个体医生培训需求调查

目的 了解个体医生性传播疾病 /艾滋病 (STD/AIDS)知识水平及培训需求 ,探讨如何对他们开展培训。方法 2 0 0 2年 7～ 9月 ,在云南、四川省中英性病艾滋病防治合作项目试点地区 ,选取 10 0家个体诊所进行问卷调查 ,并访谈 4 4名个体医生和 4 1名就诊者。结果 发现个体医生多数 ( 84 % )未受过STD/AIDS培训 ,性病诊疗水平较低 ,STD/AIDS专业知识测试平均不及格 ( 5 5分 )。 87%愿意接受培训 ,多数 ( 5 9 8% )希望采取学术讲座形式培训。结论 为加强STD/AIDS的控制 ,应加强对个体医生的STD/AIDS专业知识培训 ,提高他们的诊疗水平 。

Epidemiological Analysis of Sexually Transmitted Disease Control and Prevention from 1998 to 2003 in Chongqing

Objectives： To understand trends and epidemiology of STDs in Chongqing from 1998 to 2003 and to provide scientific evidence for developing preventive strategies and distributing government health resources effectively. Methods： STD case-reporting data collected from 43 counties and districts in Chongqing from 1998 to 2003 were analyzed with STD Data Management Software and Excel Software. Results： A total of 133,323 cases of eight different STDs were reported from 1998-2003. The annual incidence of all eight STDs combined was 71.89/10^5.Generally, reported cases and incidence have decreased since 2001. Although gonorrhoea diagnoses made up a significant proportion of the STD burden, this proportion decreased annually. The proportion of the STD burden attributed to Condyloma accuminatum （CA） was always above 30 percent. The proportions of non-gonoccocal urethritis, genital herpes and syphilis within the combinedSTD burden increased gradually from 1998 to 2003.Reported cases of HIV increased rapidly over this time. A total of 214 HIV cases were reported from 1998 to 2003,the majority of which were among men. For HIV, the maleto-female ratio was 1.17, but CA was found among more women than men. Incidence for all STDs was highest among 20-39 year olds, who accounted for 72.2% of reported infections. The majority of STDs were transmitted through extra-marital intercourse,accounting for 55.3%. Conclusion： The STD epidemic in Chongqing changed from 1998-2003. STD incidence declined, as a result of various factors. The epidemiology of STDs has changed.HIV incidence has increased rapidly. This indicates that the AIDS epidemic has reached a critical period. The results of this study suggest a need for readjusting control measures and redistributing health resources.

458名已婚育龄妇女生殖保健状况分析

2006年,我站对辖区内苏密沟乡6个村458名已婚育龄妇女进行了生殖健康普查,普查结果显示:农村已婚妇女患妇科疾病,发病之多,且发病之广泛,发病占普查总人数的64.5%,令人担忧。本次普查发现,女性感染的主要疾病是由细菌、真菌、病毒、寄生虫等病原微生物的感染所致。1现状分析1.1医源性感染:消毒操作不规范,消毒未达灭菌目的的器械、妇科检查、人工流产、代环、取环等引发。

Analysis of the Current situation of Syphilis in a Sexually Transmitted Disease Clinic

