Beltrami C, Manfredi R, D'Antuono A, Chiodo F, Varotti C
Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna Alma Mater Studiorum, S. Orsola Hospital, Bologna, Italy.
New Microbiol. 2003 Jul;26(3):233-41.
To determine demographic, epidemiological, clinical features and risk factors of sexually-transmitted diseases (STD) in adolescents and young adults referring to a STD centre in Northern Italy, patients diagnosed with a STD and aged 13-20 years, were prospectively evaluated from the year 1991. Teenagers showed an appreciable and increasing risk of a broad spectrum of STD, and represented 3.6-13.3% of patients yearly diagnosed with a STD in a nine-year period. More than 10% of patients were under the age of 18, and did not report condom use in the six months preceding diagnosis in 96.7% of cases. A significant increase in the female gender was found since 1993 (but our series was massively influenced by the recent immigration of female sex workers, who declared frequent condom use), while male homosexuals and drug addicts represented a minority. When excluding subjects engaged in prostitution, over 50% of patients declared only 0-1 sexual partners during the last six months, but a significant increase in sexual promiscuity was observed over time (1997-1999 versus 1991-1996) (p<.02). Over two thirds of our teenagers never used a condom prior to the diagnosis of STD, and the apparently increased temporal trend to condom utilization proved related only to the recent immigration of sex workers; lack of condom use proved significantly related to the male gender, and a lower education. Non-gonococcal STD and human Papillomavirus infection accounted for over 60% of overall diseases, while the frequency of molluscum contagiosum, gonorrhea, HSV genital ulcer, and Chlamydia disease ranged from 6.1 to 7.4%, and that of syphilis, phthiriasis, trichomoniasis, and HIV infection varied from 1.3 to 4.7%. Non-gonococcal STD and syphilis were increasingly diagnosed over time, especially in immigrant prostitutes (and despite their frequent condom use). According to our surveillance study of teenagers, a number of demographic, epidemiological, and clinical features of STD showed significant variations over time: recent immigration, spread of prostitution, increased sexual promiscuity, and infrequent condom use, are relevant and/or persisting risk factors. A permanent monitoring of STD in young adults and adolescents is strongly warranted, to allow a timely diagnosis and an appropriate treatment, and to plan preventive strategies specifically addressed to this target population, with special attention to immigrants and sex workers.
为确定意大利北部一家性传播疾病（STD）中心就诊的青少年和青年人性传播疾病的人口统计学、流行病学、临床特征及危险因素，对1991年起诊断为性传播疾病且年龄在13 - 20岁的患者进行前瞻性评估。青少年患多种性传播疾病的风险显著且呈上升趋势，在九年期间每年诊断为性传播疾病的患者中占3.6% - 13.3%。超过10%的患者年龄在18岁以下，96.7%的病例在诊断前六个月未报告使用避孕套。自1993年以来女性患者显著增加（但我们的系列研究受近期女性性工作者移民的影响很大，她们宣称经常使用避孕套），而男性同性恋者和吸毒者占少数。排除从事卖淫的受试者后，超过50%的患者在过去六个月仅宣称有0 - 1个性伴侣，但随着时间推移（1997 - 1999年与1991 - 1996年相比）性乱行为显著增加（p <.02）。超过三分之二的青少年在诊断性传播疾病之前从未使用过避孕套，避孕套使用的明显上升趋势仅与近期性工作者的移民有关；未使用避孕套与男性性别及较低教育程度显著相关。非淋菌性性传播疾病和人乳头瘤病毒感染占所有疾病的60%以上，而传染性软疣、淋病、单纯疱疹病毒生殖器溃疡和衣原体病的发病率在6.1%至7.4%之间，梅毒、阴虱病、滴虫病和艾滋病毒感染的发病率在1.3%至4.7%之间。随着时间推移，非淋菌性性传播疾病和梅毒的诊断越来越多，尤其是在移民性工作者中（尽管她们经常使用避孕套）。根据我们对青少年的监测研究，性传播疾病的一些人口统计学、流行病学和临床特征随时间有显著变化：近期移民、卖淫活动的蔓延、性乱行为增加以及避孕套使用不频繁，都是相关的和/或持续存在的危险因素。强烈有必要对青年人和青少年的性传播疾病进行持续监测，以便及时诊断和适当治疗，并制定专门针对这一目标人群的预防策略，特别关注移民和性工作者。
