HIV pozitif kişilerde cinsel yolla bulaşan etkenlerin sıklığı
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Tarih
2018
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ: Cinsel yolla bulaşan enfeksiyonlar (CYBE), toplum sağlığı açısından önemli, dünyanın her bölgesinde sık görülen enfeksiyonlardır. Ülkemizde de CYBE’ler öncelikli sağlık sorunları arasındadır. Türkiye de HIV pozitif kişilerdeki cinsel yolla bulaşan etkenlerin sıklığını saptamaya yönelik daha önce herhangi bir çalışma yapılmamıştır. Bu çalışmada, HIV pozitif kişilerdeki cinsel yolla bulaşan hastalık etkenlerinden Neisseria gonorrhoeae (N. gonorrhoeae) , Chlamydia trachomatis (C. trachomatis) , Trichomonas vaginalis (T. vaginalis), Mycoplasma genitalium (M. genitalium) , Mycoplasma hominis (M. hominis), Ureaplasma urealyticum (U. urealyticum), Ureaplasma parvum (U. parvum), Herpes simpleks virüs tip 1 ve 2 (HSV 1 ve 2), Human Papilloma virüs'ün (HPV) 19 yüksek riskli genotipi (16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 69, 73, 82) ve 9 düşük riskli genotipini (6, 11, 40, 42, 43, 44, 54, 61, 70) taramak ve etkenlerin HIV pozitif kişilerdeki sıklığını araştırmak amaçlanmıştır.
GEREÇ ve YÖNTEM: Eylül 2015 ile Nisan 2016 tarihleri arasında, 90 [14’ü kadın (%15.6), 76’sı erkek (%84.4)] HIV pozitif hastadan vajinal ve üretral sürüntü örnekleri toplandı. Klinik örneklerden nükleik asitlerin ekstraksiyonu üretici firma protokolüne göre yapıldı (Ribospin vRD viral RNA / DNA Ekstraksiyon Kiti, GeneAll, Seegene, Güney Kore). Chlamydia trachomatis, N. gonorrhoeae, M. genitalium, M. hominis, U. urealyticum, U. parvum, T. vaginalis etkenleri çoklu olarak amplifiye edildi (AnyplexTM II STI-7 Detection (V1.1), Seegene, Güney Kore) ve BioRad cihazı kullanılarak etkenler saptandı. HPV’nin yüksek ve düşük riskli genotiplerini belirlemede üretici firma (Anyplex II HPV28 Detection kit, Seegene, Güney Kore) protokolü uygulandı. Klinik örneklerden HSV tip 1 ve tip 2 saptanmasında HSV 1/2 Qual Kit (Roche Diagnostics GmbH, Mannheim, Almanya ) kullanıldı ve etken Light-Cycler cihazında saptandı.
BULGULAR: HIV pozitif hastaların 49’unda (%54,4) en az bir cinsel yolla bulaşan etken pozitif bulundu. Kadın hastaların 12'sinde (%85,7), erkek hastaların 37'sinde (%48,7) etken pozitifliği saptandı. Hastaların 17'sinde (%18,8) tek etken saptanırken, 32'sinde (%35,5) birden fazla etken saptandı. Trichomonas vaginalis, HSV-1 ve HSV-2, klinik örneklerin hiç birinde saptanmadı. Örneklerin 31'inde (%34,4) HPV, 20'sinde (%22,2) U. urealyticum, 15'inde (%16,6) U. parvum, 8'indee(%8,8) M. genitalium, 8'inde (%8,8) M. hominis, 5'inde (%5,5) N. gonorrhoeae, 2'sinde (%2,2) C. trachomatis, saptandı. HPV DNA pozitif bulunan 31 örneğin 13'ünde (%41,9) olası yüksek riskli ve yüksek riskli tip, 6'sında (%6,6) düşük riskli tip ve 12' sinde (%13,3) hem yüksek hem de düşük riskli tip birlikte bulundu.
SONUÇ: Cinsel yolla bulaşan herhangi bir hastalık belirtisi olmayan HIV (+) kişilerin yaklaşık %55’inde bir veya birden fazla HIV dışı cinsel yolla bulaşan etken pozitif bulunmuştur. Bu hastaların %35’inde çoklu etken saptanmıştır. HIV(+) kişilerde en sık rastlanan ilk üç etken sırasıyla HPV (%35), U.urealyticum (%22) ve U.parvum (%17) olmuştur. Diğer bakteriyel etkenlerin sıklığı %2-8 arasında bulunmuştur. T. vaginalis ve HSV1-2 hiçbir hastada saptanmamıştır. HPV pozitif bulunan hastaların yaklaşık yarısında yüksek riskli tipler saptanmıştır ve en sık saptanan tip HPV 16 olmuştur. HPV enfeksiyonunun hastanemize başvuran HIV pozitif hastalarda önemli bir cinsel yolla bulaşan etken olduğu görülmüştür ve herhangi bir belirti göstermeyen hastalarda bile etkene yönelik tarama yapılması sonucuna varılmıştır.