Objective： To analyze the current situation of syphilis in the sexually transmitted diseases （STDs） clinic, from January 1994 to December 2002 was studied. Methods： All syphilis patients were confirmed by history, physical examination, dark-field microscopy of samples taken from the chancre or satellite lymph nodes,or positive serological tests. Results： From 1994 to 2002, there were 2067 cases of early syphilis, accounting for 20.01% （2067/10330） of all STD cases. The annual proportion of syphilis cases among all STD cases from 1994 to 2002 was 0.57%, 0.53%, 3.54%, 16.20%, 31.29%, 27.88%, 25.63%, 17.11%, 10.48%, respectively. Of 2067 syphilis patients,49.64% （1026/2067） were male and 50.36% （1041/2067） were female. 44.75% （925/2067） of all cases presented with primary syphilis, 44.90% （928/2067） with secondary syphilis, 9.77% （202/2067） with latent syphilis （without any conspicuous clinical signs or symptoms）, and 0.58% （12/2067） with congenital syphilis. The 30-39 year old cohort accounted for the largest proportion, at 37.68% （779/2067） of all syphilis cases. The 20-29 year old cohort also accounted for a large proportion, at 37.20% （769/2067） of all cases,followed by the 40-49 year old cohort, at 17.95% （371/2067）. Syphilis was most prevalent among the unemployed,self-employed laborers, and office workers in decreasing order. The majority of cases were graduates of either primary school, high school, or college. Of all syphilis cases, 87.86% （1816/2067） were married, and 12.14%（251/2067, including children） were unmarried. 76.78% （1587/2067） of all cases were acquired through extramarital intercourse. 14.03% （290/2067） of cases were infected by their spouses. 0.58% （12/2067） of cases were due to vertical transmission. 8.61% （178） of cases were acquired through indirect contact. Conclusion： The proportion of syphilis infection among all STDs remained stable from 1994 to 1995,quickly and dramatically increased from 1996 to 1999,and then gradually tapered down from 2000 to 2002. The incidence of congenital syphilis infections increased throughout the study period.

SEXUALLY TRANSMITTED DISEASE CONTROL IN CHINA(1949—1994)

This paper surnmarizes the historical experiences in venereal disease control in China during the 1950s.Venereal diseases had been all but eliminated in the whole country till 1964. However, along with the implementation of open-door policy and economic reform in the 1980s, the social environment was changed to a great extent in this country. Sexually transmitted diseases (STDs) were reintreduced in the Chinese mainland and new foci of infection established themselves in some cities. During the recent 8 years the national STD case-reporting and sentinel surveillance systems have been set up. The results of surveillance show that the annual incidence of STD has been on the increase. The existing factors associated with the increasing incidence of STD mainly are ; population movement , increasing affiuence in a part of population,the availability of multiple sexual partners (including the prostitution)and asymptomatic STD increased.Finally, the strategies for STD control are discussed in detail.

Epidemiological Analysis of Syphilis in China From 1985 to 2000

Objectives: To understand trends and epidemiological featuresof syphilis over the recent years in China and provide a scien-tific basis for developing prevention strategies. Methods: From 1985 to 2000, syphilis case-reporting datacollected from all provinces, autonomous regions and munici-palities were analyzed by applying epidemiological methods. Results: (1) Epidemic trends: syphilis incidence has steadilyrisen in China from 1985 to 2000, especially after 1993, when itassumed an exponential growth pattern. 80,406 cases of syphi-lis were reported in the country in 1999, which was almost 40times the number reported in 1993. During the period of1993-1999, the annual average growth of the syphilis incidencerate was 83.55%. Perhaps due to a recent national law en-forcement campaign, the number of reported syphilis casesdropped slightly in 2000. (2) Geographical distribution: Syphi-lis spread from coastal, 'open' cities (especially some cities inFujian province) to inland urban areas, then to rural areas.Regions with a high incidence rate of syphilis in China were theMinjiang, Yangtze, and Zhujiang River Deltas, Beijing andTianjin municipalities, and Northeast China. There was a sig-nificant difference of syphilis incidence rates and growth ratesbetween these areas. A serious epidemic occurred in some ar-eas, with an incidence rate reaching over 200 cases out of100,000. (3) Population distribution: the ratio of male and fe-male cases gradually changed from 1.57:1 in 1993 to 1.02:1 in2000. The rate was the highest in the 20-29 age group and thelowest in 10-14 age group. A great difference existed in preva-lence between different population groups and different areas,and some areas with serious epidemics had high prevalencerates even amoung the general population. (4) Clinical stage ofsyphilis: Primary and secondary syphilis cases have beendominating with a percentage of 90% of all syphilis cases. Pri-mary syphilis was the most common in males and secondarysyphilis in females. Secondary and latent syphilis cases in fe-males were more than in males. (5) The congenital syphilisincidence has increased dramatically. Two cases were reportedin 1991 and 468 cases in 2000. Conclusion: The syphilis epidemic in China became muchmore severe between 1985 and 2000, and such increasingtrends deserve our serious attention.

