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Novel STD Prevention Services for Men who have Sex with Men 针对与同性发生性行为的男性 (MSM) 的新型性病预防服务. Jeffrey D. Klausner, MD, MPH Director, STD Prevention Services San Francisco Department of Public Health 旧金山公共卫生部 性传播疾病预防服务办公室主任 Jeffrey D. Klausner 医学博士兼公共卫生硕士

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novel std prevention services for men who have sex with men msm

Novel STD Prevention Services for Men who have Sex with Men针对与同性发生性行为的男性 (MSM) 的新型性病预防服务

Jeffrey D. Klausner, MD, MPH

Director, STD Prevention Services

San Francisco Department of Public Health

旧金山公共卫生部

性传播疾病预防服务办公室主任

Jeffrey D. Klausner 医学博士兼公共卫生硕士

Associate Clinical Professor of Medicine

Divisions of AIDS and Infectious DiseasesUniversity of California San Francisco

加州旧金山大学

艾滋病和传染病学院

临床医学副教授

increases in male rectal gonorrhea san francisco
Increases in male rectal gonorrhea, San Francisco男性直肠淋病患者增长率(旧金山)

CDC MMWR 1999;48(3):45-55

gonorrhea in msm san francisco 1999 2008 1999 2008 msm
Gonorrhea in MSM, San Francisco, 1999-2008 1999-2008 年间旧金山 MSM 淋病患者增长率

SFDPH, STD Section, 2008

2008,SFDPH,STD 部分

early syphilis 1998 2007 1998 2007
Early Syphilis 1998–2007 1998–2007 年间早期梅毒病例数
public health response
Public Health Response公共健康应对措施
  • Enhanced surveillance

监管力度增强

  • More clinical & lab services

临床与化验服务增多

  • Health provider education

健康提供者教育

  • Community health promotion

社区健康程度提高

  • Address select risk factors

解决首要风险因素

  • Public Health Evaluation

公共健康评估

slide6

Strong association (OR = 8.7, P<.05) between meeting

partner on the Internet and syphilis

和互联网上认识的性伴侣约会与感染梅毒之间的密切联系 (OR = 8.7, P<.05)

JAMA 2000; 284:447-450

percent of syphilis cases reporting meeting partners by venue california
Percent of Syphilis Cases Reporting Meeting Partners by Venue, California在聚会场所与性伴侣约会感染梅毒的病例比例(加州)

Internet

互联网

Bars/Clubs

酒吧/俱乐部

Bathhouses/Sex Clubs

洗浴中心/色情俱乐部

Private/Circuit Parties

私人/盛大舞会

7/2006 Provisional Data - CA DHS STD Control Branch

7/2006 临时数据 - 加利福尼亚 DHS STD 控制分支机构

std control strategy
STD Control Strategy性病控制战略
  • Screen

检查

  • Treat

治疗

  • Treat partners

治疗性伴侣

  • Screen

检查

most rectal chlamydial infections in msm are asymptomatic msm
Most rectal chlamydial infections in MSM are asymptomaticMSM 中多数直肠衣原体感染者无症状

14%

Symptomatic

有症状

Asymptomatic

无症状

86%

N= 316

Kent et al. CID 2005

Kent 等,CID 2005

std screening
STD Screening性病检查
  • STDs are asymptomatic

性病无症状

    • Promote screening

加大检查力度

    • Use accurate screening tests

采用精确的检查检验方法

  • Make screening easy

使检查简单易行

screen with nucleic acid tests
Screen with nucleic acid tests采用核酸检验方法进行检查
pharyngeal gonorrhea positivity san francisco 2005 n 9 727 2005 n 9 727
Pharyngeal Gonorrhea Positivity San Francisco, 2005 (n=9,727) 2005 年旧金山咽部淋病呈阳性的患者比例(n=9,727)

Overall prevalence 7.8%

总患病率为 7.8%

rectal gonorrhea positivity san francisco 2005 n 6 968 2005 n 6 968
Rectal Gonorrhea PositivitySan Francisco, 2005 (n=6,968)2005 年旧金山直肠淋病呈阳性的患者比例 (n=6,968)

Overall prevalence 7.0%

总患病率为 7.0%

rectal chlamydia positivity in san francisco 2005 n 6 861 2005 n 6 861
Rectal Chlamydia Positivity in San Francisco, 2005 (n=6,861)2005 年旧金山直肠衣原体呈阳性的患者比例 (n=6,861)

