N H l i M TRUNG DUONG SINH DUC THEO THOI GIAN TA110 TiNH/ THANH PHb DUOC GIAM SAT TRONG Biewi
TRONG GIAI BOAN 2006 - 2010
Phgm Thj Lan t, Nguyen Duy Hung 2
™ Truung Dai hpc Y Ha Npi, «) Bpnh vipn Da liiu Trung uang
Nghiin ciru nhim md ti swphSn bi nhiim trUng dudng sinh due tai 10 tinh/thanh phi dupe gidm s^t tnpng diem theo thdi gian trong giai doan 2006 -2010. Kit qui cho thiy ty le mic cic benh STIdnam thanh nien khim tuyin nghia vij quin si/ (NVQS) chiim tyli rit thip. Nhiem nim vi Chlamydia dphpnO' mang thai (PNMT) chiim ty ii cao trong giai doan 2006- 2008 Ty 1$ niy giim manh trong nim 2009. T^iemic liu vi Chlamydia d nam STl cao vi cd sw dao ddng l&n giija cic nam theo hlnh sin (tir 4% din 16%): ting cao tmng nSm 2006, 2007 vi 2009. Phpni^ bin dim cd ty li mic binh giang mai vi liu a mire cao, tuang dii in dmh a khoing 2,0% va dang c6 xu hudng giam. Ty le nhiim Chlamydia a Phij ncr ban dam rat cao, cao nhat trong nam 2007 (14,0%). Ty li mac STI cao a Phu nu' ban dSm vanam STI trong giai doan 2006- 2010 vi dang cd xu hu&ng giim. Ty ip mic STI a nam tuyin NVQS rit thap
Tip khoa: nhiem triing du'dng sinh dgc, giam sat trpng diem, phg nu' ban dam, nghien chich ma tiiy
I. DAT V A N Dt
Theo bao eao ciia chuang trinh phoi hi?p cua Lien tnrfp quic v l HIV/AIDS (UNAIDS) va To chirc Y t l t h l gidi (WHO), trong nam 2006 tren loan t h l gidi cd khoang 4,3 trieu ngudi mdi nhiem HIV, trong do cd„3,8 trl^u ngudi Idn. S i ngudi nhilm HIV edn sing din culi' nam 2006 la 39,5 trieu ngudi, trong dd khu vu'C cgn Sahara la 24,7 trieu, Bing Nam A la 7,8 trieu [7], WHO udc tinh so ngudi mdi mlc nhiem triing dudng sinh dgc (NTDSD) hang nam tren toan cau la 390 trieu ngudi.
Khu vuc Chau A - Thai Binh Dudng khoang tren 35 trl^u ngudi mdi mlc cae nhilm khuin nay hang nam, trong dd triing roi am dgo cao nhlt ehilm tdi 47%, nhiem Chlamydia trachomatis 33%, lau 18% va giang mai 2%
[9]. s i benh nhan mlc NTBSD theo bao cao ma benh vien Da Lieu Trung uong nhan dup'C hang nam tren 130.000 trudng hgrp.
Tuy nhien, theo udc tinh ciia cae ehuyen gia thl hang nam co khoang gin 1 trieu trudng hop mdi mlc. Da s i benh nhan tu mua thuoc dilu trj hoac din chtra tn tai cac thay thuie tu nhan, Cac benh NTOSD do cac tac nhan la vi khuan, vl-rut, nim, kl sinh vat gay nen va lay truyin tu ngudi nay sang ngudi khac qua quan he tinh due. Hlu hit cae vl khuan, nim va ki sinh-vjt co t h l bi diet bdi cSe thuoe dieu tri hieu qua. Trai Igi, cae vi-riit hien nay ehua ed thule nao diet dudc, do vay chiing ton tai trong eo t h l trong mot thdi gian dai hogc suit ddi. GiSm sat cae benh NTOSD la sy thu thgp Hen tyc va cd he thing cae ylu t i v l su phan b i va chilu hudng benh theo thdi gian va dia diem. Mgc tieu cua nghien ciru nay nhlm md ta su phan b l nhilm triing dudng sinh dgc tgi 10 tinh/thanh phi dudc giam sSt trpng dilm theo thdi gian trong giai dogn 2006-2010.
