Bacterial vaginosis:a synthesis of the literature on etiology,prevalence,risk factors,and relationship with chlamydia and gonorrhea infections

Bacterial vaginosis(BV) is a common vaginal disorder in women of reproductive age. Since the initial work of Leopoldo in 1953 and Gardner and Dukes in 1955, researchers have not been able to identify the causative etiologic agent of BV. There is increasing evidence, however, that BV occurs when Lactobacillus spp., the predominant species in healthy vaginal flora, are replaced by anaerobic bacteria, such as Gardenella vaginalis, Mobiluncus curtisii, M. mulieris, other anaerobic bacteria and/or Mycoplasma hominis. Worldwide, it estimated that 20%–30% of women of reproductive age attending sexually transmitted infection(STI) clinics suffer from BV, and that its prevalence can be as high as 50%–60% in high-risk populations(e.g., those who practice commercial sex work(CSW). Epidemiological data show that women are more likely to report BV if they: 1) have had a higher number of lifetime sexual partners; 2) are unmarried; 3) have engaged in their first intercourse at a younger age; 4) have engaged in CSW, and 5) practice regular douching. In the past decade, several studies have provided evidence on the contribution of sexual activity to BV. However, it is difficult to state that BV is a STI without being able to identify the etiologic agent. BV has also emerged as a public health problem due to its association with other STIs, including: human immunodeficiency virus(HIV), herpes simplex virus type 2(HSV-2), Chlamydia trachomatis(CT) and Neisseria gonorrhoeae(NG). The most recent evidence on the association between BV and CT/NG infection comes from two secondary analyses of cohort data conducted among women attending STI clinics. Based on these studies, women with BV had a 1.8 and 1.9-fold increased risk for NG and CT infection, respectively. Taken together, BV is likely a risk factor or at least an important contributor to subsequent NG or CT infection in high-risk women. Additional research is required to determine whether this association is also present in other low-risk sexually active populations, such as among women in the US military. It is essential to conduct large scale cross-sectional or population-based case-control studies to investigate the role of BV as a risk factor for CT/NG infections. These studies could lead to the development of interventions aimed at reducing the burden associated with bacterial STIs worldwide.

Screening for asymptomatic chlamydia and gonorrhea in adolescent males in an urban pediatric emergency department

AIM To determine the prevalence of Chlamydia trachomatis(CT) and Neisseria gonorrhea(GC) in young men seeking care in the emergency department(ED) for non-sexually transmitted infection(STI) related symptoms.METHODS This was a prospective, cross-sectional study in an urban ED. The main outcome was the rate of positive CT and GC on urine nucleic acid amplification testing in males aged 16-21 presenting with non-STI related complaints. RESULTS Two hundred and eighty-four patients were enrolled, 271 were included in the final data analysis [age range 16-21, median: 18(quartiles 16-18, 19-21)]. Overall, 17(6.3%, 95%CI: 4%-10%) tested positive for CT and 0%(95%CI: 0%-2%) were found to have GC. The proportion of sexually active subjects was 71%(95%CI: 65%-76%) and 2%(95%CI: 0.6%-4%) reported sex with men. Previous STI testing was reported in 46%(95%CI: 43%-54%) and 13%(95%CI: 8%-20%) of those patients previously tested had a history of STI. Of the patients who tested positive for CT in the ED, 88%(95%CI: 64%-98%) were successfully followed up. CONCLUSION The prevalence of CT infection found by screening was 6.3%. Screening and follow-up from the ED was successful. The findings justify routine STI screening in male adolescents presenting to the ED with non-STI related complaints.

