Besa Castellà Marta, Agustí Benito Cristina, Roca Saumell Carme, Mascort Roca Juan José
Centro de Atención Primaria Florida Sud, Institut Català de la Salut, Hospitalet de Llobregat, Barcelona, España; Grupo de trabajo sobre infecciones, subgrupo de infecciones de transmisión sexual, de la CAMFiC.
Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, España; Institut Germans Trias i Pujol (IGTP), Campus Can Ruti, Badalona, Barcelona, España.
Aten Primaria. 2023 May;55(5):102597. doi: 10.1016/j.aprim.2023.102597. Epub 2023 Mar 17.
These days sexually transmitted infections (STIs) are important public health problems not only due to their high prevalence, but also because they require early diagnosis and treatment to avoid complications. In recent years, there has been an exponential increase in cases of infections caused by Chlamydia trachomatis and gonococcus in the population under 25years of age. In addition, an increase in the incidence of syphilis and hepatitisC (HCV) has also been detected, especially in men who have sex with other men (MSM). Genital herpes continues to be the second most frequent STI in the world, behind condyloma acuminata, and the first cause of genital ulcer among Spain in the sexually active population. A decrease in reported HIV cases was observed during 2020, but almost half of these new cases had a late diagnosis (<350CD4cell/μL). Current guidelines recommend offering STI annual screening to populations at risk or more often depending on the risk. STIs can appear in the form of syndromes, such as secretory syndrome (urethritis, proctitis, and cervicitis) or ulcerated syndrome (ulcers). The STIs that can cause secretory syndrome are mainly caused by Neisseria gonorrhoeae and C.trachomatis, which co-infect up to 40% of cases, and also cause urethritis, cervicitis or proctitis depending on where they are located. Gonococcus has an incubation period of 2-7days and Chlamydia 2-6weeks, and they are diagnosed using PCR and/or culture (the last one only valid for gonococcus) of samples collected according to sexual activities. Empirical treatment to cover both germs will be accomplished with ceftriaxone, 1g single intramuscular dose plus doxycycline 100mg every 12h orally for 7days, or azithromycin 1g single dose orally (we will use azithromycin only if we suspect a poor compliance with treatment, difficulty in going to the control or in pregnancy). Likewise, whenever we diagnose an STI firstly, we must offer advice and health education in order to promote the adoption of safe sexual behaviours and the correct use of barrier methods. Secondly, we must also screen for other STIs (HIV, syphilis, hepatitisB, and hepatitisA andC depending on the risk), offer HBV and HAV vaccination if it is appropriate, and finally study and treat all sexual partners from the previous 3months.
如今，性传播感染（STIs）不仅因其高流行率成为重要的公共卫生问题，还因其需要早期诊断和治疗以避免并发症。近年来，25岁以下人群中沙眼衣原体和淋球菌引起的感染病例呈指数级增长。此外，梅毒和丙型肝炎（HCV）的发病率也有所上升，尤其是在男男性行为者（MSM）中。生殖器疱疹仍然是世界上第二常见的性传播感染，仅次于尖锐湿疣，并且是西班牙性活跃人群中生殖器溃疡的首要原因。2020年报告的艾滋病毒病例有所减少，但几乎一半的新病例诊断较晚（<350个CD4细胞/μL）。当前指南建议对有风险的人群每年进行性传播感染筛查，或根据风险情况更频繁地进行筛查。性传播感染可能以综合征的形式出现，如分泌性综合征（尿道炎、直肠炎和宫颈炎）或溃疡综合征（溃疡）。可引起分泌性综合征的性传播感染主要由淋病奈瑟菌和沙眼衣原体引起，它们共同感染的病例高达40%，并且根据其所在位置还会引起尿道炎、宫颈炎或直肠炎。淋球菌的潜伏期为2至7天，衣原体为2至6周，根据性行为采集的样本通过聚合酶链反应（PCR）和/或培养（最后一种仅对淋球菌有效）进行诊断。覆盖两种病原体的经验性治疗可采用头孢曲松，1克单次肌内注射，加用多西环素100毫克，每12小时口服一次，共7天，或阿奇霉素1克单次口服（仅在怀疑治疗依从性差、难以复诊或处于妊娠期时使用阿奇霉素）。同样，每当我们首次诊断出性传播感染时，我们必须提供咨询和健康教育，以促进采用安全性行为和正确使用屏障方法。其次，我们还必须筛查其他性传播感染（艾滋病毒、梅毒、乙型肝炎，以及根据风险情况筛查甲型和丙型肝炎），在适当情况下提供乙型肝炎病毒和甲型肝炎病毒疫苗接种，最后对前3个月内的所有性伴侣进行检查和治疗。