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TCNCYH Phy trUdng 80 (38) - 2012
II. D6\ TU'ANG VA PHU'aNG P H A P 1. Doi tuyng
Nhbm quin t h l dupe giim sit trpng dilm (GSTD) bao gim phy nO' bin d i m (PNBD), bOnh nhOn STI nam. nghiOn chich ma luy (NCMT), phy nO' mang thai (PNMT), nam thanh niOn khim tuyln nghfa vy quin sy (NVQS) va nhbm khic.
2. Phuang phap nghien cuu nghiOn cuu mb l i theo dbi dpe nhim mb t i sy phin b l nhilm trung dudng sinh dye tgi 10 tinh/thinh phi duye giim sit trpng dilm theo thdi gian trong giai dogn 2006 - 2010.
' Cb" miu nghiOn euu dupe tinh cho mli m. K^T QUA NGHIEN CU'U
nhbm quin t h l duyc giim s i t thubc mil tinh/
thinh p h i 10: 300 phy nO- bin dim, 300 nam bOnh nhin STI, 300 ngudi nghiOn chich ma tOy 800 phy nO mang thai, 800 nam thanh niOn khim tuyln NVQS v i 800 dll tupng IhuOc nhbm khic.
* Phuang phip tiln hinh thu thOp miu nghiOn cuu:
Liy miu dbc lOp vdi cie nghiOn cuu/gi^m s i l khic; l i y miu liOn lye v i theo nguyOn lie bi mOt ty nguyOn; chpn dii tuyng giim sSt khbng cin ed v i o tinh hinh nhilm STI/HIV trudc khi tham gia; duy tri dia dilm giam s^t trpng dilm qua c i c ndm va thdi gian liy mau tu thing 5 d i n thing 8 hing nOm.
08 07 OE OS 04
02 01 on
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- • - G i a n g mai
— I 4 u Chlamydia
Bieu do 1. Tinh hinh phan bo cac b^nh STI cr nhdm nam thanh nien kham tuyen NVQS Kit qua cho thay ty le mlc cic bgnh STI d nhdm nam thanh nien kham tuyln NVQS dlu chilm ty le r l t thap. Benh giang mai ed ty le mlc eao nhat d thdi dilm nam 2006; giam gan vl 0, tuong tu nhu e4e STI khac trong c4c nSm 2007 - 2009; sau do ty l§ mlc tang Igi trong nSm 2010,
6.00 4,00
^""° ^ " " ' 2008 2009 2010 Bleu do 2. Tinh hinh phan bo cac bjnh STI d nhdm PNMT
Ket qua cho thay ty le nhilm nam va Chlamydia d PNMT cao hon so vdi ty le mlc cac STI khac. Nhilm nim va Chlamydia d PNMT chiem ty le cao trong glal dogn til' 2006 - 2008; sau dd ty le nay giam mgnh trong nam 2009 v l ty le mlc gan 0, dgt ngang mire vdi ty Ig cac STI khae trong giai dogn 2009 - 2010. Trong khi dd, ty Ig mlc Igu va giang mai d PNMT thap trong ea giai doan 2006-2010.
