生殖器溃疡疾病的病因。在巴黎的一家性传播疾病诊所对 278 例患者进行的前瞻性研究。

Etiology of genital ulcer disease. A prospective study of 278 cases seen in an STD clinic in Paris.

机构信息

Centre clinique et biologique des MST, Hôpital Saint-Louis AP-HP, 42 Rue Bichat, Paris, France.

出版信息

Sex Transm Dis. 2010 Mar;37(3):153-8. doi: 10.1097/OLQ.0b013e3181bf5a98.

DOI:10.1097/OLQ.0b013e3181bf5a98

PMID:19910862

Abstract

OBJECTIVES

The goal of this study was to identify the causes and factors associated with genital ulcer disease (GUD) among patients attending a sexually transmitted disease (STD) clinic in Paris.

METHODS

This study was a prospective investigation of GUD cases. Data were collected from 1995 to 2005. In each case, a Dark Field Examination (DFE), Gram stain, inoculation onto Thayer Martin agar, Columbia agar and chocolate agar with 1% isovitalex and 20% fetal calf serum, PCR Chlamydia trachomatis (Amplicor Roche), culture for herpes simplex virus (HSV) on MRC 5 cells and PCR HSV (Argene Biosoft) were obtained from the ulceration. First Catch Urine (FCU) PCR for Chlamydia trachomatis and syphilis, HIV, HSV, and HBV serologies were also performed.

RESULTS

A total 278 cases of GUD were investigated, 244 (88%) in men and 34 (12%) in women. Primary syphilis accounted for 98 cases (35%), genital herpes for 74 (27%), chancroid for 8 (3%), other infections for 12 (5%). In 91 (32%) patients, no identifiable microorganism was documented. Primary syphilis was more prevalent in MSMs (P < 0.0001), while genital herpes and chancroid were significantly associated with heterosexuality (both P < 0.0001). A high level of HIV infection (27%) was found, particularly in patients with primary syphilis (33%). In the univariate analysis, no statistical difference was found between syphilis and herpes according to clinical presentation, pain being the only item slightly more frequent in herpes (P = 0.06). In the multivariable model syphilis was associated with being MSM (OR: 51.3 [95% CI: 14.7-178.7], P < 0.001) and with an ulceration diameter >10 mm (OR: 9.2 [95% CI: 2.9-30.7], P < 0.001). Genital herpes was associated with HIV infection in the subgroup of MSWs (OR: 24.4 [2.4-247.7], P = 0.007). We did not find significant differences in the clinical presentation of the ulcers according to HIV status.

CONCLUSION

The profound changes of the epidemiology of GUD during the decade, due to disappearance of chancroid and reemergence of infectious syphilis have led to a new distribution of pathogens, genital herpes, primary syphilis and GUD from unknown origin, accounting each for one third of cases. No clinical characteristic is predictive of the etiology, underlining the importance of performing a thorough microbiologic evaluation. Close association with HIV is still a major public health problem.

摘要

目的

本研究旨在确定在巴黎性传播疾病（STD）诊所就诊的患者发生生殖器溃疡疾病（GUD）的原因和相关因素。

方法

这是一项对 GUD 病例的前瞻性研究。数据收集于 1995 年至 2005 年。在每个病例中，都进行了暗场检查（DFE）、革兰氏染色、接种于 Thayer Martin 琼脂、哥伦比亚琼脂和巧克力琼脂（含 1%异维罗昔和 20%胎牛血清）、聚合酶链反应检测沙眼衣原体（Amplicor Roche）、在 MRC 5 细胞上培养单纯疱疹病毒（HSV）以及聚合酶链反应检测单纯疱疹病毒（Argene Biosoft），均从溃疡处获取。还进行了首次采集尿液（FCU）PCR 检测沙眼衣原体和梅毒、HIV、HSV 和 HBV 血清学检查。

结果

共调查了 278 例 GUD 患者，244 例（88%）为男性，34 例（12%）为女性。原发性梅毒占 98 例（35%），生殖器疱疹占 74 例（27%），软下疳占 8 例（3%），其他感染占 12 例（5%）。在 91 例（32%）患者中，未发现可识别的微生物。男男性行为者（MSM）中原发性梅毒更为常见（P<0.0001），而生殖器疱疹和软下疳与异性恋显著相关（均 P<0.0001）。发现 HIV 感染率较高（27%），尤其是原发性梅毒患者（33%）。在单变量分析中，根据临床表现，梅毒和疱疹之间未发现统计学差异，疼痛只是疱疹患者略为更常见的一项（P=0.06）。在多变量模型中，梅毒与 MSM 相关（OR：51.3[95%CI：14.7-178.7]，P<0.001），与溃疡直径>10mm 相关（OR：9.2[95%CI：2.9-30.7]，P<0.001）。在 MSM 亚组中，生殖器疱疹与 HIV 感染相关（OR：24.4[2.4-247.7]，P=0.007）。我们没有发现 HIV 状态对溃疡临床表现的显著差异。