STUDY OBJECTIVE:To examine the prevalence, symptomatology, risk factors, and other infections associated with urogenital chlamydial infection in pregnant teenagers. DESIGN:Retrospective case-control study by medical record review. SETTING:Prenatal care clinic for adolescents at University of Tennessee Medical Center, Knoxville, Tennessee. PARTICIPANTS:Pregnant adolescents younger than 19 years of age who were diagnosed with chlamydial infection on the first prenatal visit from 1988 to 1994 were studied. Pregnant adolescents of similar age and socioeconomic background who came in the same day for the first prenatal visit, but were not infected, made up the control group. INTERVENTION:Routine prenatal questionnaires regarding personal and medical histories, and routine prenatal screening, including pelvic examination with Papanicolaou (PAP) smear and laboratory investigations for common genital infections and sexual transmitted disease (STDs), were obtained. MAIN OUTCOME MEASURES:Analyzed the prevalence of chlamydial infection and compared the infected group to the control group with regard to race, behavioral factors, symptoms, prenatal screening results, other concurrent genital infections, and histories of STDs. RESULTS:Of a total population of 596 pregnant teenagers, 67 (11.24%) were infected with Chlamydia trachomatis. In multivariate analysis, black race (odds ratio [OR] = 4.01; 95% confidence interval [CI] = 1.74-9.23; p = 0.001) and greater gestational age at first prenatal visit (OR = 1.11; 95% CI = 1.04-1.18; p = 0.001) were independently associated with chlamydial infection. Age, marital status, number of pregnancies, smoking, alcohol abuse, drug abuse, age at first intercourse, and multiple sex partners were not associated with the infection. Likewise, the symptom of vaginal discharge (a complaint of > 70% in each group), other genital co-infections (found > 50% in each group, mainly candidiasis and bacterial vaginosis), abnormal PAP smears (found > 60% in each group) and histories of STDs or previous chlamydial infection were not significantly different between case and control groups. Human papillomavirus infection, trichomonal infection, and dysplasia or atypia were found more often in patients infected with chlamydia, but were not statistically significant. CONCLUSION:Pregnant adolescents in east Tennessee were at risk for chlamydial infection as well as for other genital infections and abnormal PAP smears. Routine prenatal chlamydial screening is warranted because of a lack of specific symptoms.

译文

目的:研究孕妇青少年泌尿生殖道衣原体感染的患病率,症状,危险因素和其他感染情况。
设计:回顾性病例对照研究,病历审查。
地点:田纳西州诺克斯维尔市田纳西大学医学中心的青少年产前保健诊所。
研究对象:1988年至1994年第一次产前检查时被诊断患有衣原体感染的19岁以下的青少年。年龄相同,社会经济背景相似的怀孕青少年在同一天进行第一次产前检查,但未感染,组成了对照组。
干预措施:获得有关个人和医学史的常规产前问卷,以及常规的产前筛查,包括用帕潘尼古拉(PAP)涂片进行盆腔检查以及常见生殖器感染和性传播疾病(STD)的实验室检查。
主要观察指标:分析衣原体感染的发生率,并比较种族,行为因素,症状,产前筛查结果,其他并发生殖器感染和性病史,比较感染者与对照组。
结果:在596名怀孕的青少年总数中,有67名(11.24%)感染了沙眼衣原体。在多变量分析中,黑人种族(赔率[OR] = 4.01; 95%置信区间[CI] = 1.74-9.23; p = 0.001)和第一次产前检查时的胎龄较高(OR = 1.11; 95%CI = 1.04- 1.18; p = 0.001)与衣原体感染独立相关。年龄,婚姻状况,怀孕次数,吸烟,酗酒,药物滥用,初次性交年龄和多性伴侣均与感染无关。同样,白带的症状(每组的投诉> 70%),其他生殖器合并感染(每组的发现> 50%,主要是念珠菌病和细菌性阴道病),PAP涂片异常(每发的发现> 60%)病例组和对照组之间的性病史或以前的衣原体感染史无显着差异。感染衣原体的患者更常发现人乳头瘤病毒感染,滴虫感染和异型增生或异型性,但无统计学意义。
结论:田纳西州东部的怀孕青少年有衣原体感染以及其他生殖器感染和PAP涂片异常的危险。由于缺乏特定症状,需要常规的产前衣原体筛查。

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