14,00 12,00 10,00 e.oo
6,00 4,00- 2.00 0.00'
a
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1
- • - L J u - A - C h i a my d I
Bieu do 3. Tinh hinh phan bo cac bgnh STI d nhbm nam STI
Ket qua cho thiy ty Ig nhiem Igu va Chlamydia d nhbm nam STI eao han nhilu so vdi ty Ig mic eic STI khie d nhbm niy. Kit qua cho thiy ty 10 mic bgnh Igu v i Chlamydia d nhbm nam STI cao v i cb sy dao dpng Idn giu'a cac nim theo hinh sin (td 4% den 16%): ting cao trong nam 2006 va 2007, cb xu hudng giam trong nam 2008, sau db tang len trong nam 2009 va giam trong nim 2010. Trong khi db, ty Ig nhiem giang mai gin nhu "on djnh" trong ca giai doan 2006 - 2010 (trong khoang 1 % - 2%). So trudng hyp phat hiOn nhiem nam d nam STI ehilm ty Ig rit thap trong ca giai dogn 2006-2010.
TCNCYH Phy trUdng 80 (38) - 2012
- Chlamydia
Bieu do 4. Tinh hinh phan b l cac bgnh STI d nhom phy nip ban dam Kit qua cho thiy phy nO- bin dim cb ty Ig mie bOnh giang mai v i lOu d mue cao. tuang dii on d[nh d quanh muc ly Ig mic khoang 2% trong e i giai dogn 2006 - 2010 va hign dang cb xu hudng giim. So trudng hyp nhilm Chlamydia va nim d PNBD chilm ty 10 rit cao, v i cao hon nhilu so vdi ty- Ig mic giang mai v i lOu OOe biOt l i ty 10 mic Chlamydia, eao nhit trong nOm 2007 (14%), sau db eb xu hudng giam din tu nim 2007 din nOm 2010. Trong khi db, ty 10 nhiem nim dao dpng theo hinh sin tu 4% den 8% trong ea giai dogn 2006 - 2010.
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—^Gangmai
— L4u Chlamyifia Nim
2006 2007
Bleu do 5. Tinh hinh phan bo cac bgnh STI a nhdm nghign chich ma tiiy Kit qua eho thay ty le benh STI dudc phat hi#n chu ylu d dii tupng NCMT la lau va giang mai. Ty Ig nSy cao hon so vol ty \i mlc c4e STI khic d nhdm dii tupng n^y. Ty le mlc l$u va giang mai cao nhat la trong nam 2007, tuy nhien ty Ip mlc ca 2 bpnh nciy d l u giam trong cic nam gin day, dgc bigt la cae trudng hpp bj Igu giam mgnh tu' trong nSm 2008 va glal dogn 2009- 2010 khdng co tardng hpp nao mlc l#u d nhdm NCMT Nhiem nim vi Chlamydia d nhom NCMT chiem ty Ig rat thap.
IV. B A N L U A N
K i t qua nghien c d u cho t h i y ty Ig m i c c i c bgnh STI d nhbm nam thanh nien kham t u y l n NVQS deu chiem ty Ig r i t t h i p . BOnh giang mai cb ty Ig m i c cao n h i t d thdi d i l m nam 2006 cung ehi c h i l m ty 10 < 0,09%; giam g i n ve 0, t u a n g l y n h u c i c STI k h i c trong cac nam 2007 - 2009; sau db ty 10 m i c t i n g Igi trong nam 2010. K i t qua n i y t h i p han so vdi nghiOn c u u trOn d i i t u p n g hanh vi t h i p tgi 5 tinh/thanh p h i : cb ty 10 m l c giang mai d tan binh la 0,2% [4], va t h i p h a n nhieu so vdi ty 10 m i c tgi e i c tinh phia nam theo bao c i o cua Bb Y te trong giai dogn 2003 - 2006 [1,2]. Nguyen nhin la do nam thanh nien k h i m t u y l n NVQS la doi t u p n g cb nguy c a t h i p ciia bgnh STI, day la nhbm d i i t u y n g cb it cac hanh vi nguy CO tinh dye [4].
