淋球菌、衣原体感染与盆腔炎的相关性
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摘要
目的:研究女性淋球菌、衣原体感染与盆腔炎(pelvic inflammatory disease,PID)发病的相关性,为临床防治提供理论依据。方法:纳入恩施州中心医院2007至2017年住院及急诊315 123例PID女性(出生于1978—1999年)。收集相关宫颈分泌物病理检测报告等病例资料,比较分析淋球菌、衣原体感染与PID发病的相关性。结果:120 748例有衣原体及淋球菌病理检测报告,10 745例有衣原体检测报告,653例仅有淋球菌检测报告,182 977例无检测报告。其中,16 778例(12.8%)检测为衣原体感染阳性,3 195例(2.6%)检测为淋球菌感染阳性,1 874例(1.6%)检测为衣原体合并淋球菌感染。最终确诊4 819例PID患者(2 222例住院患者,2 597例急诊患者)。校准年龄、原住地、成长所在地、社会经济地位因素,与衣原体淋球菌检测均阴性的女性相比,衣原体及淋球菌均阳性的女性PID的相对危险度为4.29(95%CI 3.66～5.03),淋球菌阳性为4.54(95%CI 3.87～5.33),而衣原体阳性为1.77(95%CI 1.61～1.94)。结论:与衣原体感染相比,淋球菌感染更容易引发PID。
Objective: To explore the risk of pelvic inflammatory disease(PID) associated with chlamydia and gonorrhea infection and subsequent repeat infections, which provides theoretical basis for clinical prevention and treatment.Methods: A total of 315 123 women, born from 1978–1999, were probabilistically linked to chlamydia and gonorrhea testing records and to hospitalizations and emergency department presentations for PID from 2007 to 2017. Statistical analysis was used to investigate the association between chlamydia and gonorrhea testing, and positivity, and risk of PID. Results: A total of 120 748 women had pathology test records for both chlamydia and gonorrhea, 10 745 chlamydia only, and 653 gonorrhea only. Among those tested, 16 778(12.8%) had positive chlamydia test, 3 195(2.6%) were positive gonorrhea test, and 1 874(1.6%) were positive for both. There were4 819 PID presentations(2 222 hospitalizations, 2 597 emergency presentations). Adjusting for age, aboriginality,health area, and socioeconomic status, compared to women negative for chlamydia and gonorrhea, the relative risk(adjusted incidence rate ratio) of PID was 4.29(95% CI 3.66–5.03) in women who were both chlamydia and gonorrhea positive; 4.54(95% CI 3.87–5.33) in those only gonorrhea positive; and 1.77(95% CI 1.61–1.94)in those only chlamydia positive. Conclusion: Gonorrhea infection confers a substantially higher risk than chlamydia of hospitalization or emergency department presentation for PID.
Objective: To explore the risk of pelvic inflammatory disease(PID) associated with chlamydia and gonorrhea infection and subsequent repeat infections, which provides theoretical basis for clinical prevention and treatment.Methods: A total of 315 123 women, born from 1978–1999, were probabilistically linked to chlamydia and gonorrhea testing records and to hospitalizations and emergency department presentations for PID from 2007 to 2017. Statistical analysis was used to investigate the association between chlamydia and gonorrhea testing, and positivity, and risk of PID. Results: A total of 120 748 women had pathology test records for both chlamydia and gonorrhea, 10 745 chlamydia only, and 653 gonorrhea only. Among those tested, 16 778(12.8%) had positive chlamydia test, 3 195(2.6%) were positive gonorrhea test, and 1 874(1.6%) were positive for both. There were4 819 PID presentations(2 222 hospitalizations, 2 597 emergency presentations). Adjusting for age, aboriginality,health area, and socioeconomic status, compared to women negative for chlamydia and gonorrhea, the relative risk(adjusted incidence rate ratio) of PID was 4.29(95% CI 3.66–5.03) in women who were both chlamydia and gonorrhea positive; 4.54(95% CI 3.87–5.33) in those only gonorrhea positive; and 1.77(95% CI 1.61–1.94)in those only chlamydia positive. Conclusion: Gonorrhea infection confers a substantially higher risk than chlamydia of hospitalization or emergency department presentation for PID.