Longitudinal association of gonorrhea and bacterial vaginosis with repeat chlamydia diagnoses among U.S. Army women: A retrospective cohort analysis

Background: Historically, sexually transmitted infections have affected the health of the U.S. military. To determine whether gonorrhea, bacterial vaginosis, genital herpes, and trichomoniasis are predictors of repeat chlamydia diagnoses among U.S. Army women, medical data reported into the Defense Medical Surveillance System during the 2006–2012 period were analyzed.Methods: For all inpatient and outpatient medical records, the first and second International Classification of Diseases,version 9(ICD-9) diagnostic positions were reviewed for each chlamydia case to determine the occurrence of repeat diagnoses. The Andersen-Gill regression model, an extension of the Cox model for multiple failure-time data, was used to study associations between predictors and repeat chlamydia diagnoses.Results: Among 28,201 women with a first chlamydia diagnosis, 5145(18.2%), 1163(4.1%), 267(0.9%), and 88(0.3%)had one, two, three, and four or more repeat diagnoses, respectively. Overall, the incidence of repeat chlamydia was8.31 cases per 100 person-years, with a median follow-up time of 3.39 years. Gonorrhea(hazard ratio(HR)=1.58, 95%CI: 1.44–1.73) and bacterial vaginosis(HR=1.40, 95% CI: 1.09–1.79) were significant predictors for repeat chlamydia.These estimated hazard ratios were attenuated, but remained significant, after controlling for age, race/ethnicity,marital status, and military rank. No significant association was found for genital herpes(HR=1.13, 95% CI: 0.55–2.29)and trichomoniasis(HR=1.43, 95% CI: 0.43–4.68).Conclusions: This large cohort study suggests that gonorrhea and bacterial vaginosis were associated with repeat chlamydia diagnoses among U.S. Army women. These findings can be used in formulating new interventions to prevent repeat chlamydia diagnoses.

On the Stability of the Solution to a Gonorrhea Diserete Mathematical Model

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Incidence of Gonorrhea and Chlamydia in Urban Settings: The Case for Neighborhood Level Analysis in Boston

The sexually transmitted infections (STIs) gonorrhea and chlamydia are known to disproportionately affect impoverished communities and communities of color, especially in urban areas. Moreover, socioeconomic and demographic factors such as poverty and race/ethnicity may contribute to a difference in treatment setting choice as well as a delay in care seeking. In an urban metropolitan area such as Boston, the overall gonorrhea and chlamydia rates are higher than national rates, and such differences are even more marked in certain neighborhoods with greater proportions of individuals who are impoverished, young, and of color. Using a retrospective analysis of city wide data, we highlight the effects of socioeconomic and demographic variables on urban STI prevalence. High poverty rates, race/ethnicity and younger adult populations are linked to disproportionately high STI rates. Interestingly, STI rates do not appear to be influenced by the universal health care coverage offered to the whole Massachusetts’ resident populations. We examine the effects of these variables in Boston neighborhoods in conjunction to STI rates and hypothesize that the observed rates are underestimates of the true prevalence of infection. Future studies will investigate how these same socioeconomic and demographic factors influence which treatment settings are chosen and subsequently lead to a delay in treatment.

Pharyngeal gonorrhea presenting with isolated neck pain

We present a case of a 22-year-old man with isolated neck pain due to pharyngeal gonorrhea.

Gonorrhea in China, 2018

Objective:Gonorrhea is a globally widespread sexually transmitted infection caused by Neisseria gonorrhoeae.This study is aimed to analyze the epidemiological characteristics of gonorrhea cases reported in China in 2018 and provide evidence for strategies making in the gonorrhea prevention and control programme.Methods:Gonorrhea cases were extracted from National Notifiable Disease Report System (NNDRS) covering 31 provinces,autonomous regions,arnd municipalities in the mainland of China.The overall incidence rate was calculated,as were rate per province,sex,age group,and occupation group.ResultS:in 2018,133,156 new cases of gonorrhea were reported in China,corresponding to an incidence rate of 9.59 cases per 100,000 population and having a 36.03% increase from 2014 (7.05 cases per 100,000 population).Zhejiang,Hainan,Guangdong,Fujian provinces,and Shanghai city had a higher reported rate (14.05-28.00 per 100,000 population).Hebei,Tianjin,Tibet,Heilongjiang,and Jilin provinces had a lower rerted rate (1.56-5.19 per 100,000 population).The males had a much higher incidence than the females (15.81 per 100,000 vs.3.08 per 100,000) and a faster rising rate (38.32% vs.27.27%).The highest rate was detected in the aged 25-29 years both of male and female (46.37 and 6.60 per 100,000,respectively),followed by those aged 30-34 years (41.12 and 6.39 per 100,000,respectively).The largest proportion of gonorrhea cases was among the farmers accounting for 27.74%,followed by the unemployed persons (24.67%),business persons (17.02%) and industrial workers (9.50%).Conclusion:In general,gonorrhea has an increasing trend from 2014 and remains a common notifiable disease in China in 2018.Young males who are sexually active are high risk populations for gonococ~ infection.The southeast coastal areas with developed economy have a higher rate of gonorrhea reported.Corresponding strategies on disease prevention and control should be performed on the high risk populations and regions.

