南非的性传播感染的多西环林暴露后预防
Remco P H Peters1,2,3, James A McIntyre4,5, Nigel Garrett6,7
1Research Unit, Foundation for Professional Development, East London, South Africa.
Southern African journal of HIV medicine
|October 5, 2023
概括
在南非,多西环素暴露后预防 (PEP) 显示在与男性发生性关系的男性 (MSM) 中预防细菌性传播感染 (STIs) 的高效性. 然而,对抗菌素耐药性 (AMR) 的担忧需要仔细考虑和持续监测.
科学领域:
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
- 抗微生物耐药性 抗微生物耐药性
背景情况:
- 南非面临着大量的细菌性传播感染 (STIs),特别是与男性发生性关系的男性 (MSM).
- 最近的试验表明,多克西环素暴露后预防 (PEP) 在减少克拉米迪亚菌和梅毒方面非常有效,在MSM中对尼塞利亚淋病中适度有效.
- 在肯尼亚的女性中没有证明多西环素PEP的有效性,并且存在对其对抗菌素耐药性 (AMR) 的影响的担忧.
研究的目的:
- 评估多西环素PEP对南非细菌性性传播疾病预防的益处.
- 权衡这些好处与现有的担忧和与抗菌素耐药性 (AMR) 相关的数据缺口.
主要方法:
- 对多西环林PEP有效性和安全性的随机对照试验的综述.
- 对南非抗菌素耐药性 (AMR) 趋势的现有数据的分析.
- 考虑多西环素PEP对性传播感染,其他病原体和微生物群的AMR的潜在影响.
主要成果:
- 在MSM中,多西环素PEP显示显著减少了 (70-85%) 克拉米迪亚菌和梅毒,并减少了约50%的尼塞利亚淋病.
- 在最初的试验中没有观察到令人担忧的AMR趋势,但N. gonorrhoeae中广泛的四环素耐药性已经在南非引起了关注.
- 关于多西环林PEP对个人和人口水平对抗药性耐药性的长期影响的数据缺口仍然存在.
结论:
- 在个别情况下为高风险的MSM提供多西环林PEP是合理的.
- 实施需要经验丰富的临床医生,获得诊断性传播疾病测试,以及强大的持续抗菌耐药性监测.
- 需要进一步研究更大的样本大小和更长的随访时间,以充分理解AMR的影响.
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