性传播疾病患者外生殖器念珠菌定植及流行病学分析
摘要
为了解性传播患者生殖器念珠菌定植现状及发病危险因素,本文对524例性传播疾病患者及200例正常人临床标本进行分离培养及菌种鉴定。结果发现性传播疾病患者组念珠菌培养阳性率为41.98%,对照组为17.50%,患者组显著高于对照组(P<0.05)其中合并尖锐湿疣患者检出率较其他性病患者高,达77.14%。本研究中,患者组(包括有症状者和无症状者)中,白色念珠菌的构成比在男性为53.29%,女性为68.35%,占绝对优势,比非白色念珠菌所占比例明显偏高。患者组中有包皮龟头炎症状及阴道炎症状患者的念珠菌培养阳性率比无症状者明显偏高,差异有显著性(P<0.01)。患者组无论男性还是女性,有症状组分离的念珠菌,均以白色念珠菌占主要地位,分别为80.77%、77.27%;而无症状患者组,以非白色念珠菌为主要部分。
本研究结论如下:性传播疾病患者生殖器念珠菌分离率较正常人高。有症状患者菌种构成以白色念珠菌占绝对优势,无症状患者以非白色念珠菌分离率较高,其中以光滑念珠菌为主,克柔念珠菌比例不低。性传播疾病诊患者不洁性交及广泛使用抗生素等可能是生殖器念珠菌病发病危险因素之一。念珠菌在生殖器定植和感染,可能与其他病原微生物的生长有相互促进作用。
Genital candidiasis is a disease cause by abnormal growth of yeasts in the mucosa of the female genital tract or male balanitis and it is fregquently diagnosed in the daily practice of gynecology,with a significant increase during the last years. Candida balanitis either presented with penile redness, spots, and/or irritation or on direct questioning complained of itching or burning sensation after sexual intercourse.
Most of Genital candidiasis cases are caused by Candia albicans, while others are due to other non-C. albicans yeasts(Candida tropicalis, Candida glabrata, Candida krusei, Candida parapsilosis,et al). All STDs were tested in patients with first care-seeking at our STD clinics, Candida pathogens were culture with Sabouraud’s chloromycn medium. We found that the positive rate of Candida spp was 41.98% in 524 case with STD, and 17.50% in 200 case of normal controls.Copaired with control group, the positive rate in STD patients showed significant difference (P<0.01). Positve rate was in those patients withcandyloma acumintum,much higher than other STDs. The C.albicans was frequently noted in fungi species . The positive rate and incidence of vaginal Candida in STD clinic patients were higher than that of normal control. According to our research, 45.34%of patiets with STD cases are caused by Candida albicans in male, and 36.63% in female, We found that Candida glabrata was the second most fregquently isolated yeast ,coinciding with the results of other authors. It seems that there is an incease in non-C.albicans yeast frequency in certain populations. It appears that after decades of the predominance of Candida albicans,a change may be occurring resulting in an increase in nonalbicans species.The dispensing of over-counter topic antifungal and the approval of oral fluconazole in recent years may duce to the change.
This study showed that although the most islated yeast from STD clinic patients’vaginal and balanitis secretions is still C.albicans, this is only true for patients with Genital candidiasis symptoms. The islation of non-C.albicans yeasts was not low,but was more frequent in the candidiasis asymptomatic perpson,representing 81.25%(male)and 76.92 %(female) of yeasts found in these groups. These finding suggest that in the STD patients with genital candidiasis cases, colonization by yeasts is associated with non-C.albicans yeasts and that the evolution to the symptoms of genital candidiasis would depend,among other factors, on replacement by C.albicans. If this idea is correct, the routine practice of carrying out cultre identifications of yeasts could contribute to clarifying the challenge of differentiating colonization’s of infection by yeasts in genital secretions, specially STD clinic patients’vaginal or balanitis secretions.Our study showed that genital candidiasis is common among person attending STD clinics, and genital candidiasis can be transmitted through sexual contacts.
本研究结论如下:性传播疾病患者生殖器念珠菌分离率较正常人高。有症状患者菌种构成以白色念珠菌占绝对优势,无症状患者以非白色念珠菌分离率较高,其中以光滑念珠菌为主,克柔念珠菌比例不低。性传播疾病诊患者不洁性交及广泛使用抗生素等可能是生殖器念珠菌病发病危险因素之一。念珠菌在生殖器定植和感染,可能与其他病原微生物的生长有相互促进作用。
Genital candidiasis is a disease cause by abnormal growth of yeasts in the mucosa of the female genital tract or male balanitis and it is fregquently diagnosed in the daily practice of gynecology,with a significant increase during the last years. Candida balanitis either presented with penile redness, spots, and/or irritation or on direct questioning complained of itching or burning sensation after sexual intercourse.
