Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA. 2022 Jan 11;327(2):161-172. doi: 10.1001/jama.2021.23487.
Approximately 1 in 5 adults in the US had a sexually transmitted infection (STI) in 2018. This review provides an update on the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes.
From 2015 to 2019, the rates of gonorrhea, chlamydia, and syphilis increased in the US; from 1999 to 2016, while the rates of herpes simplex virus type 1 (HSV-1) and HSV-2 declined. Populations with higher rates of STIs include people younger than 25 years, sexual and gender minorities such as men and transgender women who have sex with men, and racial and ethnic minorities such as Black and Latinx people. Approximately 70% of infections with HSV and trichomoniasis and 53% to 100% of extragenital gonorrhea and chlamydia infections are asymptomatic or associated with few symptoms. STIs are associated with HIV acquisition and transmission and are the leading cause of tubal factor infertility in women. Nucleic acid amplification tests have high sensitivities (86.1%-100%) and specificities (97.1%-100%) for the diagnosis of gonorrhea, chlamydia, M genitalium, trichomoniasis, and symptomatic HSV-1 and HSV-2. Serology remains the recommended method to diagnose syphilis, typically using sequential testing to detect treponemal and nontreponemal (antiphospholipid) antibodies. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and the nitroimidazoles, such as metronidazole, are effective treatments for gonorrhea, chlamydia, syphilis, M genitalium, and trichomoniasis, respectively, but antimicrobial resistance limits oral treatment options for gonorrhea and M genitalium. No cure is available for genital herpes. Effective STI prevention interventions include screening, contact tracing of sexual partners, and promoting effective barrier contraception.
Approximately 1 in 5 adults in the US had an STI in 2018. Rates of gonorrhea, chlamydia, and syphilis in the US have increased, while rates of HSV-1 and HSV-2 have declined. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and the nitroimidazoles are effective treatments for gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, and trichomoniasis, respectively, but antimicrobial resistance limits oral therapies for gonorrhea and Mycoplasma genitalium, and no cure is available for genital herpes.
2018 年，约五分之一的美国成年人患有性传播感染（STI）。本综述提供了淋病、衣原体、梅毒、生殖支原体、滴虫病和生殖器疱疹的流行病学、诊断和治疗的最新信息。
从 2015 年到 2019 年，美国的淋病、衣原体和梅毒的发病率有所上升；从 1999 年到 2016 年，单纯疱疹病毒 1 型（HSV-1）和单纯疱疹病毒 2 型（HSV-2）的发病率下降。性传播感染率较高的人群包括 25 岁以下的人群、性少数群体（如男同性恋者和跨性别女性）和少数族裔，如黑人和拉丁裔。约 70%的单纯疱疹病毒和滴虫病感染以及 53%至 100%的生殖器外淋病和衣原体感染无症状或症状很少。性传播感染与艾滋病毒的获得和传播有关，也是女性输卵管因素不孕的主要原因。核酸扩增检测对淋病、衣原体、生殖支原体、滴虫病和有症状的单纯疱疹病毒 1 型和单纯疱疹病毒 2 型的诊断具有高敏感性（86.1%-100%）和特异性（97.1%-100%）。血清学仍然是诊断梅毒的推荐方法，通常使用序贯检测来检测密螺旋体和非密螺旋体（抗磷脂）抗体。头孢曲松、多西环素、青霉素、莫西沙星和硝基咪唑类药物（如甲硝唑）分别是淋病、衣原体、梅毒、生殖支原体和滴虫病的有效治疗药物，但抗菌药物耐药性限制了淋病和生殖支原体的口服治疗选择。生殖器疱疹目前无法治愈。有效的性传播感染预防干预措施包括筛查、性伴侣接触者追踪和促进有效的屏障避孕。
2018 年，约五分之一的美国成年人患有性传播感染。美国的淋病、衣原体和梅毒的发病率有所上升，而 HSV-1 和 HSV-2 的发病率有所下降。头孢曲松、多西环素、青霉素、莫西沙星和硝基咪唑类药物分别是淋病、衣原体、梅毒、生殖支原体和滴虫病的有效治疗药物，但抗菌药物耐药性限制了淋病和生殖支原体的口服治疗选择，生殖器疱疹目前无法治愈。