Ty Ig nhiOm nam d P N M T cao h a n so vdi ty Ig m i c cae STI khae. NguyOn n h i n l i do khi mang thai s y can b i n g cua mbi t u d n g i m dao va hg t h i n g mien djch c a the n g u d i phy nu" se bj p h i v d , Luc n i y n i m se khong chiu s y kiem che eua cac vi k h u i n k h i c song trong am dgo nhu trong dieu kiOn binh t h u d n g cua ea t h l . Khi phy nu' mang thai se l i y l u to thugn Ipi lam p h i t sinh v i p h i t t r i l n n i m cpng sinh t r d thanh n i m gay bOnh [8]. K i t qua nghien c d u cung cho t h i y ty Ig n h i l m Chlamydia d PNMT cao han so vdi ty 10 m i c cac STI k h i c (Igu va giang mai). T u a n g t y k i t qua nghien c u u d nhbm phy n u eb thai tgi H i Npi va TP Ho Chi Minh vdi ty Ig m i e eao [4]. Trong nghien c u u nay n h i l m n i m va Chlamydia d P N M T chiem ty Ig cao trong giai dogn t u 2006 - 2008; sau db ty Ig n i y giam mgnh trong n i m 2009 vO ty Ig m i c g i n 0, dgt ngang m u c vdi ty Ig cac STI khac trong giai dogn 2009 - 2010. Cb d u p e k i t qui nay l i do higu qua t u e i c c h u a n g trinh can thigp phbng, c h I n g bgnh l i y truyen qua Sudng tinh dye d i d u y e t h y e hign. C h u a n g
trinh da t i e dpng tich e y e den nhbm dbi t u p n g PNMT giup giam ty 10 m i c trong giai dogn 2 0 0 9 - 2 0 1 0 .
Ty Ig n h i l m Igu v i Chlamydia d nhbm nam STI cao han n h i l u so vdi ty le m i c c i c STI khac d nhbm n i y . So vdi m p l sb nghien c u u ket qua nay eb xu hub-ng eao han [4,5,6].
K i t qua cung cho thay ty Ig m i e bgnh Igu v i Chlamydia d nhbm nam STI eao va cb s y dao dpng Idn giO'a cac n i m theo hlnh sin (tu 4 % d i n 16%): tang cao trong nam 2006 va 2007, cb xu h u d n g g i i m trong nam 2008, sau db tang len trong nam 2009 va giam trong nam 2010. Nam STI la nhbm dbi t u y n g cb hanh vi linh dye khbng an loan nen ty Ig m i e eae bgnh lay Iruyen qua d u d n g tinh dye t h u a n g eb xu h u d n g cao, day cOng la ly do chinh k h i l n hp phai den cac c a s d y t l de kham ehua benh. Trong khi db, ty Ig n h i l m giang mai gan n h u "on dinh" d nhbm doi t u p n g nay trong ca giai dogn 2006 - 2010 (trong khoang 1 % - 2%). So t r u d n g hpp phat hign nhiem n i m d nam STI e h i l m ty le r i t t h i p trong ea giai doan 2 0 0 6 - 2 0 1 0 .
Phu n u ban dam eb ty Ig mac benh giang mai v i Igu d muc eao, t u a n g dbi on dinh d quanh muc ty le m i c khoang 2,0% trong ca giai dogn 2006 - 2010 va hien dang cb xu hudng giam. So t r u d n g h p p nhiOm Chlamydia va n i m d PNBD chiem ty 10 rat eao, v i cao han nhieu so vdi ty le mac giang mai v i lau. Dac biet la ty 10 m i c Chlamydia, cao n h i t trong nam 2007 (14,0%),'sau d o c b x u h u a n g giam d i n t u nam 2007 den nam 2010. Chlamydia la vi k h u i n gay bOnh d u d n g sinh due - t i l t nieu. Bieu hien l i m sang eua benh t h u d n g khbng d i l n hinh l i m n g u d i bgnh khbng b i l t minh mac bgnh, do vgy bOnh v i n tien then gay lay lan cho cbng dong va bien chung cho n g u d i bgnh. Nhieu t r u d n g h p p phy n u b\ vb sinh, ehua n g o i i t u eung do nhiem Chlamydia gay viem vbi tn>ng.