National Guidelines on Diagnosis and Treatment of Gonorrhea in China (2020)

Gonorrhea is one of the main sexually transmitted diseases in China.It mainly affects the genitourinary tract,and its clinical manifestations vary from asymptomatic to complicated types.The diagnosis of gonorrhea should be based on the patient's epidemiologicai history,clinical manifestations,and laboratory examination results.Treatment should be prompt and standardized and should involve the recommended treatment regimens.Patients should be appropriately followed up after treatment.The antimicrobial resistance of gonococcal isolates has become a severe problem of clinical concern.In order to provide technical guidance of the diagnosis and treatment of gonorrhea for health care workers,the authors developed the guidelines based on the version of 2014,which will be of important in the standardizing medical care of gonorrhea,and further facilitating control and prevention of the disease.

淋球菌耐药机制和治疗策略研究进展

淋球菌是引起淋病的病原体,淋球菌对抗生素的耐药性不断增加,影响淋病的有效治疗。随着耐药淋球菌株的不断增加,其临床治疗难度也越来越大。本文就近年来对淋球菌的耐药进展、耐药机制、治疗研究等方面进行综述。

兰茂辨治男科病证方药运用的临证发微

兰茂所著《医门擥要》医药结合且论医用药,医理明达简要,治法方药详悉。文章通过研究兰茂辨治男科病证的方药,并结合自己的临证心悟,分析其治疗淋浊、遗精、精癃的学术思想:(1)先攻邪,后扶正,宜补肾为主治淋浊;(2)保心滋肾,因寒因热治遗精;(3)滋肾清肺,气化通利治精癃。

A reliable numerical analysis for stochastic gonorrhea epidemic model with treatment effect

The phenomena of disease spread are unpredictable in nature due to random mixing of individuals in a population.It is of more significance to include this randomness while modeling infectious diseases.Modeling epidemics including tlieir stochastic behavior could be a more realistic approach in many situations.In thus paper,a stochastic gon orrhea epidemic model with treatment effect has been analyzed numerically.Numerical solution of stochastic model is presented in comparison with its deterministic part.The dynamics of the gonorrhea disease is governed by a threshold quantity Ai called basic reproductive number.If.A1<1.then disease eventually dies out while A1>1 shows the persistence of disease in population.The standard numerical schemes like Euler Maruyaina.stochastic Euler and stochastic Rurige Kutta are highly dependent on step size and do not behave well in certain scenarios.A competitive non-standard finite dif ference numerical scheme in stochastic setting is proposed,which is independent of step size and remains consistent with the corresponding deterministic model.

基于CiteSpace的中医药治疗尿路感染的可视化分析

目的 对近20年中医药治疗尿路感染研究文献进行可视化分析。方法 检索中国知网、维普网和万方数据知识服务平台2003—2023年关于中医药治疗尿路感染的相关文献,利用Cite Space软件分析其年度发文量、作者、机构与关键词情况。结果 共纳入1 562篇文献,近年来发文量整体呈下降趋势,不同作者中孙伟教授发文量最多,机构中发文最多的是天津中医药大学。关键词图谱显示中西医结合治疗慢性肾盂肾炎热度较高,近期突现较强的关键词为数据挖掘、热淋清颗粒、复发性尿路感染。结论 近20年来中医药治疗尿路感染受到业界广泛关注,慢性肾盂肾炎及中西医结合治疗是目前主要的研究热点;未来的研究发展趋势可能是对于复发性尿路感染治疗的深入研究及热淋清颗粒的作用机制及临床疗效评价。

