1NovelSTDPreventionServicesforMenwhohaveSexwithMen

針對(duì)與同性發(fā)生性行為的男性(MSM)的新型性病預(yù)防服務(wù)JeffreyD.Klausner,MD,MPHDirector,STDPreventionServicesSanFranciscoDepartmentofPublicHealth舊金山公共衛(wèi)生部性傳播疾病預(yù)防服務(wù)辦公室主任JeffreyD.Klausner醫(yī)學(xué)博士兼公共衛(wèi)生碩士AssociateClinicalProfessorofMedicineDivisionsofAIDSandInfectiousDiseases

UniversityofCaliforniaSanFrancisco加州舊金山大學(xué)艾滋病和傳染病學(xué)院臨床醫(yī)學(xué)副教授Increasesinmalerectalgonorrhea,SanFrancisco

男性直腸淋病患者增長(zhǎng)率（舊金山）CDCMMWR1999;48(3):45-55GonorrheainMSM,SanFrancisco,1999-2008

1999-2008年間舊金山MSM淋病患者增長(zhǎng)率

SFDPH,STDSection,20082008，SFDPH，STD部分4EarlySyphilis1998–2007

1998–2007年間早期梅毒病例數(shù)5PublicHealthResponse

公共健康應(yīng)對(duì)措施Enhancedsurveillance監(jiān)管力度增強(qiáng)Moreclinical&labservices臨床與化驗(yàn)服務(wù)增多Healthprovidereducation健康提供者教育Communityhealthpromotion社區(qū)健康程度提高Addressselectriskfactors解決首要風(fēng)險(xiǎn)因素PublicHealthEvaluation公共健康評(píng)估6JAMA2000;284:447-450Strongassociation(OR=8.7,P<.05)betweenmeetingpartnerontheInternetandsyphilis和互聯(lián)網(wǎng)上認(rèn)識(shí)的性伴侶約會(huì)與感染梅毒之間的密切聯(lián)系(OR=8.7,P<.05)

7PercentofSyphilisCasesReportingMeetingPartnersbyVenue,California

在聚會(huì)場(chǎng)所與性伴侶約會(huì)感染梅毒的病例比例（加州）Internet互聯(lián)網(wǎng)Bathhouses/SexClubs洗浴中心/色情俱樂部Private/CircuitParties私人/盛大舞會(huì)Bars/Clubs酒吧/俱樂部7/2006ProvisionalData-CADHSSTDControlBranch7/2006臨時(shí)數(shù)據(jù)-加利福尼亞DHSSTD控制分支機(jī)構(gòu)8STDControlStrategy

性病控制戰(zhàn)略Screen檢查Treat治療Treatpartners治療性伴侶Screen檢查9MostrectalchlamydialinfectionsinMSMareasymptomatic

MSM中多數(shù)直腸衣原體感染者無癥狀N=31614%86%Kentetal.CID2005Kent等，CID2005Asymptomatic無癥狀Symptomatic有癥狀10STDScreening

性病檢查STDsareasymptomatic性病無癥狀Promotescreening加大檢查力度Useaccuratescreeningtests采用精確的檢查檢驗(yàn)方法Makescreeningeasy使檢查簡(jiǎn)單易行11Screenwithnucleicacidtests

采用核酸檢驗(yàn)方法進(jìn)行檢查12PharyngealGonorrheaPositivity

SanFrancisco,2005(n=9,727)

2005年舊金山咽部淋病呈陽性的患者比例

(n=9,727)Overallprevalence7.8%總患病率為7.8%13RectalGonorrheaPositivity

SanFrancisco,2005(n=6,968)

2005年舊金山直腸淋病呈陽性的患者比例(n=6,968)Overallprevalence7.0%總患病率為7.0%14RectalChlamydiaPositivityin

SanFrancisco,2005(n=6,861)

2005年舊金山直腸衣原體呈陽性的患者比例(n=6,861)Overallprevalence8.4%總患病率為8.4%15Patientaccesstoservices,education