Most of Genital candidiasis cases are caused by Candia albicans, while others are due to other non-C. albicans yeasts(Candida tropicalis, Candida glabrata, Candida krusei, Candida parapsilosis,et al). All STDs were tested in patients with first care-seeking at our STD clinics, Candida pathogens were culture with Sabouraud’s chloromycn medium. We found that the positive rate of Candida spp was 41.98% in 524 case with STD, and 17.50% in 200 case of normal controls.Copaired with control group, the positive rate in STD patients showed significant difference (P<0.01). Positve rate was in those patients withcandyloma acumintum,much higher than other STDs. The C.albicans was frequently noted in fungi species . The positive rate and incidence of vaginal Candida in STD clinic patients were higher than that of normal control. According to our research, 45.34%of patiets with STD cases are caused by Candida albicans in male, and 36.63% in female, We found that Candida glabrata was the second most fregquently isolated yeast ,coinciding with the results of other authors. It seems that there is an incease in non-C.albicans yeast frequency in certain populations. It appears that after decades of the predominance of Candida albicans,a change may be occurring resulting in an increase in nonalbicans species.The dispensing of over-counter topic antifungal and the approval of oral fluconazole in recent years may duce to the change.
This study showed that although the most islated yeast from STD clinic patients’vaginal and balanitis secretions is still C.albicans, this is only true for patients with Genital candidiasis symptoms. The islation of non-C.albicans yeasts was not low,but was more frequent in the candidiasis asymptomatic perpson,representing 81.25%(male)and 76.92 %(female) of yeasts found in these groups. These finding suggest that in the STD patients with genital candidiasis cases, colonization by yeasts is associated with non-C.albicans yeasts and that the evolution to the symptoms of genital candidiasis would depend,among other factors, on replacement by C.albicans. If this idea is correct, the routine practice of carrying out cultre identifications of yeasts could contribute to clarifying the challenge of differentiating colonization’s of infection by yeasts in genital secretions, specially STD clinic patients’vaginal or balanitis secretions.Our study showed that genital candidiasis is common among person attending STD clinics, and genital candidiasis can be transmitted through sexual contacts.
引文
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[4] Spinillo A, Capuzzo E, Gulminetti R, et al.Prevalence of and risk fators for fungal vaginitis caused by non-albicans species. Obstet Gynecol[J], 1997;176(1):138~141.
[5] Spinillo A,Pizzoli G, Colonna L, et al. Epidemiologic characteristics of women with idiopathic recurrent vulvovaginal candidiasis[J]. Obstet Gynecol, 1993; 81(5): 721~727.
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[7] Bauters TG, Dhont MA, Temmerman MI, Nelis HJ. Prevalence of vulvovaginal candidiasis and susceptibility to fluconazole in women[J]. Obst Gyn . 2002; 187:569~574.
[8] Verghese S, Padmaja P, Asha M, Elizabeth SJ, Anitha A, Kundavi KM, Jayanthi N, Varma, T.Prevalence, species distribution and antifungal sensitivity of vaginal yeasts in infertile women[J], Pathol Microbiol . 2001;44:313~314.
[9] Osboume. NG, Gnebin L, Pratsonl, Vaginitis in Sexually active Women: relationship to nine sexually transmitted organisms[J]. Am Jobstet Gync,1982; 142~962.
[10] 黄碧静. 妊娠妇女阴道真菌病人阴道调查[J]. 中华产科杂志,1988;23(4): 237.
[11] 黄进波,李森真,林欢儿. 生殖道念珠菌病病原真菌的调查及药敏实验[J]. 中国真菌学杂志, 2006;1(4): 215~218.
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[13] 张锡宝. 高危人群阴道念珠菌带菌情况及抗真菌药物药敏分析[J ]. 中国麻风皮肤病杂志, 2001; 3: 20.
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[16] Houang ETS, Chu KC, Koehler A P, et al. Use of CHROM agar Candida for genital specimens in the diagnostic laboratory[J]. Clin Pathol, 1997; 50(7): 563~565.
[17] 叶应妩,王毓三,主编.全国临床检验操作规程[M].第 3版,南京:东南大学出版社,1991; 142~143.
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[19] 陈永艳,罗显华. 男性生殖器尖锐湿疣复发与念珠菌性龟头炎发病相关性的临床分析[J]. 中国皮肤性病学杂志, 2004;18(8):484~485.
