Silva Guilherme Almeida Rosa da, Motta Heloisa Loureiro de Sá Neves, Souza Erik Friedrich Alex de, Cardoso Pedro Afonso Nogueira Moises, Pilotto José Henrique, Eyer-Silva Walter Araujo, Ribeiro Luiz Cláudio Pereira, Santos Mônica Soares Dos, Azevedo Marcelo Costa Velho Mendes de, Pinto Jorge Francisco da Cunha, Motta Rogerio Neves, Ferry Fernando Raphael de Almeida
Universidade Federal do Estado do Rio de Janeiro, Serviço de Clínica Médica, 10ᵃ Enfermaria, Rio de Janeiro, Rio de Janeiro, Brazil.
Fundação Oswaldo Cruz, Laboratório de AIDS e Imunologia, Rio de Janeiro, Rio de Janeiro, Brazil.
Rev Inst Med Trop Sao Paulo. 2018 Oct 25;60:e65. doi: 10.1590/S1678-9946201860065.
A prevalence of 3.47% of asymptomatic Chlamydia trachomatis urethritis has been previously reported among males living with HIV infection in Brazil. This study aims to assess the recurrence of C. trachomatis urethritis three years later in the same cohort of patients and analyze associated risk factors. A total of 115 male patients diagnosed with HIV infection, with no symptoms of urethritis and observed since May of 2015 in followup visits were enrolled. They had urine samplers tested by PCR for C. trachomatis and N. gonorrhoeae between February and March 2018. Results: Three of the four patients who had asymptomatic C. trachomatis urethritis three years before were recurrently positive for C. trachomatis urethritis. Two new patients were diagnosed as positives, accounting for a total asymptomatic C. trachomatis urethritis prevalence of 4.34%. The prevalence during the whole study was 5.21%. The relative risk for a new urethritis episode among those previously diagnosed with urethritis is RR=41.62 (95% CI: 9.42-183.84), p < 0.01. Patients who presented asymptomatic urethritis anytime and who were recurrently positive for C. trachomatis had a lower mean age (p<0.01). Married individuals were protected regarding asymptomatic urethritis [p<0.01, OR = 0.04 (0.005-0.4)] and had lower risk to develop recurrence [p<0.01, RR = 0.86 (0.74-0.99)]. Illicit drugs users had risk associated to asymptomatic urethritis [p=0.02, OR= 5.9 (1.03-34)] and higher risk to develop recurrence [p<0.01, RR=1.1 (1-1.22)]. Conclusion: The recurrence of asymptomatic C. trachomatis urethritis after treatment among males living with HIV infection in Brazil can be considered high and should not be neglected.
先前有报道称，巴西感染艾滋病毒的男性中无症状沙眼衣原体尿道炎的患病率为3.47%。本研究旨在评估同一组患者三年后沙眼衣原体尿道炎的复发情况，并分析相关危险因素。共有115名被诊断为感染艾滋病毒且无尿道炎症状的男性患者入组，这些患者自2015年5月起接受随访观察。在2018年2月至3月期间，他们接受了尿液样本的沙眼衣原体和淋病奈瑟菌PCR检测。结果：三年前患有无症状沙眼衣原体尿道炎的4名患者中有3名沙眼衣原体尿道炎复发呈阳性。另外两名新患者被诊断为阳性，无症状沙眼衣原体尿道炎的总患病率为4.34%。整个研究期间的患病率为5.21%。先前被诊断患有尿道炎的患者发生新的尿道炎发作的相对风险为RR = 41.62（95%置信区间：9.42 - 183.84），p < 0.01。曾出现无症状尿道炎且沙眼衣原体反复呈阳性的患者平均年龄较低（p < 0.01）。已婚个体在无症状尿道炎方面受到保护[p < 0.01，比值比（OR）= 0.04（0.005 - 0.4）]，复发风险较低[p < 0.01，相对风险（RR）= 0.86（0.74 - 0.99）]。非法药物使用者患无症状尿道炎的风险较高[p = 0.02，OR = 5.9（1.03 - 34）]，复发风险也较高[p < 0.01，RR = 1.1（1 - 1.22）]。结论：巴西感染艾滋病毒的男性在治疗后无症状沙眼衣原体尿道炎的复发率较高，不应被忽视。