2019-2021年四川成都某医院淋病奈瑟菌对大观霉素、阿奇霉素及头孢菌素类药物敏感性检测及结果分析

目的检测我院2019—2021年淋病奈瑟菌临床分离菌株对大观霉素、阿奇霉素及头孢菌素类药物的敏感性,为淋病的治疗和防控提供参考。方法收集并保存淋病奈瑟菌临床分离株,琼脂稀释法和微量肉汤稀释法测定大观霉素、阿奇霉素、头孢曲松和头孢克肟的最小抑菌浓度(MIC),分析比较菌株对各药物的耐药率或低敏率。结果2019—2021年共分离收集淋病奈瑟菌菌株279株。其中未发现对大观霉素的耐药菌株;发现对阿奇霉素耐药菌株31株,耐药率分别为16.00%、8.82%和8.11%,平均耐药率为11.11%;发现对头孢曲松低敏菌株43株,低敏率分别为12.00%、14.71%和18.92%,平均低敏率为15.41%;发现对头孢克肟低敏菌株27株,低敏率分别为4.00%、2.94%和18.92%,平均低敏率为9.68%。每年发现同时对头孢曲松低敏和阿奇霉素耐药的菌株数量均为2株,占比分别为2.00%、2.94%和1.80%,总体占比2.15%。结论大观霉素和头孢曲松仍适合本地区作为治疗淋病的一线药物,需关注本地区淋病奈瑟菌对头孢曲松低敏率的逐年增长趋势。

2018-2022年海安市淋病流行病学特征分析和防控体会探讨

目的分析2018-2022年海安市淋病流行病学特征,探讨淋病的预防控制体会。方法通过传染病报告信息管理系统收集2018-2022年海安市报告的淋病病例资料,运用描述流行病学方法分析流行病学特征,总结预防控制的心得体会。结果2018-2022年海安市淋病年均报告发病率为9.03/万人,处于全国平均水平。男性发病率高于女性,18~30岁和30~45岁年龄组发病率高于0~18岁、45~60岁和>60岁年龄组,单身、离异、丧偶等未婚状况者发病率高于已婚者,小学及以下文化程度者高于初中、高中和大学文化程度者,农民、待业或职业不详者高于服务行业、工人和其他职业者,流动人口发病率高于常住人口,门诊就诊的检出者高于住院和体检筛查者,性接触感染发病率高于间接接触和母婴传播者,治愈率高于好转和去向不详者,差异均有统计学意义(P<0.05)。不同季节的发病率比较无差异(P>0.05)。结论本地区的淋病发病率处于低水平的稳态趋势,应进一步完善防控机制,做好重点人群的宣教和监管工作,有效降低淋病的发病率。

FQ-PCR检测尿道炎病原体的临床应用及评价

目的为临床提供一次反应可同时检测由奈瑟氏淋球菌(Neissria gonorrhea,NG)、解脲支原体(Ureaplasma urealyticum,UU)及沙眼衣原体(Chlamydia trachomatis,CT)引起的淋菌性尿道炎和非淋菌性尿道炎的荧光定量PCR实验方法。对不同的试剂盒进行评价、比较,优化其荧光定量PCR反应条件。方法在一次荧光定量PCR反应中,利用任意一套标准品同时检测三种病原体,进行χ2检验。将同样的标本分别用三种不同试剂盒试验,将结果进行χ2检验。优化反应条件,比较结果有无差异,进行t检验。结果用同一厂家试剂盒的一套标准品分别同时检测三种病原体,结果无统计学差异,P>0.05。三个厂家试剂盒无明显差异,P>0.05。将某些反应条件优化,结果无显著影响,t=1.1806,P>0.05。结论用同一厂家试剂盒的一套标准品分别同时检测三种病原体,可减少标准品的使用量,且优化反应条件后又可以节省时间,为临床提供了快速、简便、经济的检测方法。

