[根据社会人口学特征和行为风险因素对感染艾滋病毒男性淋病奈瑟菌、沙眼衣原体、阴道毛滴虫和生殖支原体感染频率的调查]

[Investigation of the Frequency of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium in Men Living with HIV in Terms of Sociodemographic Characteristics and Behavioral Risk Factors].

作者信息

Ayaz Çağlayan Merve, Karakaplan Nesrin Damla, İnkaya Ahmet Çağkan, Çakır Banu, Ünal Serhat, Zarakolu Pınar

机构信息

Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye.

Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Türkiye.

出版信息

Mikrobiyol Bul. 2023 Jul;57(3):378-389. doi: 10.5578/mb.20239931.

Abstract

The aim of this study was to investigate the frequency of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium in men living with HIV in terms of sociodemographic characteristics and behavioral risk factors. In this cross-sectional, single center study, all HIV-infected male patients, aged ≥ 18 years, including those being followed-up (n= 142) and the new admissions (n= 16) at Hacettepe University, Department of Infectious Diseases between March 1st, 2017 and May 1st, 2018 were included. After obtaining the informed consent form; age, follow-up days in STI-clinic, marital status, education, employment status; STI-related sign and symptoms, prior STI diagnosis, multiple sexual partners during the last year, exchanging sex for money, sexual orientation, drug use, condom use with regular and casual partner and also risk factors regarding partners were inquired as behavioural risk factors. A sample of first-voided urine of each participant was tested for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium by using nucleic acid amplification test (NAAT) (BD-MAX system, BD Diagnostics, USA) and BD MAX Mycoplasma-Ureaplasma-OSR for BioGX, (BD Diagnostics, The Netherlands). All participants living with HIV, men who have sex with men (MSM) and heterosexual men were grouped as STI-positive and STI-negative and compared. For all statistical analysis, SPSS 24 software was used. During the period of 14 months; the data was determined as follows: median follow-up time was 1138 (IQR= 159.5- 1494.5) days, median age was 35 (IQR= 28-42) years, 73.3% were single, 68.3% were at least college graduates or had higher educational attainment, 78.1% were currently employed. Of the participants, 26.9% reported STI-related sign and symptoms, 50.0% at least one STI episode in the past. Nine (5.6%) M.genitalium, five (3.1%) N.gonorrhoeae, and four (2.5%) C.trachomatis were detected in the urine samples of 17 (10.7%) individuals. N.gonorrhoeae and C.trachomatis were detected simultaneously in only one patient's urine sample. STI-positive patients (n= 17) were determined to be younger compared to STI-negative group [(p= 0.02; 27 years (IQR= 24-37) vs 35 years (IQR= 28-42)], had prominent STI-related signs and symptoms (p< 0.001) and had more multiple sexual partners (p= 0.03). The median CD4+ T lymphocyte count were relatively lower (p= 0.03) in STI-positive patients and plasma HIV RNA level was higher compared to the STI-negative participants (p= 0.05). STI-positive MSM group were younger [p= 0.01; 26 years (IQR= 23.5-29) vs 33 years, (IQR= 28-40)], STI-related signs and symptoms were more prominent (p= 0.02), the frequency of exchanging sex for money/drugs among their partners (p= 0.03) was higher compared to their STI-negative counterparts. Among STI-positive heterosexual patients, the presence of STI-related signs and symptoms (p= 0.04), drug use among their partners (p= 0.04) and plasma HIV RNA level (p<0.01) were significantly higher. STI was identified as an important health problem in this series of men living with HIV, 63.0% of whom had MSM and had a relatively high education level and socioeconomic status. Young age, having multiple partners, drug use, exchanging sex for money/drugs were prominent among the participants and their partners. Public health studies should focus on preventing STIs in young people living with HIV who have behavioral risk factors.

摘要

本研究旨在根据社会人口学特征和行为危险因素,调查感染人类免疫缺陷病毒(HIV)男性中淋病奈瑟菌、沙眼衣原体、阴道毛滴虫和生殖支原体的感染率。在这项横断面单中心研究中,纳入了2017年3月1日至2018年5月1日期间在哈杰泰佩大学传染病科就诊的所有年龄≥18岁的HIV感染男性患者,包括正在接受随访的患者(n = 142)和新入院患者(n = 16)。在获得知情同意书后,询问了年龄、在性传播感染(STI)门诊的随访天数、婚姻状况、教育程度、就业状况;STI相关的体征和症状、既往STI诊断、过去一年中的多个性伴侣、以性换钱、性取向、药物使用、与固定和临时伴侣使用安全套的情况以及伴侣的危险因素等行为危险因素。使用核酸扩增试验(NAAT)(BD-MAX系统,BD诊断公司,美国)和用于BioGX的BD MAX支原体-脲原体-OSR(BD诊断公司,荷兰)对每位参与者的首次晨尿样本进行淋病奈瑟菌、沙眼衣原体、阴道毛滴虫和生殖支原体检测。所有HIV感染者、男男性行为者(MSM)和异性恋男性被分为STI阳性和STI阴性两组并进行比较。所有统计分析均使用SPSS 24软件。在14个月期间,数据如下:中位随访时间为1138(四分位间距[IQR]=159.5 - 1494.5)天,中位年龄为35(IQR = 28 - 42)岁,73.3%为单身,68.3%至少为大学毕业生或具有更高学历,78.1%目前就业。在参与者中,26.9%报告有STI相关的体征和症状,50.0%过去至少有一次STI发作。在17名(10.7%)个体的尿液样本中检测到9例(5.6%)生殖支原体、5例(3.1%)淋病奈瑟菌和4例(2.5%)沙眼衣原体。仅在一名患者的尿液样本中同时检测到淋病奈瑟菌和沙眼衣原体。与STI阴性组相比,STI阳性患者(n = 17)年龄更小[(p = 0.02;27岁(IQR = 24 - 37)对35岁(IQR = 28 - 42)],有更明显的STI相关体征和症状(p < 0.001)且有更多的多个性伴侣(p = 0.03)。STI阳性患者的CD4 + T淋巴细胞计数中位数相对较低(p = 0.03),与STI阴性参与者相比,血浆HIV RNA水平较高(p = 0.05)。STI阳性MSM组年龄更小[(p = 0.01;26岁(IQR = 23.5 - 29)对33岁(IQR = 28 - 40)],STI相关体征和症状更明显(p = 0.02),与STI阴性的同行相比,其伴侣中以性换钱/毒品的频率更高(p = 0.03)。在STI阳性异性恋患者中,STI相关体征和症状的存在(p = 0.04)、其伴侣中的药物使用情况(p = 0.04)和血浆HIV RNA水平(p < 0.01)明显更高。在这一系列感染HIV的男性中,STI被确定为一个重要的健康问题,其中63.0%为MSM,且教育水平和社会经济地位相对较高。参与者及其伴侣中,年龄小、有多个性伴侣、药物使用、以性换钱/毒品等情况较为突出。公共卫生研究应侧重于预防有行为危险因素的HIV感染年轻人中的STI。

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