 Aug 5;139(3):178-85. doi: 10.7326/0003-4819-139-3-200308050-00007.
For two decades, treatment guidelines for sexually transmitted diseases (STDs) have recommended empirical co-treatment for chlamydia when patients are treated for gonorrhea. Because the epidemiology of and diagnostic testing for STDs have changed over time, co-treatment may no longer be needed as a clinical or public health strategy.
To assess the prevalence of chlamydia among patients at STD clinics who are infected with and treated for Neisseria gonorrhoeae and to determine whether co-treatment recommendations are still justified.
Cross-sectional analysis of data from a multisite study.
Five public STD clinics (Baltimore, Maryland; Denver, Colorado; Long Beach, California; Newark, New Jersey; and San Francisco, California), July 1993 through October 1995.
3885 heterosexual patients (2184 men and 1701 women) who agreed to participate in a trial of counseling interventions and had conclusive results from diagnostic tests for gonorrhea and chlamydia performed routinely as part of the trial.
Infection with Chlamydia trachomatis as determined by polymerase chain reaction.
Chlamydia trachomatis was detected in 20% (95% CI, 16% to 24%) of 411 men and 42% (CI, 35% to 50%) of 151 women with laboratory-confirmed N. gonorrhoeae. Chlamydia trachomatis was detected in 19% (CI, 15% to 22%) of 410 men and 35% (CI, 28% to 43%) of 154 women with treatment indications for gonorrhea who would not otherwise have been treated for chlamydia: chlamydia prevalence among these patients was significantly higher than among patients without treatment indications for either gonorrhea or chlamydia: 7% in men and 9% in women (relative risk, 2.58 [CI, 1.92 to 3.47] and 4.12 [CI, 3.05 to 5.57], respectively).
The frequent presence of chlamydia among patients at STD clinics who received treatment for gonorrhea, including sex partners of gonorrhea-infected patients, supports continuing current recommendations for co-treatment.
二十年来，性传播疾病（STD）治疗指南一直建议，当患者接受淋病治疗时，对衣原体进行经验性联合治疗。由于性传播疾病的流行病学情况和诊断检测方法随时间发生了变化，联合治疗作为一种临床或公共卫生策略可能不再必要。
评估在性传播疾病诊所接受淋病感染治疗的患者中衣原体的感染率，并确定联合治疗的建议是否仍然合理。
对一项多中心研究的数据进行横断面分析。
1993年7月至1995年10月期间，五家公共性传播疾病诊所（马里兰州巴尔的摩市；科罗拉多州丹佛市；加利福尼亚州长滩市；新泽西州纽瓦克市；加利福尼亚州旧金山市）。
3885名异性恋患者（2184名男性和1701名女性），他们同意参与一项咨询干预试验，并作为试验的一部分，对淋病和衣原体进行了常规诊断检测，结果确凿。
通过聚合酶链反应确定沙眼衣原体感染情况。
在411名经实验室确诊为淋病的男性中，20%（95%CI，16%至24%）检测出沙眼衣原体；在151名经实验室确诊为淋病的女性中，42%（CI，35%至50%）检测出沙眼衣原体。在410名有淋病治疗指征但未接受衣原体治疗的男性中，19%（CI，15%至22%）检测出沙眼衣原体；在154名有淋病治疗指征但未接受衣原体治疗的女性中，35%（CI，28%至43%）检测出沙眼衣原体：这些患者中的衣原体感染率显著高于既无淋病治疗指征也无衣原体治疗指征的患者：男性为7%，女性为9%（相对风险分别为2.58 [CI，1.92至3.47]和4.12 [CI，3.05至5.57]）。
在接受淋病治疗的性传播疾病诊所患者中，包括淋病感染患者的性伴侣，衣原体感染很常见，这支持继续沿用目前的联合治疗建议。
