Vincelette J, Baril J G, Allard R
Service de microbiologie et de maladies infectieuses, Hôpital Saint-Luc, Montréal.
CMAJ. 1991 Mar 15;144(6):713-21.
To identify the predictors of chlamydial infection and gonorrhea among patients tested by general practitioners.
Prospective study.
General private practice, family planning and abortion clinic, adolescent clinic, sexually transmitted disease (STD) clinic and community health clinic in downtown Montreal.
The 2856 patients were included because of symptoms compatible with an STD, a history of sexual contact with a person known or suspected to have chlamydial infection, a history of a nonexclusive sexual relationship or presentation for an abortion.
Patient information was obtained by the attending physician on a standard form. Enzyme immunoassay (EIA) for Chlamydia trachomatis and culture for Neisseria gonorrhoeae were performed on cervical (female) or urethral (male) samples. Stepwise logistic regression was used to identify the predictors of infection.
The EIA results were positive in 11.1% of the cases and the culture results in 2.3%. Among the males chlamydial infection was independently associated with low age (odds ratio [OR] = 0.88 per year), heterosexuality (OR = 4.99), urethral discharge (OR = 3.74) and the absence of a history of gonorrhea (OR = 0.51). Gonorrhea was associated with urethral discharge (OR = 24.3) and homosexuality (OR = 3.68). Among the females chlamydial infection was associated with low age (OR = 0.79 per year), a history of sexual contact with a person known to have chlamydial infection (OR = 2.30), multiple sexual partners in the previous 12 months (OR = 1.60) and a reason for the test other than screening purposes (OR = 0.60). Gonorrhea was associated with a reason other than screening (OR = 0.24) and low age (OR = 0.74 per year). Among the patients tested for screening purposes age was the only significant predictor of chlamydial infection (OR = 0.79 per year), and the prevalence of gonorrhea was 0.4%. The actual rate of chlamydial infection was 11.8% among the patients younger than 25 years, 5.7% among those 25 to 34 years and 0.6% among those over 34.
Age alone can be used as a criterion to screen for chlamydial infection among asymptomatic patients without a history of sexual contact with a person known or suspected to have such infection and with a history of a nonexclusive relationship. The prevalence in our population justifies screening people up to 34 years of age.
确定全科医生所检查患者中衣原体感染和淋病的预测因素。
前瞻性研究。
蒙特利尔市中心的普通私人诊所、计划生育与堕胎诊所、青少年诊所、性传播疾病（STD）诊所及社区健康诊所。
纳入2856名患者，原因是其症状与性传播疾病相符、有与已知或疑似衣原体感染患者的性接触史、有非专一性关系史或因堕胎前来就诊。
主治医生通过标准表格获取患者信息。对宫颈（女性）或尿道（男性）样本进行沙眼衣原体酶免疫测定（EIA）及淋病奈瑟菌培养。采用逐步逻辑回归确定感染的预测因素。
EIA结果在11.1%的病例中呈阳性，培养结果在2.3%的病例中呈阳性。在男性中，衣原体感染与低年龄（比值比[OR]=每年0.88）、异性恋（OR=4.99）、尿道分泌物（OR=3.74）及无淋病病史（OR=0.51）独立相关。淋病与尿道分泌物（OR=24.3）及同性恋（OR=3.68）相关。在女性中，衣原体感染与低年龄（OR=每年0.79）、有与已知衣原体感染患者的性接触史（OR=2.30）、过去12个月内有多个性伴侣（OR=1.60）及非筛查目的的检测原因（OR=0.60）相关。淋病与非筛查原因（OR=0.24）及低年龄（OR=每年0.74）相关。在因筛查目的接受检测的患者中，年龄是衣原体感染的唯一显著预测因素（OR=每年0.79），淋病患病率为0.4%。25岁以下患者中衣原体实际感染率为11.8%，25至34岁患者中为5.7%，34岁以上患者中为0.6%。
对于无已知或疑似衣原体感染患者性接触史且无非专一性关系史的无症状患者，仅年龄可作为筛查衣原体感染的标准。我们人群中的患病率表明应对34岁及以下人群进行筛查。
