Passey M
Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
P N G Med J. 1996 Sep;39(3):252-60.
This paper outlines three important issues in the clinical management of sexually transmitted diseases (STDs) in Papua New Guinea which have, until now, gone unrecognized or been neglected. Suggestions for possible solutions are made. The high prevalence of both chlamydial and trichomonal infections in women cannot be ignored. Both of these infections have been shown to increase the transmission of HIV. The current algorithm for the treatment of vaginal discharges does not include treatment for trichomonal infection in the first instance, yet trichomoniasis has been shown to be the most common STD in community studies both here and elsewhere. Trichomoniasis is usually asymptomatic in men, but still increases the risk of HIV transmission; furthermore, it causes illness in their female partners and thus needs to be treated. The current recommended regimens for the treatment of gonococcal and chlamydial infection are complex due to the number of drugs recommended for gonorrhoea to combat the problem of drug resistance, and the length of therapy for chlamydia. Compliance with such a regimen is likely to be poor, particularly in asymptomatic partners. We need to consider the relative advantages provided by a drug which could be given as a single oral dose for chlamydia, and perhaps for both infections. Azithromycin is one possibility, as it has been shown to be effective for chlamydial infection in numerous studies, and has been found satisfactory for gonorrhoea where local isolates were susceptible. Testing of a small number of isolates from Papua New Guinea has shown that azithromycin may be suitable for use here, but further susceptibility testing needs to be performed. Utilization of services for STDs, particularly by women, is extremely low. This is due to a combination of factors involving limited knowledge of symptomatology and its significance, the asymptomatic nature of many infections, the structure of the services, health worker behaviour, and social attitudes. To address these issues we must make modifications to STD service provision, as well as provide widespread information about the potentially serious consequences of contracting STDs, including both infertility and AIDS. Possible modifications to the services are discussed, and include making routine screening available for women through currently existing services such as family planning and antenatal clinics and considering the possibility of establishing Women's Health Clinics which would provide all primary reproductive health services in an integrated manner.
本文概述了巴布亚新几内亚性传播疾病（STD）临床管理中的三个重要问题，这些问题至今未被认识或受到忽视。文中还提出了可能的解决建议。女性衣原体和滴虫感染的高患病率不容忽视。这两种感染均已被证明会增加艾滋病毒的传播。当前治疗阴道分泌物的算法在一开始并不包括对滴虫感染的治疗，但在本地及其他地区的社区研究中，滴虫病已被证明是最常见的性传播疾病。滴虫病在男性中通常无症状，但仍会增加艾滋病毒传播的风险；此外，它会导致其女性伴侣患病，因此需要进行治疗。由于推荐用于淋病以应对耐药问题的药物数量众多，以及衣原体感染的治疗疗程较长，目前推荐的淋病和衣原体感染治疗方案较为复杂。遵守这样的方案可能效果不佳，尤其是在无症状的伴侣中。我们需要考虑一种可单剂量口服用于治疗衣原体感染，或许也可用于治疗这两种感染的药物所具有的相对优势。阿奇霉素是一种可能性，因为在众多研究中它已被证明对衣原体感染有效，并且在本地分离株敏感的情况下，已被发现对淋病治疗效果令人满意。对来自巴布亚新几内亚的少量分离株进行的检测表明，阿奇霉素可能适用于此地，但还需要进行进一步的药敏试验。性传播疾病服务的利用率极低，尤其是女性。这是由多种因素共同导致的，包括对症状及其重要性的了解有限、许多感染的无症状性质、服务结构、卫生工作者的行为以及社会态度。为解决这些问题，我们必须对性传播疾病服务的提供进行调整，并广泛宣传感染性传播疾病可能产生的严重后果，包括不育和艾滋病。文中讨论了对服务可能进行的调整，包括通过计划生育和产前诊所等现有服务为女性提供常规筛查，并考虑设立妇女健康诊所的可能性，该诊所将以综合方式提供所有主要的生殖健康服务。
