Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD.
Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD.
Ann Epidemiol. 2019 Apr;32:20-27. doi: 10.1016/j.annepidem.2019.01.010. Epub 2019 Jan 26.
Psychosocial stress has been associated with susceptibility to many infectious pathogens. We evaluated the association between perceived stress and incident sexually transmitted infections (STIs; Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis genital infections) in a prospective study of women. Stress may increase vulnerability to STIs by suppressing immune function and altering the protective vaginal microbiota.
Using the 1999 Longitudinal Study of Vaginal Flora (n = 2439), a primarily African American cohort of women, we fitted Cox proportional hazards models to examine the association between perceived stress and incident STIs. We tested bacterial vaginosis (measured by Nugent Score) and sexual behaviors (condom use, number of partners, and partner concurrence) as mediators using VanderWeele's difference method.
Baseline perceived stress was associated with incident STIs both before and after adjusting for confounders (adjusted hazard ratio = 1.015; 95% confidence interval, 1.005-1.026). Nugent score and sexual behaviors significantly mediated 21% and 65% of this adjusted association, respectively, and 78% when included together in the adjusted model.
This study advances understanding of the relationship between perceived stress and STIs and identifies high-risk sexual behaviors and development of bacterial vaginosis-both known risk factors for STIs-as mechanisms underlying this association.
心理社会压力与许多传染性病原体的易感性有关。我们评估了在对女性进行的前瞻性研究中，感知压力与性传播感染（衣原体、淋病奈瑟菌和阴道毛滴虫感染）的发生率之间的关系。压力可能通过抑制免疫功能和改变保护性阴道微生物群来增加易患性传播感染的风险。
使用 1999 年阴道菌群纵向研究（n=2439），这是一个主要由非裔美国人组成的女性队列，我们使用 Cox 比例风险模型来检验感知压力与性传播感染的发生率之间的关系。我们使用 VanderWeele 的差异方法来检验细菌性阴道病（通过 Nugent 评分测量）和性行为（使用避孕套、性伴侣数量和性伴侣一致性）作为中介因素。
基线感知压力与未调整混杂因素前后的性传播感染发生率相关（调整后的危险比=1.015；95%置信区间，1.005-1.026）。Nugent 评分和性行为分别显著介导了 21%和 65%的这种调整关联，当它们一起包含在调整后的模型中时，介导了 78%。
这项研究增进了对感知压力与性传播感染之间关系的理解，并确定了高风险性行为和细菌性阴道病的发展——两者都是性传播感染的已知危险因素——作为这种关联的潜在机制。
