Riedner Gabriele, Todd Jim, Rusizoka Mary, Mmbando Donan, Maboko Leonard, Lyamuya Eligius, Hoffmann Oliver, MacLean I, Grosskurth Heiner, Hayes Richard
London School of Hygiene & Tropical Medicine, London, UK.
Sex Transm Infect. 2007 Apr;83(2):91-6. doi: 10.1136/sti.2006.021287. Epub 2006 Sep 13.
To determine trends in the prevalence and aetiological distribution of genital ulcer syndrome (GUS) in a cohort of female bar workers and to assess factors associated with these trends.
An open cohort of 600 women at high risk of HIV and sexually transmitted infection (STI) was offered screening and treatment for STI at 3-month intervals. The prevalence of GUS and associated aetiological agents (Herpes simplex virus (HSV), Treponema pallidum and Haemophilus ducreyi) were monitored over 27 months through clinical examination, dry lesion swabbing and multiplex polymerase chain reaction. The effects of HIV status and other factors on the prevalence trends of STI were assessed.
A total of 753 women were recruited into the cohort over 10 examination rounds. At recruitment, the seroprevalence was 67% for HIV and 89% for HSV type 2 (HSV-2). During follow-up, 57% of ulcers had unknown aetiology, 37% were due to genital herpes and 6% to bacterial aetiologies, which disappeared completely in later rounds. The absolute prevalence of genital herpes remained stable at around 2%. The proportion of GUS caused by HSV increased from 22% to 58%, whereas bacterial causes declined. These trends were observed in both HIV-negative and HIV-positive women.
The changes observed in the frequency and proportional distribution of GUS aetiologies suggest that regular STI screening and treatment over an extended period can effectively reduce bacterial STI and should therefore be sustained. However, in populations with a high prevalence of HSV-2, there remains a considerable burden of genital herpes, which soon becomes the predominant cause of GUS. Given the observed associations between genital herpes and HIV transmission, high priority should be given to the evaluation of potential interventions to control HSV-2 either through a vaccine or through episodic or suppressive antiviral therapy and primary prevention.
确定女性酒吧工作者队列中生殖器溃疡综合征（GUS）的患病率及病因分布趋势，并评估与这些趋势相关的因素。
对600名感染艾滋病毒和性传播感染（STI）高危女性组成的开放队列，每隔3个月提供一次STI筛查和治疗。通过临床检查、干燥病变拭子采样和多重聚合酶链反应，在27个月内监测GUS及其相关病原体（单纯疱疹病毒（HSV）、梅毒螺旋体和杜克雷嗜血杆菌）的患病率。评估艾滋病毒感染状况和其他因素对STI患病率趋势的影响。
在10轮检查中，共有753名女性被纳入该队列。招募时，艾滋病毒血清阳性率为67%，2型单纯疱疹病毒（HSV-2）为89%。随访期间，57%的溃疡病因不明，37%由生殖器疱疹引起，6%由细菌病因引起，细菌病因在后续轮次中完全消失。生殖器疱疹的绝对患病率保持在2%左右稳定。由HSV引起的GUS比例从22%增加到58%，而细菌病因导致的比例下降。在艾滋病毒阴性和阳性女性中均观察到这些趋势。
GUS病因的频率和比例分布变化表明，长期定期进行STI筛查和治疗可有效减少细菌性STI，因此应持续进行。然而，在HSV-2患病率高的人群中，生殖器疱疹负担仍然相当大，很快成为GUS的主要病因。鉴于观察到生殖器疱疹与艾滋病毒传播之间的关联，应高度优先评估通过疫苗、间歇性或抑制性抗病毒治疗以及一级预防来控制HSV-2的潜在干预措施。
