Tabet S R, Krone M R, Paradise M A, Corey L, Stamm W E, Celum C L
Department of Medicine, School of Medicine, University of Washington, Seattle, USA.
AIDS. 1998 Oct 22;12(15):2041-8. doi: 10.1097/00002030-199815000-00016.
To determine the prevalence of sexually transmitted diseases (STD) and incidence of and risk factors for STD, including HIV-1, among a cohort of HIV-negative men who have sex with men (MSM).
Seattle, Washington, United States.
Prospective cohort of 578 HIV-negative MSM in which risk factors for acquiring a STD over 12 months follow-up were evaluated using a cumulative incidence analysis.
Baseline tests obtained were: herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) Western blots, hepatitis B, and syphilis serologies; anorectal and pharyngeal Neisseria gonorrhoeae (GC) cultures; first-catch urine for leukocyte esterase (LE) and Chlamydia trachomatis (CT) ligase chain reaction (LCR). Men with a positive urine LE had urethral GC cultures obtained. The following outcomes were measured over 12 months follow-up: incident symptomatic bacterial STD (urethritis, proctitis, epididymitis), HSV-1 and HSV-2 seroconversion, and HIV-1 seroconversion. The 31 incident cases of STD (men with bacterial STD) were compared with those 489 men without symptomatic bacterial STD or seroconversion to HSV-1, HSV-2 or HIV-1 infection.
Bacterial STD were found in nine participants at enrollment; there were two cases of nonchlamydial urethritis, two cases of nonchlamydial epididymitis, and five cases of asymptomatic GC infection. At enrollment, HSV-2 antibodies were detected in 149 (26.0%) of 572 men and prior hepatitis B infection in 145 (34.8%) of 417 unvaccinated men. During the 1-year of follow-up, 31 men (5.7/100 person-years) had 34 episodes of a symptomatic bacterial STD syndrome (urethritis, epididymitis or proctitis). Urethritis was the most common STD syndrome, detected in 29 men, of whom 10 had GC and 19 had nongonococcal urethritis. In the 1-year of follow-up, five participants seroconverted to HIV-1 (1.3/100 person-years), four to HSV-2 (1.0/100 person-years), and seven to HSV-1 (4.3/100 person-years). Unprotected insertive anal sex [odds ratio (OR) 2.6; 95% confidence interval (CI) 1.2-5.6]; and nitrite inhalant ('poppers') use (OR, 2.3; 95% CI, 1.0-5.0) were independently associated with incident STD.
STD and HIV infection continue to be acquired even in a city with an overall low bacterial STD prevalence and among educated MSM receiving regular HIV screening and risk-reduction. Urethritis was the most common STD detected, and public health messages aimed at MSM need to emphasize safe insertive as well as receptive sexual practices.
确定一组男男性行为者（MSM）中，性传播疾病（STD）的患病率、包括HIV - 1在内的STD发病率及危险因素。
美国华盛顿州西雅图。
578名HIV阴性MSM的前瞻性队列，通过累积发病率分析评估其在12个月随访期间感染STD的危险因素。
基线检测项目包括：1型和2型单纯疱疹病毒（HSV - 1和HSV - 2）免疫印迹法、乙肝及梅毒血清学检测；肛门和咽部淋病奈瑟菌（GC）培养；初段尿白细胞酯酶（LE）及沙眼衣原体（CT）连接酶链反应（LCR）检测。尿LE阳性者进行尿道GC培养。在12个月随访期间测量以下结果：新发有症状细菌性STD（尿道炎、直肠炎、附睾炎）、HSV - 1和HSV - 2血清转换及HIV - 1血清转换。将31例STD新发病例（患细菌性STD的男性）与489例无有症状细菌性STD或未发生HSV - 1、HSV - 2或HIV - 1感染血清转换的男性进行比较。
入组时9名参与者发现有细菌性STD；2例非衣原体性尿道炎，2例非衣原体性附睾炎，5例无症状GC感染。入组时，572名男性中有149名（26.0%）检测出HSV - 2抗体，417名未接种疫苗的男性中有145名（34.8%）有既往乙肝感染。在1年随访期间，31名男性（5.7/100人年）发生34次有症状细菌性STD综合征（尿道炎、附睾炎或直肠炎）发作。尿道炎是最常见的STD综合征，29名男性中检测出该疾病，其中10名有GC感染且19名有非淋菌性尿道炎。在1年随访期间，5名参与者发生HIV - 1血清转换（1.3/100人年），4名发生HSV - 2血清转换（1. /100人年），7名发生HSV - 1血清转换（4.3/100人年）。无保护的插入式肛交[比值比（OR）2.6；95%置信区间（CI）1.2 - 5.6]；以及使用亚硝酸酯吸入剂（“Poppers”）（OR，2.3；95%CI，1.0 - 5.0）与新发STD独立相关。
即使在一个细菌性STD总体患病率较低的城市，以及在接受定期HIV筛查和降低风险干预的受过教育的MSM中，STD和HIV感染仍在发生。尿道炎是检测到的最常见STD，针对MSM的公共卫生信息需要强调安全的插入式以及接受式性行为。
