Lule G, Behets F M, Hoffman I F, Dallabetta G, Hamilton H A, Moeng S, Liomba G, Cohen M S
University of Malawi, College of Medicine, Blantyre.
Genitourin Med. 1994 Dec;70(6):384-8. doi: 10.1136/sti.70.6.384.
To evaluate gonococcal (GU) and nongonococcal urethritis (NGU), chlamydia antigen, and serostatus for syphilis and human immunodeficiency virus (HIV) among males attending a Malawian STD clinic with complaints of urethral discharge and/or dysuria. To collect demographic and behavioural data and to determine the effectiveness of five treatments for urethritis.
Urethritis was diagnosed using microscopy and culture for Neisseria gonorrhoeae. Sera were screened with rapid plasma reagin (RPR) and if reactive, with microhaemagglutination for Treponema pallidum (MHA-TP). HIV antibodies and chlamydia antigen were detected using enzyme immunoassay. Patients were randomised for treatment, cure was assessed 8-10 days later.
At enrolment, GU was diagnosed in 415 (80.3%) and NGU in 59 (11.2%) of 517 males. Chlamydia antigen was found in 26 (5.2%) of 497 specimens tested. Syphilis seropositivity rate (RPR and MHA-TP reactive) was 10.7%. Overall HIV seroprevalence was 44.2%; 71.7% of men with reactive syphilis serology were HIV(+) compared with 40.9% of syphilis seronegatives (OR: 3.6, p < 0.001). Trimethoprim 320 mg/sulphamethoxazole 1600 mg by mouth for 2 days (TMPSMX), or the combination of amoxicillin 3 gm, probenicid 1 gm, and clavulanate 125 mg by mouth once (APC), failed to cure gonorrhoea effectively. Amoxicillin 3 gm, probenicid 1 gm, and clavulanate 125 mg, by mouth once with doxycycline 100 mg BID for 7 days (APC-D), gentamicin 240 mg IM once (GENT), ciprofloxacin 250 mg by mouth once (CIPRO) cured 92.9% to 95% of gonorrhoea. APC-D treatment did not generate less NGU at follow-up. HIV serostatus did not affect cure of urethritis.
All patients presenting with urethritis should be treated syndromically using a simple algorithm and screened for syphilis seroreactivity for appropriate treatment and counselling.
评估马拉维一家性传播疾病诊所中主诉尿道分泌物和/或排尿困难的男性的淋菌性尿道炎（GU）、非淋菌性尿道炎（NGU）、衣原体抗原以及梅毒和人类免疫缺陷病毒（HIV）的血清状态。收集人口统计学和行为数据，并确定五种尿道炎治疗方法的有效性。
采用显微镜检查和淋病奈瑟菌培养诊断尿道炎。血清用快速血浆反应素（RPR）进行筛查，若呈阳性反应，则用梅毒螺旋体微量血凝试验（MHA-TP）进一步检测。使用酶免疫测定法检测HIV抗体和衣原体抗原。患者被随机分组接受治疗，8 - 10天后评估治愈情况。
在517名男性中，入组时415例（80.3%）被诊断为GU，59例（11.2%）为NGU。在497份检测标本中，26例（5.2%）发现衣原体抗原。梅毒血清阳性率（RPR和MHA-TP呈阳性反应）为10.7%。总体HIV血清阳性率为44.2%；梅毒血清学反应阳性的男性中71.7%为HIV阳性，而梅毒血清学阴性者中这一比例为40.9%（比值比：3.6，p < 0.001）。口服甲氧苄啶320 mg/磺胺甲恶唑1600 mg，连服2天（TMPSMX），或口服阿莫西林3 g、丙磺舒1 g和克拉维酸125 mg一次（APC），未能有效治愈淋病。口服阿莫西林3 g、丙磺舒1 g和克拉维酸125 mg一次，同时口服强力霉素100 mg，每日2次，连服7天（APC-D），肌注庆大霉素240 mg一次（GENT），口服环丙沙星250 mg一次（CIPRO），治愈淋病的比例为92.9%至95%。APC-D治疗在随访时并未减少NGU的发生。HIV血清状态不影响尿道炎的治愈。
所有出现尿道炎症状的患者都应采用简单的方案进行综合征治疗，并筛查梅毒血清反应，以便进行适当的治疗和咨询。