引文
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19.Silver BJ,Knox J,Smith KS,et al.Frequent occurrence of undiagnosed pelvic inflammatory disease in remote communities of central Australia[J].Med J Aust,2012,197(11):647-651.
20.Pelvic inflammatory disease[J].Obstet Gynecol,2010,116(2 Pt 1):419-428.
21.Ness RB,Soper DE,Holley RL,et al.Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease:results from the Pelvic Inflammatory Disease Evaluation and Clinical Health(PEACH)randomized trial[J].Am J Obstet Gynecol,2002,186(5):929-937.
2.Westr?m L,Joesoef R,Reynolds G,et al.Pelvic inflammatory disease and fertility.A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results[J].Sex Transm Dis,1992,19(4):185-192.
3.Gray-Swain MR.Pelvic inflammatory disease in adolescents[J].Curr Opin Obstet Gynecol,2006,18(5):503-510.
4.Wiesenfeld HC,Hillier SL,Meyn LA,et al.Subclinical pelvic inflammatory disease and infertility[J].Obstet Gynecol,2012,120:37-43.
5.Davies B,Turner K.Risk of pelvic inflammatory disease after Chlamydia infection in a prospective cohort of sex workers[J].Sex Transm Dis,2013,40(3):230-234.
6.Low N,Egger M,Sterne JA,et al.Incidence of severe reproductive tract complications associated with diagnosed genital chlamydial infection:the Uppsala Women's Cohort Study[J].Sex Transm Infect,2006,82(3):212-218.
7.Moore MS,Golden MR,Scholes D.Assessing trends in chlamydia positivity and gonorrhea incidence and their associations with the incidence of pelvic inflammatory disease and ectopic pregnancy in Washington state,1988-2010[J].Sex Transm Dis,2016,43(1):2-8.
8.Short VL,Totten PA,Ness RB,et al.Clinical presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease[J].Clin Infect Dis,2009,48(1):41-47.
9.Haggerty CL.Mycoplasma genitalium:an emerging cause of pelvic inflammatory disease[J].Infect Dis Obstet Gynecol,2011,2011:959816.
10.Cherpes TL,Wiesenfeld HC,Melan MA,et al.The associations between pelvic inflammatory disease,Trichomonas vaginalis infection,and positive herpes simplex virus type 2 serology[J].Sex Transm Dis,2006,33(12):747-752.
11.Ness RB,Kip KE,Hillier SL,et al.A cluster analysis of bacterial vaginosis-associated microflora and pelvic inflammatory disease[J].Am J Epidemiol,2005,162(6):585-590.
12.Fact sheet on Ebola virus disease(updated May 2017)[J].Wkly Epidemiol Rec,2017,92(20):286-292.
13.Centres for Disease Control and Prevention.Sexually transmitted diseases surveillance 2015[M].Atlanta,GA:CDC,2016.
14.Kirby Institute.Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander people:surveillance and evaluation report 2016[M].Sydney,Australia:Kirby Institute,2016.
15.Graham S,Guy RJ,Donovan B,et al.Epidemiology of chlamydia and gonorrhoea among Indigenous and non-Indigenous Australians,2000-2009[J].Med J Aust,2012,197(11):642-646.
16.Newman LM.Epidemiology of STD disparities in African American communities[J].Sex Transm Dis,2008,35(12 Suppl):S4-S12.
17.Reekie J,Donovan B,Guy R,et al.Trends in chlamydia and gonorrhoea testing and positivity in Western Australian Aboriginal and nonAboriginal women 2001-2013:a population-based cohort study[J].Sex Health,2017,14(6):574-580.
18.Lis R,Rowhani-Rahbar A.Mycoplasma genitalium infection and female reproductive tract disease:a meta-analysis[J].Clin Infect Dis,2015,61(3):418-426.
19.Silver BJ,Knox J,Smith KS,et al.Frequent occurrence of undiagnosed pelvic inflammatory disease in remote communities of central Australia[J].Med J Aust,2012,197(11):647-651.
20.Pelvic inflammatory disease[J].Obstet Gynecol,2010,116(2 Pt 1):419-428.
21.Ness RB,Soper DE,Holley RL,et al.Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease:results from the Pelvic Inflammatory Disease Evaluation and Clinical Health(PEACH)randomized trial[J].Am J Obstet Gynecol,2002,186(5):929-937.