Molecular Detection, Culture and Isolation of Mycoplasma Pneumoniae From Reproductive Tract of STD Patients

Objective: To confirm whether Mycoplasma pneumoniae (MP) are present in reproductive tract of STD patients inChina. Methods: Application of nested PCR (nPCR) and DNAsequencing to test samples of urethral/vaginal swabs withMP culture confirmation of several nPCR positive patients. Results: 74 of 786 STD patients were positive for MP bynPCR, with a rate of 9.4%. of the 484 male patients, 10.5%were positive, and among the 302 female patients, 7.6%were positive. There was no significant difference betweenthem (P<0.05). of 12 cases of MP positive samples by nPCR,4 cases were first generation culture-positive, and one ofthem passed to the next generation successfully. DNAsequencing was performed on the nPCR product of oneswab sample and one MP culture isolation. The determinedsequence was identical to the typical MP strain. Conclusion: In China, MP are present in reproductivetract of both male and female STD patients.

Study on Serotypes and Auxotypes of Neisseria Gonorrhoeae in Guangzhou

Objective:To investigate the serotypes and auxotypes distribution of Neisseria gonorrhoeae in Guangzhou. Method: 131 strains of Neisseria gonorrhoeae wereserotyped by co-agglutination test and 108 strains wereauxotyped by La Scolea's method. Results: Out of 131 strains of Neisseria gonorrhoeae,87.8% (115/131) were WⅡ/WⅢ, while 9.9% (13/131) wereWⅠ. The most important auxotypes were Proto, Pro and ILe,42.6% (46/108), 21.3% (23/108) and 12.0%, respectively. WⅡ/WⅢ was distributed among the all auxotypes aboveand WI found only in both Proto and Pro. Conclusion: The study illustrated the prevailing serotype,WⅡ/WⅢ, and higher prevalence of Ile- in Guangzhou.

Advances on Syndromic Management of Sexually Transmitted Diseases

Research data showed that syndromic approach could successfully manage gonococcal and chlamydial infections in males and syphilis and chancroid in males and females. However, low sensitivity, specificity and positive predictive value were found in the syndromic management of vaginal discharge. It is recommended that the syndromic algorithm for management of vaginal discharge used when serving high-risk and symptomatic women.

SEXUALLY TRANSMITTED DISEASES:INCIDENCE AND DISTRIBUTION

The incidence of sexually transmitted diseases(STDs) increased from 26. 04 per 100 000 in 1987 to 104. 81 per 100 000 in 1993 in selected areas of the country. Gonorrhea is by far the most common STD but its constituent ratio declined because of a rapid increase of nongonococcal uretheritis and genital warts during most recent years. The incidence of syphilis is relatively low and cases of congenital infection are noted. The wide spread of resistant Neisseria gonorrhoeae infection gives a challenge to the therapeutical and control strategies of STDs. Sexually transmitted Chlamydia trachomatis infections, an important cause of urethritis. cervicitis and pelvic inflammatory disease. is becoming common in our country. Attention has been drawn on viral hepatitis in their means of transmission by sexually behaviors, and also, on the homosexuals, assumed to be the high risk group to catch STDs. Coordinated national efforts to control STDs in China have been taken.

Human papilloma virus vaccination: Review article and an update

Human papilloma virus （HPV） is sexually transmitted and associated with uterine cervix, vaginal, and vulvar cancers in females, oropharyngeal and anal cancer in both genders, and penile cancer in males. Moreover, genital warts are benign tumors which are HPV-related and can occur in both genders. This is a review of HPV structure, HPV infection transmission, the global impact of HPV and its associated diseases, HPV vaccines and their efficacy and safety, public acceptance of HPV vaccines, the obstacles for its acceptance and strategies to address the barriers. Cervarix （a bivalent vaccine with protection against HPV types 16 and 18） and Gardasil （a quadrivalent vaccine with protection against HPV types 6, 11, 16 and 18） are 2 recommended vaccines. The longest follow up of 9.4 years has shown effcacy and protection of the vaccine against HPV types 16 and 18. The adverse effects have been minimal and the vaccine is considered safe. Numerous studies are conducted to follow the vaccinated individuals to better understand the effect of HPV vaccine on incidence of HPV-related cancers and precancerous lesions.

