女性生殖道感染流行病学调查和阴道分泌物病征处理探索性研究

An epidemiological survey on reproductive track infection and the investigation on syndromic approach on vaginal discharge.

目的 调查深圳市各类育龄妇女生殖道感染 (RTI)的流行情况及宫颈感染 (淋病和衣原体感染 )的影响因素 ,进而探索阴道分泌物病征处理方案的可行性。方法 2 0 0 1年 10月至 2 0 0 2年 4月 ,分别针对深圳市三种不同类型的育龄妇女共 4 74 4名 (其中 3895名一般人群 ,4 38名有症状的妇科和性病门诊就诊者和 4 11名高危人群 )进行了妇科检查和各种RTI的实验室诊断调查 ,其中淋球菌和衣原体用PCR方法检测。同时使用结构式调查表收集研究对象婚育史 ,生殖道感染相关行为等。分析宫颈感染的相关危险因素、症状和体征。在此分析的基础上探索阴道分泌物的病征处理方案的形成和可行性。结果 深圳市一般人群中有 2 7.6 %的妇女患有至少一种生殖道感染。宫颈感染率为 5 .0 %。分析发现近 3个月有新性伴 (OR =1.6 ,95 %CI:1.1～ 2 .4 )、有人工流产史 (OR =1.6 ,95 %CI:1.1～ 2 .4 )、年龄小于 2 5岁 (OR =1.6 ,95 %CI :1.1～ 2 .4 )和不使用避孕套 (OR =1.7,95 %CI :1.1～ 2 .4 )是宫颈感染的危险因素。危险评估和阴道分泌物异常体征对宫颈感染的灵敏度为6 3.8% ,特异度为 5 5 .1% ,阳性预测值为 7.0 %。结论 深圳市三类育龄妇女RTI感染均较多 ,其中高危人群的患病率最高 ,其次是门诊就诊人群。

Objective To investigate the reproductive track infection (RTI) situation and risk factors for cervical infection (Neisseria gonorrhoeae or Chlamydia trachomatis) among different kinds of women of childbearing age in Shenzhen city, China. To assess the feasibility of the syndromic approach for vaginal discharge. Methods The survey was administrated to 4 744 eligible women in Shenzhen city during October 2001 and April 2002. The subjects included three different kinds of population: 3 895 cases of general population, 438 STD/gynecological clinic outpatients and 411 people with high risk behavior. Gynaecologic examination and RTI laboratory diagnosis were performed for each subject. PCR method based test was used to detect the Neisseria gonorrhoeae and Chlamydia trachomatis infection. Standardized questionnaire were designed to collect the information about RTI related behaviors, and history of marriage and child bearing, et al. The risk factors, symptoms and signs of cervical infection were analyzed. Syndromic approach was established and its feasibility was assessed. Results Twenty seven point six per centage of women in Shenzhen were infected with at least one kind of RTI, including 5.0 % with cervical infection. The risk factors for cervical infection were: individuals having had new sex partner within last 3 months ( OR = 1.6 , 95% CI : 1.1 2.4 ), having had the experience of abortion ( OR = 1.6 , 95% CI : 1.1 2.4 ), aged 25 or less ( OR = 1.6 ,95% CI : 1.1 2.4 ) and never using condom during sex intercourse ( OR = 1.7 ,95% CI : 1.1 2.4 ). The sensitivity of syndromic approach of risk assessment and signs for cervical infection among general population was 63.8 %, while specificity was 55.1 % with the positive predictive value 7.0 %. Conclusions RTI infection was common among all three kinds of childbearing women in Shenzhen city. The prevalence of RTI was the highest among high risk population, followed by STD/gynecological clinic outpatients. The efficacy of syndromic approach for cervical infection in general population was not ideal.