非淋菌非衣原体性宫颈炎生殖支原体感染状况的临床分析
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摘要
近年来有关生殖支原体(Mycoplasma genitalium,Mg)与非淋菌性尿道炎、盆腔炎等相关性研究表明Mg是泌尿生殖道感染的重要病原体之一,但Mg与非淋菌非衣原体性宫颈炎(Nongonococcal nonchlamydial cervicitis,NGNCC)的相关性研究少有报道。
本研究采用现况研究法对158例NGNCC患者、98例非NGNCC性病门诊女性就诊者及94例健康女性进行问卷调查,并采用培养及两种PCR方法对三组人群宫颈分泌物标本进行Mg分离和检测。结果:(1)158例NGNCC中16例(10.13%)Mg阳性,98例非NGNCC性病门诊女性就诊者中3例(3.06%)Mg阳性,94例健康女性未检出Mg,NGNCC组Mg感染率与其他各组差异均有统计学意义(P <0.05)。(2)NGNCC组Mg阳性者临床及流行病学状况分析:16例Mg感染者均有宫颈黄色粘液脓性分泌物,其中13例有宫颈糜烂,11例既往有持续性、复发性宫颈炎病史;年龄以26~35岁居多,大专以下学历为主,服务业和无业人员最多,主要是城市常住人口,已婚患者构成比高,多有非婚、多性伴接触史。(3)12例NGNCC单纯Mg阳性者给予美满霉素200mg/日口服,共7天,其中10例患者完成随访和治疗,治疗1周后有9例患者症状改善。(4)将350例受检者分为Mg阳性组和阴性组,经多因素Logistic分析,结果性伴数(OR=5.542,95%CI 1.945~15.787)、性生活频率(OR=5.382,95%CI 1.881~15.398)及既往宫颈炎史(OR=5.824,95%CI 1.923~17.643)与Mg感染相关。结论:NGNCC患者Mg感染率较高,Mg可能是NGNCC的致病因素之一。
Mycoplasma genitalium (Mg) was first identified in the early 1980s among men with nongonococcal urethritis (NGU). Its unique biological characteristics and the relation with nongonococcal urethritis、chronic prostatitis、cervicitis、pelvic inflammatory disease and HIV infections have been focused by scholars. Mucopurulent cervicitis (MPC) is a frequent condition of young women attending a sexually transmitted diseases (STD) clinic. Although Neisseria gonorrhoeae (Ng) and/or Chlamydia trachomatis (Ct) are/is recovered from approximately a third to a half of women with it, the etiologic agent of nongonococcal nonchlamydial cervicitis (NGNCC) is often unidentified. And treatment is depended on experience, so the treatment is not very effectective. Detection of the pathogens may result into specific therapeutic measures, with varying degrees of success.
In recent years, several studies have shown that Mg is strongly associated with MPC, but few general studies about Mg and NGNCC in particular. The aim of this study was to obtain information on Mg infection with NGNCC concerning prevalence, association to clinical manifestations, the situation of epidemiology and risk factors.
We detected Mg、Ct、Ng、Ureaplasma urealyticum (Uu)、Mycoplasma hominis (Mh) by culture and PCR methods;Trichomonas vaginalis (Tv) by wet-mount microscopy. Cervical secretions were obtained from 3 different female populations: 158 NGNCC patients, 98 non-NGNCC patients and 94 healthy volunteers. At the same time, a structured questionnaire was filled by the participants for information about age, marital status, the culture level and the infection sources, age at first intercourse, cervical status, number of sex partmers in the past two years, averange frequency of sexual intercourse, condom using, history of cervicitis or other STDs history in the past two years, and sex partner’s STDs history. The Mg positive patients without other pathogens were detected Mg again after treatment.
Results: (1) We detected Mg in 16(10.13%) of 158 NGNCC patients. Among the 16 positive cases, 4 had other pathogens, of which Uu was the most common. Respectively, the positive rates Mg in non-NGNCC patients and healthy volunteers were 3.06%(3/98) and 0.00%. Significant difference was found each two groups (P<0.05) except non-NGNCC patients and healthy volunteers (P>0.05). (2) Mucopurulent secretion was the most common clinical feature of 16 Mg infection of NGNCC. 11 cases (68.75%) had persistent or recurrent cervicitis. (3) The epidemiological survey and analysis of Mg positive with NGNCC cases:①26~35 year-old people were the most common;②less likely to have more than a high school education, service and the jobless were the most in the professional;③the city region was the major in the region distributing;④the married women had the higher percentage;⑤62.50%(10/16) had experience of sexual intercourse with more than 2 sexual partners. (4) Minocycline can eradicated Mg from 10 cases of NGNCC with Mg infection. 9 cases’signs and symptoms of cervicitis disappeared. (5) The relevant factors of infection with Mg were more than 2 life-time sexual parners (OR=5.542, 95%CI 1.945~15.787), the average frequency of sexual intercourse(OR=5.382, 95%CI 1.881~15.398) and had history of cervicitis (OR=5.824, 95%CI 1.923~17.643).
Our conclusion: (1) Mg is prevalent in the cervix of women with NGNCC, it’s strongly associated with NGNCC. (2) We should pay more attention to the high risk population. (3) Minocycline can eradicated Mg infection, and signs and symptoms of cervicitis can be improved. (4) Epidemics and transmitting of NGNCC were associated with many risk factors. This study provides the experimental evidence for the pathogen, diagnosis and treatment of the NGNCC, and is helpful in the prevention of it.
