Department of Medicine, University of Manitoba, 771 McDermot Avenue, Winnipeg, Manitoba, Canada.
Sex Transm Dis. 2010 Mar;37(3):159-64. doi: 10.1097/OLQ.0b013e3181bd1007.
Syndromic case management remains the cornerstone for STI (sexually transmitted infection) treatment in many countries. We undertook this study to better understand the etiology of STIs in adults in south India and to inform STI management guidelines.
Adult males and females presenting with genital complaints were recruited from clinics in Karnataka state, south India. A questionnaire was administered, physical examination performed, and blood collected for herpes simplex virus-type 2 (HSV-2) and syphilis serology. Men with urethral discharge (UD) and women with vaginal discharge were tested for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Trichomonas vaginalis (TV). Vaginal swabs were also tested for bacterial vaginosis and yeast infection. Participants with genital ulcers were tested for Treponema pallidum (TP), Haemophilus ducreyi (HD), and HSV-2. human immunodeficiency virus (HIV) testing was offered to all individuals.
There were 401 male and 412 female participants, and rates of HIV infection were high (men, 17%; women, 15%). HSV-2 was significantly associated with HIV in men and women. Among men with the complaint of UD, NG was identified in 35%, CT in 10.5%, and TV in 8.5%. Very little NG or CT was detected among women with vaginal discharge. However, bacterial vaginosis was identified in approximately 40% of women, with significant amounts of TV and Candida also detected. HSV-2 was the most commonly identified pathogen among participants with genital ulcer disease, and the clinical distinction of herpetic versus nonherpetic lesions was not helpful.
Current STI management guidelines should be reevaluated in south India. Consideration should be given to treating all persons with GUD for both HSV-2 and syphilis, and to adding initial treatment for TV for men with UD in areas of high background prevalence of HSV-2 and TV, respectively. This population is at high risk for HIV, and should be counseled and tested appropriately.
在许多国家，症状性病例管理仍然是性传播感染（STI）治疗的基石。我们进行这项研究是为了更好地了解印度南部成年人 STI 的病因，并为 STI 管理指南提供信息。
从印度南部卡纳塔克邦的诊所招募出现生殖器症状的成年男性和女性。进行问卷调查、体格检查和采集血液样本，用于检测单纯疱疹病毒 2 型（HSV-2）和梅毒血清学。有尿道分泌物（UD）的男性和有阴道分泌物的女性接受淋病奈瑟菌（NG）、沙眼衣原体（CT）和阴道毛滴虫（TV）检测。阴道拭子还用于检测细菌性阴道病和酵母菌感染。有生殖器溃疡的参与者接受梅毒螺旋体（TP）、杜克雷嗜血杆菌（HD）和 HSV-2 检测。向所有个体提供人类免疫缺陷病毒（HIV）检测。
共有 401 名男性和 412 名女性参与者，HIV 感染率较高（男性 17%，女性 15%）。HSV-2 与男性和女性的 HIV 显著相关。在有 UD 症状的男性中，发现 35%有 NG，10.5%有 CT，8.5%有 TV。在有阴道分泌物的女性中很少发现 NG 或 CT。然而，约 40%的女性被诊断为细菌性阴道病，同时还发现大量的 TV 和假丝酵母菌。HSV-2 是生殖器溃疡疾病参与者中最常见的病原体，HSV-2 引起的疱疹性和非疱疹性病变的临床区别没有帮助。
应重新评估印度南部的现行 STI 管理指南。应考虑对所有生殖器溃疡疾病患者进行 HSV-2 和梅毒的治疗，并在 HSV-2 和 TV 背景流行率高的地区，对有 UD 的男性添加 TV 的初始治疗。该人群 HIV 感染风险较高，应进行适当的咨询和检测。
