乌干达坎帕拉男性尿道分泌物综合征患者中未经治疗的梅毒、耐淋病奈瑟菌和其他性传播感染的高负担。
High burden of untreated syphilis, drug resistant Neisseria gonorrhoeae, and other sexually transmitted infections in men with urethral discharge syndrome in Kampala, Uganda.
机构信息
Division of Infectious Disease, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Mason F. Lord Center Tower, Suite 381, Baltimore, MD, 21224, USA.
Infectious Disease Institute, Kampala, Uganda.
出版信息
BMC Infect Dis. 2022 May 7;22(1):440. doi: 10.1186/s12879-022-07431-1.
OBJECTIVES
Prompt diagnosis and treatment of sexually transmitted infections (STIs) are essential to combat the STI epidemic in resource-limited settings. We characterized the burden of 5 curable STIs chlamydia, gonorrhea, trichomoniasis, Mycoplasma genitalium, syphilis, and HIV infection in Ugandan men with urethritis.
METHODS
Participants were recruited from a gonococcal surveillance program in Kampala, Uganda. Questionnaires, penile swabs were collected and tested by nucleic acid amplification. Gonococcal isolates were tested for antimicrobial sensitivity. Sequential point-of-care tests on blood samples were used to screen for syphilis and HIV. Bivariable and multivariable multinomial logistic regression models were used to estimate odds ratios for preselected factors likely to be associated with STIs. Adherence to STI treatment guidelines were analyzed.
RESULTS
From October 2019 to November 2020, positivity (95% CI) for gonorrhea, chlamydia, trichomoniasis, and Mycoplasma genitalium, were 66.4% (60.1%, 72.2%), 21.7% (16.8%, 27.4%), 2.0% (0.7%, 4.9%), and 12.4% (8.7%, 17.3%) respectively. All Neisseria gonorrhoeae isolates were resistant to ciprofloxacin, penicillin, and tetracycline, but susceptible to extended spectrum cephalosporins and azithromycin. HIV and syphilis prevalence was 20.0% (50/250) and 10.0% (25/250), and the proportion unaware of their infection was 4.0% and 80.0% respectively. Most participants were treated per national guidelines. Multivariable analysis demonstrated significant associations between curable STI coinfections and younger age, transactional sex, but not HIV status, nor condom or alcohol use.
CONCLUSIONS
STI coinfections including HIV their associated risk factors, and gonococcal AMR were common in this population. The majority with syphilis were unaware of their infection and were untreated. Transactional sex was associated with STI coinfections, and > 80% of participants received appropriate treatment.
目的
在资源有限的环境中，及时诊断和治疗性传播感染（STI）对于控制 STI 流行至关重要。本研究旨在描述乌干达男性尿道炎患者中 5 种可治愈的 STI（衣原体、淋病、滴虫病、生殖支原体、梅毒和 HIV 感染）的负担。
方法
参与者从乌干达坎帕拉的淋球菌监测计划中招募。通过核酸扩增检测采集并测试了参与者的问卷和阴茎拭子。对淋病分离株进行了抗菌敏感性测试。使用基于血液样本的连续即时检测对梅毒和 HIV 进行了筛查。使用二变量和多变量多项逻辑回归模型估计了与 STI 可能相关的预选择因素的比值比。分析了 STI 治疗指南的遵循情况。
结果
2019 年 10 月至 2020 年 11 月，淋病、衣原体、滴虫病和生殖支原体的阳性率（95%CI）分别为 66.4%（60.1%，72.2%）、21.7%（16.8%，27.4%）、2.0%（0.7%，4.9%）和 12.4%（8.7%，17.3%）。所有淋病奈瑟菌分离株均对环丙沙星、青霉素和四环素耐药，但对扩展谱头孢菌素和阿奇霉素敏感。HIV 和梅毒的流行率分别为 20.0%（50/250）和 10.0%（25/250），分别有 4.0%和 80.0%的感染者未意识到自己的感染情况。大多数参与者按照国家指南进行了治疗。多变量分析表明，可治愈的 STI 合并感染与年龄较小、性交易有关，与 HIV 状况、避孕套使用或饮酒无关。
结论
在该人群中，STI 合并感染包括 HIV 及其相关危险因素和淋病奈瑟菌的 AMR 较为常见。大多数梅毒感染者未意识到自己的感染情况且未得到治疗。性交易与 STI 合并感染有关，超过 80%的参与者接受了适当的治疗。
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