本研究采用现况研究法对158例NGNCC患者、98例非NGNCC性病门诊女性就诊者及94例健康女性进行问卷调查,并采用培养及两种PCR方法对三组人群宫颈分泌物标本进行Mg分离和检测。结果:(1)158例NGNCC中16例(10.13%)Mg阳性,98例非NGNCC性病门诊女性就诊者中3例(3.06%)Mg阳性,94例健康女性未检出Mg,NGNCC组Mg感染率与其他各组差异均有统计学意义(P <0.05)。(2)NGNCC组Mg阳性者临床及流行病学状况分析:16例Mg感染者均有宫颈黄色粘液脓性分泌物,其中13例有宫颈糜烂,11例既往有持续性、复发性宫颈炎病史;年龄以26~35岁居多,大专以下学历为主,服务业和无业人员最多,主要是城市常住人口,已婚患者构成比高,多有非婚、多性伴接触史。(3)12例NGNCC单纯Mg阳性者给予美满霉素200mg/日口服,共7天,其中10例患者完成随访和治疗,治疗1周后有9例患者症状改善。(4)将350例受检者分为Mg阳性组和阴性组,经多因素Logistic分析,结果性伴数(OR=5.542,95%CI 1.945~15.787)、性生活频率(OR=5.382,95%CI 1.881~15.398)及既往宫颈炎史(OR=5.824,95%CI 1.923~17.643)与Mg感染相关。结论:NGNCC患者Mg感染率较高,Mg可能是NGNCC的致病因素之一。
Mycoplasma genitalium (Mg) was first identified in the early 1980s among men with nongonococcal urethritis (NGU). Its unique biological characteristics and the relation with nongonococcal urethritis、chronic prostatitis、cervicitis、pelvic inflammatory disease and HIV infections have been focused by scholars. Mucopurulent cervicitis (MPC) is a frequent condition of young women attending a sexually transmitted diseases (STD) clinic. Although Neisseria gonorrhoeae (Ng) and/or Chlamydia trachomatis (Ct) are/is recovered from approximately a third to a half of women with it, the etiologic agent of nongonococcal nonchlamydial cervicitis (NGNCC) is often unidentified. And treatment is depended on experience, so the treatment is not very effectective. Detection of the pathogens may result into specific therapeutic measures, with varying degrees of success.
In recent years, several studies have shown that Mg is strongly associated with MPC, but few general studies about Mg and NGNCC in particular. The aim of this study was to obtain information on Mg infection with NGNCC concerning prevalence, association to clinical manifestations, the situation of epidemiology and risk factors.
We detected Mg、Ct、Ng、Ureaplasma urealyticum (Uu)、Mycoplasma hominis (Mh) by culture and PCR methods;Trichomonas vaginalis (Tv) by wet-mount microscopy. Cervical secretions were obtained from 3 different female populations: 158 NGNCC patients, 98 non-NGNCC patients and 94 healthy volunteers. At the same time, a structured questionnaire was filled by the participants for information about age, marital status, the culture level and the infection sources, age at first intercourse, cervical status, number of sex partmers in the past two years, averange frequency of sexual intercourse, condom using, history of cervicitis or other STDs history in the past two years, and sex partner’s STDs history. The Mg positive patients without other pathogens were detected Mg again after treatment.
Results: (1) We detected Mg in 16(10.13%) of 158 NGNCC patients. Among the 16 positive cases, 4 had other pathogens, of which Uu was the most common. Respectively, the positive rates Mg in non-NGNCC patients and healthy volunteers were 3.06%(3/98) and 0.00%. Significant difference was found each two groups (P<0.05) except non-NGNCC patients and healthy volunteers (P>0.05). (2) Mucopurulent secretion was the most common clinical feature of 16 Mg infection of NGNCC. 11 cases (68.75%) had persistent or recurrent cervicitis. (3) The epidemiological survey and analysis of Mg positive with NGNCC cases:①26~35 year-old people were the most common;②less likely to have more than a high school education, service and the jobless were the most in the professional;③the city region was the major in the region distributing;④the married women had the higher percentage;⑤62.50%(10/16) had experience of sexual intercourse with more than 2 sexual partners. (4) Minocycline can eradicated Mg from 10 cases of NGNCC with Mg infection. 9 cases’signs and symptoms of cervicitis disappeared. (5) The relevant factors of infection with Mg were more than 2 life-time sexual parners (OR=5.542, 95%CI 1.945~15.787), the average frequency of sexual intercourse(OR=5.382, 95%CI 1.881~15.398) and had history of cervicitis (OR=5.824, 95%CI 1.923~17.643).
Our conclusion: (1) Mg is prevalent in the cervix of women with NGNCC, it’s strongly associated with NGNCC. (2) We should pay more attention to the high risk population. (3) Minocycline can eradicated Mg infection, and signs and symptoms of cervicitis can be improved. (4) Epidemics and transmitting of NGNCC were associated with many risk factors. This study provides the experimental evidence for the pathogen, diagnosis and treatment of the NGNCC, and is helpful in the prevention of it.
引文
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