患者獲取服務(wù)、教育的渠道Klausner,STD,1999;Klausneretal,AIDSCare2004Klausner，STD，1999；Klausner等，AIDS護(hù)理

200416GayMen’sPreventionCenter

男性同性戀疾病預(yù)防中心1718OnlineSTDtesting

性病網(wǎng)上檢驗(yàn)

Levineetal,STD,2005

Levine等，STD，2005=Newcase=新病例6.4%reactivesyphilstests6.4%反應(yīng)性梅毒檢驗(yàn)19Rapidtreatment

快速治療Single-doseoraltherapy單劑量口服藥療法Field-deliveredtherapy現(xiàn)場(chǎng)實(shí)施療法Internet-basedprescriptions基于互聯(lián)網(wǎng)的處方Monitortimetotreatment監(jiān)督治療時(shí)間20Partnertreatment

性伴侶治療PartnertreatmentinMSM,1998-20081998-2008年MSM性伴侶治療人數(shù)21Partnernotification

性伴侶通知Patientreferral患者轉(zhuǎn)介Peer-based,confidentialoranonymous同伴轉(zhuǎn)介，以保密或匿名方式Provider-referral提供者轉(zhuǎn)介Healthdepartment,voluntaryandanonymous衛(wèi)生部門，以自愿或匿名方式22Internetpartnernotificationguidelines

互聯(lián)網(wǎng)性伴侶通知指南MessagessentfromInternetserviceproviderlesslikelytobediscarded;usesamee-mailproviderascase.Healthdepartmentsmayneedmultiplee-mailaccounts.互聯(lián)網(wǎng)服務(wù)提供者發(fā)送的郵件丟失的可能性很??；使用與病例相同的電子郵件帳戶提供者。衛(wèi)生部門可能需要多個(gè)電子郵件帳戶。Includereferenceto“Serioushealthmatter”inmessageheader;includeverifiableinformation在郵件標(biāo)題注明“待嚴(yán)肅對(duì)待的健康問題”；包含有據(jù)可查的信息Nogroupmessages;usesameprinciplesofconfidentialityaswithpostalserviceortelephone不群發(fā)郵件；郵局服務(wù)或電話服務(wù)采用相同的保密原則Upone-mailresponse,collectinformationtodevelopmorepersonalcontact收到回復(fù)的電子郵件后，收集信息，以獲取更多個(gè)人聯(lián)系方式23InS:Peer-to-peerOnlinePartnerNotificationandTreatment

InS：同伴對(duì)同伴網(wǎng)上

性伴侶通知和治療

Woodruff,PlosMed,200824Repeatscreening

復(fù)查Repeattestingofanygonorrhea,chlamydiaorsyphiliscaseat3months3個(gè)月時(shí)對(duì)任何淋病、衣原體疾病或梅毒病例進(jìn)行復(fù)查Repeatscreeningat3-6monthsinthoseMSMwithmultiplepartners3到6個(gè)月時(shí)對(duì)那些有多個(gè)性伴侶的MSM進(jìn)行復(fù)查25Conclusion

結(jié)論Aculturally-competentandcommunity-informedresponseiscriticalineffectiveSTDprevention,treatmentandcontrolservices具備文化能力，有相關(guān)知識(shí)的社區(qū)的應(yīng)對(duì)措施對(duì)于有效的性病預(yù)防、治療和控制服務(wù)至為關(guān)鍵Usetechnology—Internet,molecular,cellular—toincreaseaccessforscreeningandtreatment使用科技—互聯(lián)網(wǎng)、分子、細(xì)胞，增加檢查和治療的渠道26SourcesformoreSTDinformation

更多性病信息來源28Acknowledgments

致謝SFDPHSTDPreventionandControlServicesSFDPH性病預(yù)防和控制服務(wù)KyleBernstein,PhDKyleBernstein博士SFPartnersinSTD/HIVPrevention性病/艾滋病預(yù)防SF合作伙伴CDC—WendyWolf,FrankStronaCDC—WendyWolf,FrankStronaDayneCol