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JAMA:生殖器疱疹血清学筛查之二:美国预防服务工作组更新的证据报告和系统评价

2016-12-24 MedSci MedSci原创

生殖器单纯疱疹病毒(HSV)感染是一种普遍的性传播感染疾病。 HSV的垂直传播可导致胎儿的发病和死亡。近期,一项发表在JAMA杂志上的研究评估了无症状成人和青少年的生殖器HSV感染的血清学筛查和预防性干预的证据,以支持美国预防服务工作队更新推荐声明。研究收集了2016年3月31日中MEDLINE、Cochrane Library、EMBASE数据库和试验注册中心的相关资料,对选中的2016年10月

生殖器单纯疱疹病毒(HSV)感染是一种普遍的性传播感染疾病。 HSV的垂直传播可导致胎儿的发病和死亡。

近期,一项发表在JAMA杂志上的研究评估了无症状成人和青少年的生殖器HSV感染的血清学筛查和预防性干预的证据,以支持美国预防服务工作队更新推荐声明。

研究收集了2016年3月31日中MEDLINE、Cochrane Library、EMBASE数据库和试验注册中心的相关资料,对选中的2016年10月31日各出版物的新证据进行监测。

研究选择的对象为:在过去或现在有生殖器疱疹症状的人中比较筛选和无筛选的英文随机临床试验(RCT); 评估HSV-2血清学筛查测试的准确性和危害的研究; RCTs评估对HSV-2血清阳性的无症状人群预防性干预措施。

研究的主要指标:筛选测试的准确性、筛选的好处、筛查的危害以及生殖器疱疹爆发的减少。

此项研究结果:共纳入19篇发表文章的17项研究(n = 9736名参与者,范围,24-3290)。大多数筛选试验准确性的研究来自高HSV-2患病率的群体(大于40%)。常用的测试的灵敏度和特异性分别为99%(95%CI,97%-100%)和81%(95%CI,68%-90%)(10项研究; n = 6537)。在较高的截点,综合的估计分别为95%(95%CI,91%-97%)和89%(95%CI,82%-93%)(7项研究; n = 5516)。

在具有16%的HSV-2患病率(具有未知症状状况的美国成年人的血清阳性率)的100000人群中,在制造商的截点处使用该测试将导致15840个真阳性结果和15960个假阳性结果(阳性预测值,50%)。

生殖器疱疹的血清学筛查与心理社会危害有关,包括与阳性测试结果相关的痛苦和焦虑。四项RCTs比较了预防性药物与安慰剂,2例在HSV-2血清阳性的非妊娠无症状成人中,2例在HSV-2血清阳性的夫妇中。两个群体的结果是不一致的。

生殖器疱疹的血清学筛查与高比率的假阳性测试结果和潜在的心理社会危害有关。 来自RCTs的证据没有确定用于无症状HSV-2感染的预防性抗病毒药物是否有益。

原始出处:
Feltner C, Grodensky C, Ebel C, Middleton JC, Harris RP, Ashok M, Jonas DE.Serologic Screening for Genital Herpes: An Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.JAMA. 2016 Dec 20;316(23):2531-2543. doi: 10.1001/jama.2016.17138.

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