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Summer 2013, Vol. 21 No. 2

Hong Kong J. Dermatol. Venereol. (2013)21, 56-63


Original Article

Co-infection rate of chlamydial urethritis in patients with gonorrhea in Hong Kong

香港衣原體尿道炎在淋病患者的共同感染率

CK Kwan 關志強, HF Ho 何慶豐, KM Ho 何景文

Abstract

Background: Both gonorrhoea and chlamydia urethritis present with dysuria and discharge. It is difficult to differentiate by history and clinical examination alone. Empirical treatment may induce drug resistance whereas complications and the spread of infections may be increased if treatment is started only after the availability of gonococcal culture and chlamydia polymerase chain reaction (PCR) results that take around few weeks. A study to determine the co-infection rate will help to streamline the treatment strategy. Objectives: The objectives are to determine (1) the co-infection rate of chlamydia among patients with gonorrhoea and (2) their independent risk factors. Methods: All available patients' records who attended the Social Hygiene Clinics of the Department of Health, Hong Kong with urogenital (urethral/cervical) smear done during July 2005 to June 2008 were reviewed. For patients having positive N. gonorrhoeae cultures, concomitant chlamydia PCR results were reviewed to determine the co-infection rate. Results: The chlamydia co-infection rate with gonorrhoea was 22.2% (95% CI=20.7%-23.7%) in which female, younger age (≤25 years) and lack of condom use were the independent risk factors of co-infection. Conclusions: Using a simple and cost-effective diagnostic tool of Gram stain and microscopy together with the knowledge of the co-infection rate of chlamydia among gonorrhoea patients in this retrospective study, empirical treatment should be considered to cover both gonococcal and chlamydial urethritis particularly in high-risk groups such as female patients, young age groups and those not using a condom.

背景:淋病和衣原體尿道炎都會出現排尿困難和尿道分泌物,這是很難從病歷和臨床檢查去區分的。憑經驗治療可能會增加耐藥性,但淋球菌培養和衣原體聚合酶鏈反應結果大約需時幾個星期,若證實後才開始治療可能會增加併發症和傳播感染的風險。研究以確定共同的感染率可能有助於簡化治療的策略。目標:目標是去確定(一)衣原體在淋病患者的共感染率和(二)他們的獨立風險因素。方法:將所有在2005年7月至2008年6月到社會衛生科診所求診而可用的病人病歷及有做泌尿生殖系統(尿道/宮頸)抹片驗查的,進行了審查。對於那些淋病菌培養顯示陽性結果的記錄,伴隨有衣原體聚合酶鏈反應結果進行了審查,以確定其共同感染率。結果:衣原體與淋病的共同感染率為 22.2%(95% CI=20.7%-23.7%),其中女性,年輕(≤25歲),而不使用安全套的,都是共同感染的獨立危險因素。結論:使用一個簡單的和具成本效益的診斷工具如革蘭氏染色和顯微鏡及這項回顧性研究中淋病患者和衣原體的共同感染率的知識,在特別高風險的群體,如女性患者,年輕人和那些不使用避孕套的,都是值得考慮給予憑經驗性治療去覆蓋淋球菌和衣原體尿道炎。

Keywords: Chlamydial urethritis, co-infection rate, gonorrhoea

關鍵詞: 衣原體尿道炎,共同感染率,淋病