TCNCYH Phy trUdng 80 (3B) - 2012
buIng trung [3]. PNBD l i nhbm dii tuyng cb hinh vi nguy ca eao v l tinh dye khbng an toin. Hp quan hO tinh dye thudng xuyOn vdi nhilu bgn tinh, v i s l lan sinh hogt tinh dye rat Idn, dong thdi hp khbng su dyng thudng xuyOn bao cao su... Vi vOy nguy ca mic cie bOnh liy truyin qua dudng tinh dye la rit cao.
Tuy nhiOn trong nhO'ng nSm gin dOy nhd cic chinh sach v i chuang trinh can IhiOp eb liiOu qua (nhu chuang trinh khuyen khIch su' dyng 100% bao cao su, chuang trinh truyin thbng thay dii hinh vi, chuang trinh quin ly bOnh lay truyen qua dudng tinh d y e . ) d i tie dOng tot den hanh vi v i thye hinh ve cae bign phip tinh dye an loin cua PNBD, nOn ty 10 mic cic bgnh nay da cb xu hubng giim xuong.
Ty 10 bgnh STI duyc phit hign ehu ylu d dll tupng NCMT l i lOu v i giang mai. Ty 10 mic cic bgnh nay eao nhit la trong nim 2007.
Dll tupng nghiOn chich ma tuy l i nhbm doi tupng cb hanh vi nguy ca cao lay nhilm HIV/
AID, Theo mOt s l nghien euu thi cb sy liOn quan giua tinh trgng nhiem HIV v i mie bgnh lay Iruyen qua dudng tinh dye. NhO'ng bOnh nhan mie bgnh STI (giang mai, igu...) lim tang nguy ca lay truyen HiV tu 2 - 9 lin, nguye Igi nhiem. HIV cung lam cho ngudi bgnh d l bj mic cac benh lay truyin qua dudng linh dye han. Do sue d l khang cua ngudi nhiem HIV suy giam nen vigc dilu trj d nhi>ng bOnh nhin nay cung trd nen khb khin han, cac t i c nhin gay bgnh trd nen d l khang vdi cac thulc dilu trj thbng thudng. Kel qua nghien euu cho thiy ty Ig mic ca 2 bgnh nay dlu giam trong cic nam gin day dgc bigt l i cac trudng hyp bj Igu giam mgnh ti> trong nim 2008 v i giai dogn 2009 - 2010 khbng eb trudng hyp nao mic lOu d nhom NCMT. Co duyc kit qua niy I i do hiOu qua ciJa cic chuang trinh can thiOp cpng dong da duyc triln khai trong nhO'ng nSm gin day Cie chuang trinh tnjyln thbng nhim thay
dii hinh vi duye i p dyng d i dgt dupe nh&ng kit q u i luang d i i tit.
V. Ktj LUAN
T9 10 niic cic bOnh STI d nhbm nam thanh niOn khim tuyln NVQS dlu chiem ty 10 rit thip; trong db bOnh giang mai eb ty 1$
mic cao nhit d thdi dilm nim 2006. Nhilm nim v i Chlamydia d PNMT chiem ty Ig cao tu 2006 - 2008; sau db ty 10 niy giim mgnh trong nim 2009 v l ty 10 mie gin 0. Ty 10 mlc lOu v i giang mai d PNMT thip trong ca giai dogn 2006 - 2010. Ty 10 mic bOnh lOu vi Chlamydia d nhbm nam STI eao va cb sy dao dOng Idn giua cae nim theo hinh sin (ti> 4%
din 16%): ting eao trong nim 2006, 2007 vi 2009. Trong khi db, ty 10 nhilm giang mai if nam STI gin nhu "In djnh" trong ea giai do?n 2006 - 2010 (trong khoang 1% - 2%). PNBD cb ty 10 mic bOnh giang mai v i lOu d muc cao, tuang dii I n djnh d khoang 2% trong ca giai dogn 2006 - 2010 va dang cb xu hudng giam.