[20] 陆健群. 生殖器尖锐湿疣与外阴阴道念珠菌病发病相关性临床探讨[J ] . 临床皮肤科杂志, 2002 ; 31(3) :166~167.
[21] 廖元兴,杨永庆,梁洁,等. 男性非淋病性尿道炎患者行病 病 原 体 的 研 究 [J ]. 中 国 麻 风 皮 肤 病 杂 志 , 2005; 21(3):178~180.
[22] Lefevre JC, Lepargnear JP,Bauriaud AR, et al. Clinical and Mrcrobiologic features of urethritis in men in Toulouse, France[J]. Sex Trans Dis, 1991;18:76.
[23] Kumar B, Bawn G, Sharma M, et al. Uarethral flora in adolescent boys[J]. Genitourin Med ,1995;71:328~330.
[24] Lockart SR, Reed BD ,Pierson CL, et al. Most frequent scenario for recurrent Candida Vaginitis is strain maintenance with substrain shuffling: demonstration by sequential DNA fingerprinting with probes Ca3, C1, and CARE2[J]. Clin Microbiol, 1996; 34(4):767~777.
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[26] Spinillo A,Pizzoli G, Colonna L, et al. Epidemiologic characteristics of women with idiopathic recurrent vulvovaginal candidiasis[J]. Obstet Gynecol, 1993; 81(5): 721~727
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[11] 廖元兴,杨永庆,梁洁,等. 男性非淋病性尿道炎患者行病 病 原 体 的 研 究 . 中 国 麻 风 皮 肤 病 杂 志 [J], 2005; 21(3):178~180.
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[16] 李军,郑和义,孙秋宁,等. 念珠菌性龟头炎及其致病菌种、药敏分析[J]. 临床皮肤科杂, 2004; 33(7):398~400.
[17] 张锡宝. 高危人群阴道念珠菌带菌情况及抗真菌药物药敏分析[J ]. 中国麻风皮肤病杂志, 2001; 3: 20.
[18]廖洁冰. 阴道炎发病原因分析[J]. 检验医学与临床. 2006;3 (4):166~167.
[19] Nwokolo NC, Boag FC. Chronic vaginal candidiasis[J]. Drugs Aging, 2000; 16(5):335~339.
[20] 廉翠红, 刘维达. 与白念珠菌豁附和侵人相关的毒力因子研 究 进 展 [J]. 国 外 医 学 皮 肤 性 病 学 分 册 ,2004; 30(5):323~325.
[21] Ries AJ. Treatment of vaginal infection: candidiasis, bacterial vaginosis, and trichomoniasis[J]. Pharma Assoc, 1997; NS37 (5): 563~569.
[22] Spinillo A, Capuzzo E, Gulminetti R, et al.Prevalence of and risk fators for fungal vaginitis caused by non-albicans species. Obstet Gynecol[J], 1997;176(1):138~141
[23] Spinillo A,Pizzoli G, Colonna L, et al. Epidemiologic characteristics of women with idiopathic recurrent vulvovaginal candidiasis[J]. Obstet Gynecol, 1993; 81(5): 721~727
[24] Márcia Edilaine Lopes Consolaro1, Thamara Aline Albertoni1, Celina Shizue Yoshida1, et al. Correlation of Candida species and symptoms among patients with vulvovaginal candidiasis in Maringá, Paraná, Brazil [J].Iberoam Micol. 2004 ;21: 202~205.
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[28] Verghese S, Padmaja P, Asha M, Elizabeth SJ, Anitha A, Kundavi KM, Jayanthi N, Varma, T.Prevalence, species distribution and antifungal sensitivity of vaginal yeasts in infertile women[J], Pathol Microbiol . 2001;44:313~314.
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[31] Osboume. NG, Gnebin L, Pratsonl, Vaginitis in Sexually active Women: relationship to nine sexually transmitted organisms [J]. Am Jobstet Gync,1982;142~962.
[32] 黄碧静. 妊娠妇女阴道真菌病人阴道调查[J]. 中华产科杂志,1988;23(4):237.
[33] Buitron Garcia R, Romero Cabello R. Cruz Talonia FStudy on Candida no-albicans species and its relation to recurrent vulvovaginal candidiasis[J]. Ginecol Obstet Mex, 2002, 70: 431~6.