Depression Among Sexually Transmitted Disease Patients

Objective: To investigate the depression status of patients withsexually transmitted diseases (STDs). Methods: The depression status of fifty-one hospitalized STDpatients was evaluated in a randomized control study usingZung's Quantitativc Table. 18 healthy control patients withsimilar demographic backgrounds were randomly chosen ascontrols. Patients with scores above or equal to 40 wereconsidered to be suffering from depression. Results: The prevalence rate of depression in the patient groupwas obviously higher than that of in the control (X^2=16.456,P<0.01). Prevalence of depression was found to be significantlyrelated to occupation (P<0.05). Though the prevalence was notfound to differ significantly between those with a treatmentcourse less than 2 months and those with one longer or equal to2 months (X^2=0.041, P>0.05), the mean depression scores of theformer group were significantly higher than those of the latter(P<0.01). No significant differences were found between newversus relapsing disease, married versus non-married, maleversus female, or differing educational backgrounds. Conclusion: STD patients showed significant prevalence ofdepression.

A Preliminary Study of The Value of Quantitative Testing of TP-DNA In The Treatment of Patients with Syphilis

Objectives: To explore the relationship betweenquantitative Treponema pallidum DNA (TP-DNA) PCR testingand the Toludine Red Unheated Serum Test (TRUST) inpatients with syphilis before and after treatment, and evaluatethe clinical value of quantitative TP-DNA testing in thediagnosis and treatment evaluation of syphilis. Methods: 29 patients with primary (12 cases) or secondary(17 cases) syphilis, who met the criteria set for this study wererecruited as subjects. All patients were treated with 2.4 millionunits benzathine penicillin IM weekly for 3 weeks.Quantitative tests of TP-DNA in the patients' plasma wereperformed using FQ-PCR before and after the treatment.Serologic tests including TRUST and TPPA were alsoperformed. Results: Before the treatment, 9 out of 12 primary syphilispatients (75%) and all secondary syphilis patients (17/17)tested positive for Treponema pallidum (TP) by TP-DNAtesting. The average quantitative test values of TP-DNA inprimary and secondary syphilis patients were (3.38±2.34)×10~4and (5.73±1.33)×10~6 copies/ml, respectively. After threemonths of treatment, 1 of the 9 primary and 5 out of 17secondary syphilis patients were positive upon TP-DNAtesting, respectively. The average quantities of TP-DNA were2.01×10~2 copies/ml in primary and 5.87×10~2 copies/ml insecondary syphilis patients with positive TRUST and TP-DNAtests, and 3.09×10~2 copies/ml for those with negative TRUSTrespectively. After nine months of treatment, all the primaryand secondary syphilis patients were negative upon TP-DNAtesting, while all primary and 14 of 17 (82.35%) secondarysyphilis patients showed negative TRUST results. Conclusion: That the results of TP-DNA tests are notconsistent with those or TRUST before and after treatmentindicates that quantitative TP-DNA testing may have valuableclinical significance in the early diagnosis and evaluation oftreatment regimens for syphilis.

STD/AIDS Education and Behavioral Intervention Among Shenzhen Female Barbers

Objective: To understand female barbers' current awareness of STD/AIDS and evaluate the effect of healtheducation and behavioral interventions. Methods: 53 barbershops in Shenzhen were selected bysampling, and their 382 female barbers were given abase-line survey and assessment of intervention followingthe intervention. Results: The survey showed that female barbersgenerally have little education and knew little aboutSTDs/AIDS. They also had some misunderstanding aboutSTDs/AIDS. Most of them knew the main transmission ofSTDs/AIDS' through sexual contact, but didn't knowwhether AIDS could be transmitted through casual contactin daily life. Their knowledge of STDs/AIDS was limited,but they had lower condom use rates and correct ideasabout when to see the doctor. Conclusion: Health education and behavioralintervention related to STD/AIDS on special populationwere effective and or good social consequence.

Detection of HSV-2 Antibody in STD Patients

In order to acknowledge the multi-infectiondata of STD patients and improve the prophylaxis andtherapy for STDs, 297 patients and 30 healthy people wereexamined using the HSV-2 plasma antibody. The resultsshowed that all kinds of STD patients were infected byHSV-2 in different ratios, the highest ratio occurring insyphilis patients.

