Fennema J S, van Ameijden E J, Coutinho R A, van den Hoek A A
Department of Public Health and Environment, Municipal Health Service, Amsterdam, The Netherlands.
AIDS. 1995 Sep;9(9):1071-8.
To determine the incidence of sexually transmitted diseases (STD; gonorrhoea, early syphilis, Chlamydia trachomatis infection, trichomoniasis and primary genital herpes) and gynaecologic disorders (vaginal candidiasis, anaerobic vaginosis, genital ulcerations of unknown cause, pelvic inflammatory disease, recurrent genital herpes, recurrent genital warts) in a cohort of HIV-infected and non-infected drug-using prostitutes in Amsterdam between 1986 and 1992.
A subgroup of 212 female drug users with a history of prostitution, who made at least one visit to a special STD clinic for drug-using prostitutes was selected from an ongoing cohort study of drug users in Amsterdam.
Using Poisson regression, the relative risk (RR) for each outcome was calculated for HIV-positive women compared with HIV-negative women. To determine potential causal relations with immune suppression, associations between disease incidence and immunologic markers (CD4 cell count and anti-CD3 response) were assessed in HIV-positive women.
Adjusted for number of clients and frequency of condom use, HIV-positive women were at strong and significantly increased risk for primary genital herpes (RR, 7.64), recurrent herpes (RR, 8.33) and recurrent genital warts (RR, 15.93); moderately (significantly) increased risks were found for gonorrhoea (RR, 1.43), trichomoniasis (RR, 1.39), vaginal candidiasis (RR, 2.11) and genital ulcers of unknown aetiology (RR, 2.60). Of these HIV-related outcomes, the risk for recurrent genital herpes and genital warts were strongly associated with decreased CD4 cell counts.
HIV-infected women experience an excess morbidity of STD and gynaecologic disorders. The strongly increased risk for genital herpes and warts in HIV-seropositive women indicates a causal relation with HIV. This study emphasizes the need for accessible medical care for drug-using prostitutes.
确定1986年至1992年间阿姆斯特丹一群感染HIV和未感染HIV的吸毒妓女中性传播疾病（STD；淋病、早期梅毒、沙眼衣原体感染、滴虫病和原发性生殖器疱疹）和妇科疾病（阴道念珠菌病、厌氧性阴道炎、病因不明的生殖器溃疡、盆腔炎、复发性生殖器疱疹、复发性尖锐湿疣）的发病率。
从阿姆斯特丹一项正在进行的吸毒者队列研究中，选取了212名有卖淫史、至少去过一次专门为吸毒妓女开设的性病诊所的女性吸毒者作为一个亚组。
使用泊松回归法，计算HIV阳性女性与HIV阴性女性相比每种结局的相对风险（RR）。为了确定与免疫抑制的潜在因果关系，在HIV阳性女性中评估了疾病发病率与免疫标志物（CD4细胞计数和抗CD3反应）之间的关联。
在对客户数量和避孕套使用频率进行调整后，HIV阳性女性患原发性生殖器疱疹（RR，7.64）、复发性疱疹（RR，8.33）和复发性尖锐湿疣（RR，15.93）的风险显著增加；淋病（RR，1.43）、滴虫病（RR，1.39）、阴道念珠菌病（RR，2.11）和病因不明的生殖器溃疡（RR，2.60）的风险有中度（显著）增加。在这些与HIV相关的结局中，复发性生殖器疱疹和尖锐湿疣的风险与CD4细胞计数降低密切相关。
感染HIV的女性患性传播疾病和妇科疾病的发病率更高。HIV血清阳性女性患生殖器疱疹和尖锐湿疣的风险大幅增加表明与HIV存在因果关系。本研究强调了为吸毒妓女提供可及医疗服务的必要性。
