Manavi K, McMillan A, Young H
Department of Genitourinary Medicine, Royal Infirmary of Edinburgh, Edinburgh EH3 9YW, UK.
Int J STD AIDS. 2004 Mar;15(3):162-4. doi: 10.1258/095646204322916588.
Little is known about the prevalence of rectal chlamydial infection amongst men who have sex with men (MSM). Previous studies using culture methods reported this to be between 4-6%. The emergence of nucleic acid amplification tests has significantly increased the sensitivity and specificity for chlamydial detection, making it possible to estimate the prevalence of rectal infection more accurately. A prospective cross sectional study involving 443 MSM who were screened for sexually transmitted infections (STIs) between May 1999 and January 2002. Rectal swabs for chlamydiae were obtained in addition to specimens for routine STI screening. Rectal chlamydiae were detected by ligase chain reaction (LCR) utilizing the Abbott LCX Amplicor with confirmation by COBASE amplicor for the majority of cases. Those with rectal chlamydial infection were treated with azithromycin. The characteristics of men with rectal chlamydial infection were compared with those who were not infected at this site. Rectal chlamydia was detected in 32 (7.2%) of 443 patients. Those with rectal chlamydial infection were more likely to have rectal symptoms (12/32) or having a partner with confirmed chlamydial (2/32) or gonococcal (3/32) urethritis than those MSM without rectal chlamydial infection. They were also more likely to have a history of receptive anal sex (25/32) in the previous three months compared to those MSM without rectal chlamydial infection (263/411). The most common symptoms of patients with rectal chlamydial infection were pruritus ani and peri-anal pain. Eight (25%) of those with rectal chlamydial infection were known to be HIV seropositive. Rectal chlamydial infection is common amongst MSM and is effectively diagnosed by LCR. The test should be included in the routine STI screening offered to MSM.
男男性行为者（MSM）中直肠衣原体感染的流行情况鲜为人知。以往使用培养方法的研究报告其感染率在4%-6%之间。核酸扩增检测的出现显著提高了衣原体检测的敏感性和特异性，从而有可能更准确地估计直肠感染的流行率。一项前瞻性横断面研究，涉及1999年5月至2002年1月期间接受性传播感染（STIs）筛查的443名男男性行为者。除了用于常规性传播感染筛查的标本外，还采集了直肠拭子用于衣原体检测。大多数病例采用雅培LCX扩增仪通过连接酶链反应（LCR）检测直肠衣原体，并通过COBASE扩增仪进行确认。直肠衣原体感染患者用阿奇霉素治疗。将直肠衣原体感染男性的特征与该部位未感染男性的特征进行比较。443名患者中有32名（7.2%）检测出直肠衣原体。与未感染直肠衣原体的男男性行为者相比，直肠衣原体感染患者更有可能出现直肠症状（12/32），或有确诊衣原体（2/32）或淋菌性（3/32）尿道炎的性伴侣。与未感染直肠衣原体的男男性行为者（263/411）相比，他们在过去三个月内也更有可能有接受肛交史（25/32）。直肠衣原体感染患者最常见的症状是肛门瘙痒和肛周疼痛。已知8名（25%）直肠衣原体感染患者HIV血清学呈阳性。直肠衣原体感染在男男性行为者中很常见，通过LCR可有效诊断。该检测应纳入为男男性行为者提供的常规性传播感染筛查中。