Risk Factors of Condom Use among Clients of Commercial Sex Workers in Saunas and Beauty Parlors in China

Objectives: To describe and analyze risk factors associatedwith disuse of condoms during commercial sexual intercourseamong clients attending sauna and massage centers. Methods: Selected female sex workers from saunas andbeauty parlors were trained as interviewers. They surveyedclients during provision of sexual services. Informationcollected included customers' demographics, knowledge ofSTDs, rationale for and history of condom use. Risk factorsfor condom usage were assessed though logistical modeling.Results: A total of 50 clients were interviewed. The rates ofcondom usage for last sexual intercourse with commercial andnon-commercial partners were 57% and 53% for clients ofsauna centers and 30% and 40% for clients of beauty parlors,respectively. The choice to use a condom was influenced byclients 60.8% of the time, sex workers 30.4%, and otherfactors 8.8%. The choice against using a condom was decidedupon by clients 69.7% of the time, sex workers 9.1%, andother factors 21.2%. Multivariate analysis showed thateducational level and perception of risk of infection werefactors for condom use. Clients with a high school educationhad a higher condom use rate than those with a middle schooleducation or less. Furthermore, clients who perceived risk ofdisease used condoms more frequently than those who did not.Conclusions: Clients played a significant role in decidingwhether or not to use a condom during commercial sex. Lackof perception of risk is a major factor for not using condoms.A program for promotion of prophylactics targeting bothcommercial sex workers and their clients is recommended.

Epidemiological Analysis of STIs in Guangzhou from 2000 to 2003

Objective： To analyze the epidemiological characteristics of sexually transmitted infections （STIs） in Guangzhou from 2000 to 2003, in order to provide scientific evidence for control and prevention efforts. Methods： STI reports and demographic data in Guangzhou from 2000 to 2003 were collected and analyzed using the National STD Computer Management Software. Results： The incidence rate of total STIs decreased.The incidence of syphilis, gonorrhea and condyloma acuminata decreased yearly from 41.71/100,000,70.13/100,000 and 83.02/100,000 in 2000 to 32.36/100,000,54.35/100,000 and 67.03/100,000 in 2003, respectively.The incidence of HIV/AIDS increased yearly.Nongonococcal urethritis （cervicitis） was the most prevalent STI. Conclusions： Incidence of STIs in Guangzhou is decreasing overall, but the incidence of HIV/AIDS is increasing and there is a change in the pattern of STI epidemics. Efforts should be made to keep the epidemic under control.

Vidas CHL Assay in the Detection of Urogenital Chlamydia Trachomatis Infection

Objectives: To evaluate the Vidas Chlamydia (CHL) assayfor detecting C.Trachomatis with swabs and first catch urine(FCU) specimens from STD patients and high riskpopulations. Methods: A total of 383 pahents were tested with tissueculture (TC), Vidas CHL and polymerase chain reaction (PCR)for C.trachomatis on male and female swabs, with Vidas CHLtesting male FCU specimens. CHL positive and equivocalresults were confirmed with a blocking assay (CHB). Truepositive were defined as either TC positive, or TC negtive butCHL and PCR positive. The performance of TC, CHL andPCR were evaluated according to this expanded goldstandard. Results: Compared with the expanded gold standard, 54 ofthe 232 male specimens were true positive results. For maleswabs, TC, CHL and PCR had sensitivities of 90.7%, 96.3%and 94.4%, and specificities of 100%, 98.3% and 97.2%,respectively. Differences were not statistically significant. Formale FCU specimens, CHL sensitivity and specificity were83.3% and 98.3%; there was little difference between theseresults and that of matched swabs. Compared with theexpanded gold standard, 28 of the 151 female swabs were truepositive; TC, CHL and PCR had sensitivities of 82.1%, 100%and 96.4%, and specificities of 100%, 98.4% and 97.6%,respectively. The difference was also not significant. Conclusions: Vidas CHL assay is very scnsitive and specificfor C.trachomatis detection with swab specimens of male andfemale STD patients. For male FCU specimens, the assay alsohad high sensitivity and specificity. CHB may not be needed inthe routine detection or Chlamydia infections. Populationswith higher incidence of C.trachomatis infection.