Overall prevalence 8.4%

总患病率为 8.4%

patient access to services education
Patient access to services, education患者获取服务、教育的渠道

Klausner, STD, 1999; Klausner et al, AIDS Care 2004

Klausner,STD,1999;Klausner 等, AIDS 护理2004

gay men s prevention center
Gay Men’s Prevention Center男性同性恋疾病预防中心
online std testing levine et al std 2005 levine std 2005
Online STD testing性病网上检验Levine et al, STD, 2005 Levine 等, STD,2005

6.4% reactive syphils tests

6.4% 反应性梅毒检验

= New case

= 新病例

rapid treatment
Rapid treatment快速治疗
  • Single-dose oral therapy

单剂量口服药疗法

  • Field-delivered therapy

现场实施疗法

  • Internet-based prescriptions

基于互联网的处方

  • Monitor time to treatment

监督治疗时间

partner treatment
Partner treatment性伴侣治疗

Partner treatment in MSM, 1998-2008

1998-2008 年 MSM 性伴侣治疗人数

partner notification
Partner notification性伴侣通知
  • Patient referral

患者转介

    • Peer-based, confidential or anonymous

同伴转介,以保密或匿名方式

  • Provider-referral

提供者转介

    • Health department, voluntary and anonymous

卫生部门,以自愿或匿名方式

internet partner notification guidelines
Internet partner notification guidelines互联网性伴侣通知指南
  • Messages sent from Internet service provider less likely to be discarded; use same e-mail provider as case. Health departments may need multiple e-mail accounts.

互联网服务提供者发送的邮件丢失的可能性很小;使用与病例相同的电子邮件帐户提供者。卫生部门可能需要多个电子邮件帐户。

  • Include reference to “Serious health matter” in message header; include verifiable information

在邮件标题注明“待严肃对待的健康问题”;包含有据可查的信息

  • No group messages; use same principles of confidentiality as with postal service or telephone

不群发邮件;邮局服务或电话服务采用相同的保密原则

  • Upon e-mail response, collect information to develop more personal contact

收到回复的电子邮件后,收集信息,以获取更多个人联系方式

inspot org peer to peer online partner notification and treatment inspot org
InSpot.org: Peer-to-peer Online Partner Notification and Treatment InSpot.org:同伴对同伴网上性伴侣通知和治疗

Woodruff, Plos Med, 2008

repeat screening
Repeat screening复查
  • Repeat testing of any gonorrhea, chlamydia or syphilis case at 3 months

3 个月时对任何淋病、衣原体疾病或梅毒病例进行复查

  • Repeat screening at 3-6 months in those MSM with multiple partners

3 到 6 个月时对那些有多个性伴侣的 MSM 进行复查

conclusion
Conclusion结论
  • A culturally-competent and community-informed response is critical in effective STD prevention, treatment and control services

具备文化能力,有相关知识的社区的应对措施对于有效的性病预防、治疗和控制服务至为关键

  • Use technology—Internet, molecular, cellular—to increase access for screening and treatment

使用科技 — 互联网、分子、细胞,增加检查和治疗的渠道

sources for more std information
SFDPH City Clinic

SFDPH 市诊所

www.SFCityClinic.org

State of CA

加州

www.stdcheckup.org

CDC STD Treatment Guidelines 2006

2006 年 CDC 性病治疗

指南

www.cdc.gov/std

Sources for more STD information更多性病信息来源

www.amazon.com

acknowledgments
Acknowledgments致谢
  • SFDPH STD Prevention and Control Services

SFDPH 性病预防和控制服务

  • Kyle Bernstein, PhD

Kyle Bernstein 博士

  • SF Partners in STD/HIV Prevention

性病/艾滋病预防 SF 合作伙伴

  • CDC—Wendy Wolf, Frank Strona

CDC—Wendy Wolf, Frank Strona

  • Dayne Collins

Dayne Collins

  • SFDPH Laboratory—Dr. Mark Pandori and Sally Liska

SFDPH 实验室— Mark Pandori 博士和 Sally Liska 博士

  • Funding from City and County of San Francisco, CDC, State of California, NIH

NIH,加州,CDC,旧金山市和旧金山县赞助

ISIS, Inc.