曼谷HIV血清阳性和HIV血清阴性孕妇的衣原体和淋菌性宫颈炎：患病率、危险因素及与围产期HIV传播的关系

Chlamydial and gonococcal cervicitis in HIV-seropositive and HIV-seronegative pregnant women in Bangkok: prevalence, risk factors, and relation to perinatal HIV transmission.

作者信息

Chaisilwattana P, Chuachoowong R, Siriwasin W, Bhadrakom C, Mangclaviraj Y, Young N L, Chearskul S, Chotpitayasunondh T, Mastro T D, Shaffer N

机构信息

Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

出版信息

Sex Transm Dis. 1997 Oct;24(9):495-502. doi: 10.1097/00007435-199710000-00001.

DOI:10.1097/00007435-199710000-00001

PMID:9339966

Abstract

OBJECTIVES

To determine the prevalence and risk factors associated with cervicitis caused by Chlamydia trachomatis and Neisseria gonorrhoeae in human immunodeficiency virus (HIV) type 1-seropositive and HIV-seronegative pregnant women in Bangkok, and the relation to perinatal HIV transmission.

METHODS

As part of a multicenter perinatal HIV transmission study in an antenatal population with 2% HIV seroprevalence, endocervical swabs obtained at mid-pregnancy from a consecutive sample of 222 HIV-seropositive and 219 HIV-seronegative pregnant women at two large hospitals in Bangkok were tested for the presence of C. trachomatis and N. gonorrhoeae by DNA hybridization probe (Gen-Probe). Clinical risk factors and DNA probe results were analyzed in relation to the women's and newborns' HIV infection status.

RESULTS

The prevalence of C. trachomatis was 16.2% in HIV-seropositive pregnant women and 9.1% in HIV-seronegative pregnant women (P = 0.03). The prevalence of N. gonorrhoeae was 2.7% in HIV-seropositive pregnant women and 1.4% in HIV-seronegative pregnant women (P = 0.5). The overall population prevalence estimate was 9.2% for C. trachomatis and 1.4% for N. gonorrhoeae. Women with gonococcal infection were more likely to be positive for C. trachomatis (RR(MH) = 5.2, P < 0.01). Young age (<21 years) and primigravid status were associated with C. trachomatis infection among HIV-seropositive women; history of multiple sex partners (>1) were associated with C. trachomatis infection among HIV-seronegative women. For HIV-seropositive women, primigravida status also was associated with C. trachomatis infection. The perinatal HIV transmission rates were similar for those with and without C. trachomatis (24.1% and 23.2%, P = 0.9) and among those with and without N. gonorrhoeae (20% and 23.5%, P = 1.0).

CONCLUSIONS

Among pregnant women in Bangkok, C. trachomatis infection was considerably more common than N. gonorrhoeae infection and was associated with HIV infection, young age and first pregnancy (HIV-seropositive women), and multiple partners (HIV-seronegative women). Our data do not suggest an association between perinatal HIV transmission and maternal C. trachomatis or N. gonorrhoeae infection identified and treated during pregnancy. The high prevalence of C. trachomatis found using a test not readily available in Thailand emphasizes the need for improved, inexpensive ways to screen for and diagnose these sexually transmitted infections in developing countries.

摘要

目的

确定曼谷地区人类免疫缺陷病毒1型（HIV - 1）血清阳性和HIV血清阴性孕妇中沙眼衣原体和淋病奈瑟菌引起的宫颈炎的患病率及相关危险因素，以及与围产期HIV传播的关系。

方法

作为一项在产前人群中进行的多中心围产期HIV传播研究的一部分（该人群HIV血清阳性率为2%），从曼谷两家大型医院连续抽取的222例HIV血清阳性孕妇和219例HIV血清阴性孕妇中，在孕中期采集宫颈拭子，采用DNA杂交探针（Gen - Probe）检测沙眼衣原体和淋病奈瑟菌的存在情况。分析临床危险因素和DNA探针检测结果与孕妇及新生儿HIV感染状况的关系。

结果

HIV血清阳性孕妇中沙眼衣原体的患病率为16.2%，HIV血清阴性孕妇中为9.1%（P = 0.03）。HIV血清阳性孕妇中淋病奈瑟菌的患病率为2.7%，HIV血清阴性孕妇中为1.4%（P = 0.5）。沙眼衣原体的总体人群患病率估计为9.2%，淋病奈瑟菌为1.4%。淋病奈瑟菌感染的女性更易感染沙眼衣原体（RR(MH)=5.2，P < 0.01）。年轻（<21岁）和初孕状态与HIV血清阳性女性的沙眼衣原体感染有关；多个性伴侣史（>1个）与HIV血清阴性女性的沙眼衣原体感染有关。对于HIV血清阳性女性，初孕状态也与沙眼衣原体感染有关。有无沙眼衣原体感染的孕妇围产期HIV传播率相似（24.1%和23.2%，P = 0.9），有无淋病奈瑟菌感染的孕妇围产期HIV传播率也相似（20%和23.5%，P = 1.0）。

结论

在曼谷的孕妇中，沙眼衣原体感染比淋病奈瑟菌感染更为常见，且与HIV感染、年轻以及初孕（HIV血清阳性女性）和多个性伴侣（HIV血清阴性女性）有关。我们的数据并未表明围产期HIV传播与孕期发现并治疗的孕妇沙眼衣原体或淋病奈瑟菌感染之间存在关联。使用泰国不易获得的检测方法发现沙眼衣原体的高患病率，强调了在发展中国家需要改进且廉价的方法来筛查和诊断这些性传播感染。