[34] Vazquez JA, Sobel JD, Peng G, et al. Evolution of vaginal Candida species recovered from human immunodeficiency virus-infected women receiving fluconazole prophylaxis: the emergence of Candida glabrata Terry Beirn Community Programs for Clinical Research in AIDS (CPCRA)[J] .Clin Infect Dis. Clin Infect Dis[J],1999;28(5):1025~1031.
[35] Lockart SR, Reed BD ,Pierson CL, et al. Most frequent scenario for recurrent Candida Vaginitis is strain maintenance with substrain shuffling: demonstration by sequential DNA fingerprinting with probes Ca3, C1, and CARE2[J]. Clin Microbiol, 1996; 34(4):767~777.
[2] Nwokolo NC, Boag FC. Chronic vaginal candidiasis[J]. Drugs Aging, 2000; 16(5):335~339.
[3] Ries AJ. Treatment of vaginal infection: candidiasis, bacterial vaginosis, and trichomoniasis[J]. Pharma Assoc, 1997; NS37 (5):563~569.
[4] Spinillo A, Capuzzo E, Gulminetti R, et al.Prevalence of and risk fators for fungal vaginitis caused by non-albicans species. Obstet Gynecol[J], 1997;176(1):138~141.
[5] Spinillo A,Pizzoli G, Colonna L, et al. Epidemiologic characteristics of women with idiopathic recurrent vulvovaginal candidiasis[J]. Obstet Gynecol, 1993; 81(5): 721~727.
[6]Márcia Edilaine Lopes Consolaro1, Thamara Aline Albertoni1,Celina Shizue Yoshida1, et al. Correlation of Candida species and symptoms among patients withvulvovaginal candidiasis in Maringá, Paraná, Brazil [J].Iberoam Micol. 2004 ;21: 202~205.
[7] Bauters TG, Dhont MA, Temmerman MI, Nelis HJ. Prevalence of vulvovaginal candidiasis and susceptibility to fluconazole in women[J]. Obst Gyn . 2002; 187:569~574.
[8] Verghese S, Padmaja P, Asha M, Elizabeth SJ, Anitha A, Kundavi KM, Jayanthi N, Varma, T.Prevalence, species distribution and antifungal sensitivity of vaginal yeasts in infertile women[J], Pathol Microbiol . 2001;44:313~314.
[9] Osboume. NG, Gnebin L, Pratsonl, Vaginitis in Sexually active Women: relationship to nine sexually transmitted organisms[J]. Am Jobstet Gync,1982; 142~962.
[10] 黄碧静. 妊娠妇女阴道真菌病人阴道调查[J]. 中华产科杂志,1988;23(4): 237.
[11] 黄进波,李森真,林欢儿. 生殖道念珠菌病病原真菌的调查及药敏实验[J]. 中国真菌学杂志, 2006;1(4): 215~218.
[12]李军,郑和义,孙秋宁,等. 念珠菌性龟头炎及其致病菌种、药敏分析. 临床皮肤科杂, 2004; 33(7): 398~400.
[13] 张锡宝. 高危人群阴道念珠菌带菌情况及抗真菌药物药敏分析[J ]. 中国麻风皮肤病杂志, 2001; 3: 20.
[14]廖洁冰. 阴道炎发病原因分析. 检验医学与临床[J]. 2006;3 (4):166~167.
[15] 廉翠红, 刘维达. 与白念珠菌豁附和侵人相关的毒力因子研究进展[J]. 国外医学皮肤性病学分册,2004; 30(5): 323~325.
[16] Houang ETS, Chu KC, Koehler A P, et al. Use of CHROM agar Candida for genital specimens in the diagnostic laboratory[J]. Clin Pathol, 1997; 50(7): 563~565.
[17] 叶应妩,王毓三,主编.全国临床检验操作规程[M].第 3版,南京:东南大学出版社,1991; 142~143.
[18] 李森真、黄进波、许良杰. 性病患者阴道念珠菌感染情况分析[J]. 临床皮肤科杂志, 2002;31(9):559~561.
[19] 陈永艳,罗显华. 男性生殖器尖锐湿疣复发与念珠菌性龟头炎发病相关性的临床分析[J]. 中国皮肤性病学杂志, 2004;18(8):484~485.
[20] 陆健群. 生殖器尖锐湿疣与外阴阴道念珠菌病发病相关性临床探讨[J ] . 临床皮肤科杂志, 2002 ; 31(3) :166~167.
[21] 廖元兴,杨永庆,梁洁,等. 男性非淋病性尿道炎患者行病 病 原 体 的 研 究 [J ]. 中 国 麻 风 皮 肤 病 杂 志 , 2005; 21(3):178~180.
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