Ty 10 nhiem Chlamydia d PNBD rit eao, cao nhit trong nim 2007 (14%). Bgnh STI difpc phat hign ehu yeu d doi tuyng NCMT la l^u v i giang mai, vdi ty Ig mic cb xu hudng giam trong cic nim gin diy.
TAI LIEU THAM K H A O 1. Bp Y te, Ban phbng chong AIDS (2003). Kit qua diOu tra danh g i i tin suatmk cac nhiem trCing lay truyOn qua dudng tinh dgc d phy nd mgi dim thubc 5 tinh biOn gidi Vi?t Nam. Vign Pasteur, Thanh pho Hb Chi Minh.
2. Bp Y te (2006). Kit qua Chuang trinh giim sit kit hyp hinh vi v i cic chi so slnii hpc HIV/STI (IBBS) tgi Vigt Nam 2005 - 2006.
Ha Npi. 19-23.
3. King K. Holmes at al (1999). Sexually Transmitted Diseases, third edition. Me Graw- Hill; 433 - 473.
trachomatis Infection in a High - Risk Population Contraception. A n Intenational Journal, 61(3);
231 - 234.
7. UNAIDS and W H O (2006). AIDS epidemic update: special report on HIV/AIDS.
1 - 3 7 , 5 9 - 6 1 .
8. Vy khoa hpc va dao tgo, Bp Y te (2010). Da lieu hpc. Nha x u i t b i n giao dye ViOt Nam, H i Npi. 138.
9. W H O (2001). Global prevalence and incidence of selected curable sexually transmitted infections overview and estimates.
Geneva. 8 - 29.
4. Nguyen Duy Hu>ng va CS (2011). K i t qua g i i m sat mpt s l n h i l m trung l i y truyen qua d u d n g tinh dye g i n k i t vai g i i m sat HIV trOn nhbm dan c u eb h i n h vi nguy c a t h i p tgi 5 tinh/thanh p h i ViOt N a m . T g p ehi Y hpe ViOt Nam, 1: 1 9 - 2 3 .
5. Nguyen Mgnh C u d n g (2009). Can thigp d y phbng lay n h i l m HIV tren nhbm gai mgi dam tgi 3 tinh An Giang, KlOn Giang v i Dong Thap, 2002 -2005. Lugn van t i l n sJ y hpc. Vign VO sinh Djch te Trung u a n g .
6. Ronald J.P., Donald R.S., Alan M.K.
(2000). The Relationship of Inflammation in the Papanicolaou Smear to Chlamydia
Summary
PREVALENCE OF SEXUALLY TRANSMITTED INFECTIONS (STIS) IN 10 PROVINCES/
CITIES SENTINEL SURVEILLANCE FOLLOWED TIME DURING 2006-2010 The study was to descnbe the prevalence of sexually transmitted infections (STIs) in 10 provinces/
cities sentinel surveillance followed time during 2006-2010. The results showed that the prevalence of STIs in military recruits occured lower proportion. The fungal infection and chlamydia in pregnant women occured high proportion during 2006-2008. then this proportion decreased in 2009. The prevalence of gonorrhea and chlamydia in male's patient attending at STI clinic were high, and had large fluctuation between years by the sin figure (from 4% to 16%o): increased in 2006. 2007 and 2009. Female sex workers (FSWs) had the high prevalence of syphilis and gonorrhea, to be relatively stable at about 2.0%, and to tend decreased. The very high prevalence of chlamydia in FSWs, was highest in 2007 (14 0%). Most STIs in injecting drug users (IDUs) was gonorrhea and syphilis. Conclusions: the high prevalence of STIs in FSWs and male's patient attending at STI clinic group during 2006-2010 and to tend decreased. The prevalence of STI in military recruits was very low.
Keyworks: sexually transmitted infections (STIs), sentinel surveillance, female sex workers (FSWs), Injecting drug users (IDUs)
