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梅毒查:美国预防服务工作组的最新证据报告和系统审查
Amy G Cantor1, Miranda Pappas2, Monica Daeges2
1Pacific Northwest Evidence-based Practice Center, Departments of Medical Informatics and Clinical Epidemiology, Family Medicine, and Obstetrics and Gynecology, Oregon Health & Science University, Portland.
JAMA
|June 9, 2016
概括
频繁的梅毒查 (每3个月一次) 改善了与男性发生性关系的HIV阳性男性的早期检测. 标准梅毒测试是准确的,但需要确认,需要进一步研究查的有效性和危害.
科学领域:
- 公共卫生和流行病学
- 传染病查
- 性健康问题
背景情况:
- 目前的梅毒查指南针对高危人群,包括有梅毒病史,感染性伴侣,艾滋病毒或多性伴侣的人群.
- 2004年的一项系统审查确定了梅毒查有效性,测试准确性和非孕妇潜在危害的基线.
研究的目的:
- 对评估非怀孕成年人和青少年梅毒查的有效性,测试准确性和危害的研究进行更新的系统审查.
- 综合有关梅毒查策略的现有证据,特别是针对高风险群体,如与男性发生性关系的男性 (MSM) 和艾滋病毒感染者.
主要方法:
- 从2004年1月到2016年3月发表的英语试验和观察研究的系统审查,搜索包括Cochrane和MEDLINE在内的数据库.
- 数据提取和质量评估由多名调查人员独立进行,以确保准确性和可靠性.
- 测量的主要结果包括疾病传播 (包括艾滋病毒),梅毒并发症,查测试的诊断准确性以及查的确诊危害.
主要成果:
- 没有证据表明查对临床结果的影响,风险评估工具的有效性或查对一般人群的危害.
- 研究表明,与一年或6个月间隔相比,每3个月对HIV阳性男性或MSM进行早期梅毒查的检测率更高.
- 在无症状个体中,三角体和非三角体梅毒测试都显示出高准确度 (灵敏度> 85%,特异性> 91%),但需要进行确认测试;反向测试显示可能增加错误反应结果.
结论:
- 更频繁的梅毒查 (每3个月一次) 与艾滋病毒阳性MSM中早期梅毒检测的增加有关.
- 标准的梅毒诊断测试是准确的,但需要确认. 反向序列查策略需要在不同人群中进行进一步的调查.
- 关于梅毒查的临床有效性,最佳查策略和相关危害的研究仍然存在重大差距.
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