OBJECTIVE: Sexually transmitted infections (STIs) are infections that are common in many parts of the World. Turkey has also been studied previously for determining factor in the incidence of sexually transmitted HIV-positive people. The aim of this study was to investigate the effects of sexually transmitted disease agents such as N. gonorrhoeae, C. trachomatis, T. vaginalis, M. genitalium, M. hominis, U. urealyticum, U. parvum, HSV 1 and HSV 2, 19 high risk genotype HPV (16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 69, 73, 82) 9 low risk genotype (6, 11, 40, 42, 43, 44, 54, 61, 70) and determining the frequency of the agents in HIV-positive individuals. MATERIALS AND METHODS: Between September 2015 and April 2016, vaginal and urethral swab samples were collected from 90 HIV positive patients (14 female, 15.6% male, 84.4%). Nucleic acid extraction was performed according to the manufacturer's protocol. (Ribospin vRD viral RNA / DNA Extraction Kit, GeneAll, Seegene, South Korea). The factors of C. trachomatis, N. gonorrhoeae, M. genitalium, M. hominis, U. urealyticum, U. parvum, T. vaginalis were amplified with AnyplexTM II STI-7 Detection (V1.1) (Seegene, South Korea) and products were detected by BioRad real time PCR. Amplification of nucleic acid was performed Anyplex II HPV28 Detection kit (Seegene, South Korea). PCR products were detected by BioRad. HSV type 1 and type 2 were performed Light-Cycler HSV 1/2 Qual Kit (Roche Diagnostics GmbH, Mannheim, Germany). RESULTS: At least one sexually transmitted agent was positive in 49 (54.4%) of the HIV-positive patients. STI positivity was found in 12 (85.7%) of the female patients and 37 (48.7%) of the male patients. In 17 (18.8%) of the patients, only one agent was detected, while 32 (35.5%) were multiple. Trichomonas vaginalis, HSV-1 and HSV-2 were not detected in any of the clinical specimens. HPV was found in 31 (%34,4), U. urealyticum in 20 (22.2%), U. parvum in 15 (16.6%), M. genitalium in 8 (8.8%), , M. hominis in 8 (8.8%), N. gonorrhoeae in 5 (5.5%) and C. trachomatis in 2 (2.2%). High-risk and probably high-risk types were found in 13 (41.9%) of the 31 HPV DNA-positive cases, 6 (6.6%) were in the low-risk type, and 12 (13.3%) were both high and low risky type found together. CONCLUSION: Approximately 55% of HIV (+) individuals without any sexually transmitted disease were found to have one or more non-HIV sexually transmitted agents positive. More than one human papillomavirus serotypes were detected in 35% of these patients. HPV (35%), U.urealyticum (22%) and U.parvum (17%) were the most frequent in HIV (+) individuals. The frequency of other bacterial agents was found to be between 2-8%. T. vaginalis and HSV 1-2 were not detected in any patient. The most common HPV type in patients was 16. Overall, half of the patients were found to be infected with high-risk HPV types. HPV positive patients were referred to the clinic for follow up.
OBJECTIVE: Sexually transmitted infections (STIs) are infections that are common in many parts of the World. Turkey has also been studied previously for determining factor in the incidence of sexually transmitted HIV-positive people. The aim of this study was to investigate the effects of sexually transmitted disease agents such as N. gonorrhoeae, C. trachomatis, T. vaginalis, M. genitalium, M. hominis, U. urealyticum, U. parvum, HSV 1 and HSV 2, 19 high risk genotype HPV (16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 69, 73, 82) 9 low risk genotype (6, 11, 40, 42, 43, 44, 54, 61, 70) and determining the frequency of the agents in HIV-positive individuals. MATERIALS AND METHODS: Between September 2015 and April 2016, vaginal and urethral swab samples were collected from 90 HIV positive patients (14 female, 15.6% male, 84.4%). Nucleic acid extraction was performed according to the manufacturer's protocol. (Ribospin vRD viral RNA / DNA Extraction Kit, GeneAll, Seegene, South Korea). The factors of C. trachomatis, N. gonorrhoeae, M. genitalium, M. hominis, U. urealyticum, U. parvum, T. vaginalis were amplified with AnyplexTM II STI-7 Detection (V1.1) (Seegene, South Korea) and products were detected by BioRad real time PCR. Amplification of nucleic acid was performed Anyplex II HPV28 Detection kit (Seegene, South Korea). PCR products were detected by BioRad. HSV type 1 and type 2 were performed Light-Cycler HSV 1/2 Qual Kit (Roche Diagnostics GmbH, Mannheim, Germany). RESULTS: At least one sexually transmitted agent was positive in 49 (54.4%) of the HIV-positive patients. STI positivity was found in 12 (85.7%) of the female patients and 37 (48.7%) of the male patients. In 17 (18.8%) of the patients, only one agent was detected, while 32 (35.5%) were multiple. Trichomonas vaginalis, HSV-1 and HSV-2 were not detected in any of the clinical specimens. HPV was found in 31 (%34,4), U. urealyticum in 20 (22.2%), U. parvum in 15 (16.6%), M. genitalium in 8 (8.8%), , M. hominis in 8 (8.8%), N. gonorrhoeae in 5 (5.5%) and C. trachomatis in 2 (2.2%). High-risk and probably high-risk types were found in 13 (41.9%) of the 31 HPV DNA-positive cases, 6 (6.6%) were in the low-risk type, and 12 (13.3%) were both high and low risky type found together. CONCLUSION: Approximately 55% of HIV (+) individuals without any sexually transmitted disease were found to have one or more non-HIV sexually transmitted agents positive. More than one human papillomavirus serotypes were detected in 35% of these patients. HPV (35%), U.urealyticum (22%) and U.parvum (17%) were the most frequent in HIV (+) individuals. The frequency of other bacterial agents was found to be between 2-8%. T. vaginalis and HSV 1-2 were not detected in any patient. The most common HPV type in patients was 16. Overall, half of the patients were found to be infected with high-risk HPV types. HPV positive patients were referred to the clinic for follow up.
Açıklama
Anahtar Kelimeler
Cinsel Yolla Bulaşan Hastalıklar, HIV, Klamidya, Gonore, Sexually Transmitted Diseases, HIV, Chlamydia, Gonorrhea
