PDF(Pubmed)
Abstract：
These days sexually transmitted infections (STIs) are important public health problems not only due to their high prevalence, but also because they require early diagnosis and treatment to avoid complications. In recent years, there has been an exponential increase in cases of infections caused by Chlamydia trachomatis and gonococcus in the population under 25years of age. In addition, an increase in the incidence of syphilis and hepatitisC (HCV) has also been detected, especially in men who have sex with other men (MSM). Genital herpes continues to be the second most frequent STI in the world, behind condyloma acuminata, and the first cause of genital ulcer among Spain in the sexually active population. A decrease in reported HIV cases was observed during 2020, but almost half of these new cases had a late diagnosis (<350CD4cell/μL). Current guidelines recommend offering STI annual screening to populations at risk or more often depending on the risk. STIs can appear in the form of syndromes, such as secretory syndrome (urethritis, proctitis, and cervicitis) or ulcerated syndrome (ulcers). The STIs that can cause secretory syndrome are mainly caused by Neisseria gonorrhoeae and C.trachomatis, which co-infect up to 40% of cases, and also cause urethritis, cervicitis or proctitis depending on where they are located. Gonococcus has an incubation period of 2-7days and Chlamydia 2-6weeks, and they are diagnosed using PCR and/or culture (the last one only valid for gonococcus) of samples collected according to sexual activities. Empirical treatment to cover both germs will be accomplished with ceftriaxone, 1g single intramuscular dose plus doxycycline 100mg every 12h orally for 7days, or azithromycin 1g single dose orally (we will use azithromycin only if we suspect a poor compliance with treatment, difficulty in going to the control or in pregnancy). Likewise, whenever we diagnose an STI firstly, we must offer advice and health education in order to promote the adoption of safe sexual behaviours and the correct use of barrier methods. Secondly, we must also screen for other STIs (HIV, syphilis, hepatitisB, and hepatitisA andC depending on the risk), offer HBV and HAV vaccination if it is appropriate, and finally study and treat all sexual partners from the previous 3months.
摘要：
如今，性传播感染（STIs）是重要的公共卫生问题，不仅是因为它们的高患病率，还因为它们需要早期诊断和治疗以避免并发症。近年来,在25岁以下的人群中，由沙眼衣原体和淋球菌引起的感染病例呈指数增长。此外,梅毒和丙型肝炎（HCV）的发病率也有所增加，尤其是与其他男性发生性关系的男性（MSM）。生殖器疱疹仍然是世界上第二常见的性传播感染，尖锐湿疣后面,也是西班牙性活跃人群中生殖器溃疡的第一个原因。在2020年期间观察到报告的HIV病例有所减少，但这些新病例中几乎有一半具有晚期诊断（<350CD4细胞/μL）。目前的指南建议对有风险的人群或更经常地根据风险进行性传播感染的年度筛查。性传播感染可以以综合征的形式出现，如分泌综合征(尿道炎，直肠炎,和宫颈炎）或溃疡综合征（溃疡）。可引起分泌综合征的性传播感染主要由淋病奈瑟菌和沙眼衣原体引起,同时感染了高达40%的病例，还会引起尿道炎，宫颈炎或直肠炎取决于他们的位置。淋球菌的潜伏期为2-7天，衣原体的潜伏期为2-6周，并使用PCR和/或根据性活动收集的样品的培养（最后一种仅对淋球菌有效）进行诊断。用头孢曲松完成覆盖两种细菌的经验性治疗，1g单次肌注剂量加多西环素100mg每12h口服7天，或阿奇霉素1g单剂量口服(只有当我们怀疑治疗依从性差时，我们才会使用阿奇霉素，难以控制或怀孕）。同样，每当我们首先诊断性传播感染时，我们必须提供建议和健康教育，以促进采取安全的性行为和正确使用障碍方法。其次,我们还必须筛查其他性传播感染(艾滋病毒，梅毒,肝炎B,和肝炎A和C取决于风险)，如果合适，提供HBV和HAV疫苗接种，最后研究和治疗前3个月的所有性伴侣。