上海地区非淋菌性尿道炎宫颈炎的病原学调查研究

对上海地区１１２４例性病门诊患者进行沙眼衣原体、解脲支原体及淋球菌的检测，证实其中４９１例有６２３株不同病原微生物引起的感染。病原中沙眼衣原体、解脲支原体和淋球菌分别占患者总数的１５．７％（１７７／１１２４）、２７％（３０４／１１２４）和１２．６％（１４２／１１２４）。约９０％的病原阳性患者为２１～４０岁。淋病患者中５０％为２种以上病原的混合感染。本文就病原检出的有关因素等问题进行了探讨。

女性淋病患者7种支原体感染情况分析

目的 了解女性淋病患者合并感染支原体 (7种 )情况。方法 应用套式聚合酶链反应 (nPCR)和DNA序列测定方法在 10 0例女性淋病患者的阴道拭子标本中进行解脲支原体 (UU)、人型支原体 (MH)、肺炎支原体 (MPN)、穿通支原体 (MPE)、生殖支原体 (MG)、发酵支原体 (MF)、梨支原体 (MPI)等 7种支原体核酸检测。结果 本组女性淋病患者UU、MH、MPH、MPE、MG、MF、MPI的检出率分别为 46%、3 4%、18%、13 %、11%、4%、0。结论 女性淋病患者中合并支原体感染情况严重。

287例男性泌尿生殖道感染病原体分析

为进一步了解目前我国男性泌尿生殖道感染的病因，利用细菌培养、解脲支原体培养、免疫荧光检测沙眼衣原体等方法，对２８７例男性泌尿生殖道感染患者进行病原体检测。结果２８２例检出病原体，其中淋球菌７８例（２７．６５％），解脲支原体４９例（１７．３７％）、沙眼衣原体４５例（１５．９５％），较国内其它报道少；而非特异性细菌感染特别是在慢性前列腺炎中增加，尤以金黄色葡萄球菌为甚，共９８例，占病例总数的３４．７５％。混合感染及条件致病菌也日益增多。药敏试验示细菌耐药株增多，尤其是对常用抗生素。提示目前国内男性泌尿生殖道感染日趋复杂，故进行病原体检测，对临床用药有十分重要的意义。

北京市通州区2005-2014年梅毒和淋病流行病学特征分析

目的分析北京通州区2005—2014年梅毒和淋病的流行特征，为制定防治策略提供依据。方法对北京通州区2005—2014年通过中国疾病预防控制信息系统上报的梅毒和淋病病例进行描述性流行病学分析。结果北京通州区2005—2014年累计报告梅毒和淋病分别为2567例和971例，年均报告发病率分别为25．59／10万和9．68／10万，发病率年均增长速度分别为11．46％和-10．53％，发病均无季节性，以20—49岁高发，职业以家务及待业为主，城区及其周边地区高发。梅毒报告病例以隐性梅毒为主（61．75％），且隐性梅毒报告病例女性多于男性，其他各期梅毒和淋病的报告病例中均男性多于女性。结论北京通州区2005—2014年梅毒和淋病的发病出现“剪刀差”特征，应根据这两种疾病的流行病学特征采取针对性措施控制其传播。

淋病患者支原体、衣原体感染分析

目的 为了解淋病患者解脲脲支原体 (Uu)、人支原体 (Mh)、肺炎支原体 (Mpn)、生殖道支原体 (Mg)、穿透支原体 (Mpe)、发酵支原体 (Mf)、梨形支原体 (Mpi)和沙眼衣原体 (Ct)合并感染情况。方法 采用套式聚合酶链反应 (n PCR)和聚合酶链反应 (PCR)技术 ,对 10 0例女性淋病患者宫颈分泌物和 91例男性淋病患者尿道分泌物做了上述 7种支原体和沙眼衣原体的检测。结果 在女性淋病患者中 ,Uu、Mh、Mpn、Mpe、Mg、Mf、Mpi和 Ct的检测率分别为 4 6 %、34%、18%、13%、11%、4 %、0、13% ,在男性淋病患者中 ,U u、Mh、Mg、Mpe、Mpn、Mf、Mpi和Ct的检测率分别为 4 8.4 %、14 .3%、13.2 %、13.2 %、8.8%、1.1%、0、5 .5 %。结论 在淋病患者中支原体和沙眼衣原体合并感染严重。