Department of Epidemiology Public Health College of Harbin Medical University 1 性传播疾病 Sexually Transmitted Diseases (STD) 哈尔滨医科大学流行病学教研室 Department of epidemiology ， Harbin Medical University

Department of Epidemiology Public Health College of Harbin Medical University 2 性传播疾病 (sexually transmitted diseases,STD) 是指主要通 过性行为或类似性行为 ( 包括阴交、肛交、口交、接吻、触摸 等）而传染的一组疾病，简称性病，过去民间称 “ 花柳病 ” 。 性病不仅发生在性器官上，也可侵犯附属淋巴器官及全身 重要器官组织。

Department of Epidemiology Public Health College of Harbin Medical University 3 Content 目录 第一节 概 述 第二节 流行过程 第三节 影响流行过程因素 第四节 艾滋病 第五节 预防策略与措施  Outlines  Epidemic process  Factors influence epidemic process  AIDS  Strategy and measurement for prevention

Department of Epidemiology Public Health College of Harbin Medical University 4 第一节 概 述 outline 定 义 病 原 学 危 害 流行概况  Definition  Etiology  Harm  Epidemic situation

Department of Epidemiology Public Health College of Harbin Medical University 5 What is a Sexually Transmitted Disease?  Diseases you can get by having sex – vaginal, oral, or anal – with someone who is already infected  Caused by bacteria or viruses that are spread through blood, semen, and vaginal fluids  Also, spread simply by touching infected skin for certain STDs, like herpes and genital warts

Department of Epidemiology Public Health College of Harbin Medical University 6 What are some STDs/VD? 4Chlamydia 4Gonorrhea (GC) 4Herpes 4Venereal Warts 4Syphilis 4Hepatitis 4HIV (AIDS)

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Department of Epidemiology Public Health College of Harbin Medical University 8 三、危 害 harm 劳动力急剧减少，人才严 重损失 人口比例严重失衡，人均 寿命降低 直接影响经济的发展 加重国家财政负担  Reduce labors, lost talented  Misbalance of population proportion, low life expectancy  Influence economic development  Heavy burden for county

Department of Epidemiology Public Health College of Harbin Medical University 9 三、流行概况 Epidemic situation 流行趋势 Epidemic trend --- 低估 underestimated 地区分布 Geographic distribution --- 全球、中国 Global, China 人群分布 Population distribution -- 年龄、性别 age gender

Department of Epidemiology Public Health College of Harbin Medical University 10 流行趋势 Epidemic trend 2000 年 WHO 正式公布 STD 估计数，世界上每天 有 100 多万人感染性病，每年约有 4 亿新 STD 患 者 梅毒 1200 万 淋病 6200 万 衣原体感染 8900 万 滴虫病 1.7 亿 尖锐湿疣 3000 万 生殖器疱疹 2000 万

Department of Epidemiology Public Health College of Harbin Medical University 11 STD Facts  1 in 4 Americans will become infected with an STD in their lifetime  2/3 of all STD cases occur in ages 25 or younger

Department of Epidemiology Public Health College of Harbin Medical University 12 从 2001 年开始，我国 STD 疫情出现了 趋势 2001 年共累计报告 8 种 STD795,612 例，较 2000 年 （ 例）下降了 7.38% 全国 STD 总报告发病率为 62.89/10 万

Department of Epidemiology Public Health College of Harbin Medical University 13 地区分布 Geographic distribution STD 在世界分布差异较大，南亚和东南亚是全球 STD 流行最严重的地区，每天至少有 40 万新病例发生 我国报告的 STD 分布特点 沿海开放省市 > 内地 经济发达地区 > 经济落后地区 内地、边远地区报告率受监测系统影响较大

Department of Epidemiology Public Health College of Harbin Medical University 14 表 年不同地区 15 ～ 49 岁成人 4 种 STD 的估计患病率（ % ）

Department of Epidemiology Public Health College of Harbin Medical University 15 全国 4 个性病高发区 four high incidence areas 珠江三角洲地区 长江三角洲地区 京津地区 东北三省 发病率较低的地区 lower incidence areas 河北 内蒙 山西 陕西 少数民族所在地区 minority areas 新疆梅毒发病率为全国首位

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Department of Epidemiology Public Health College of Harbin Medical University 17 图 25-2 我国性病地区分布图 Geography distribution of STDs in China

Department of Epidemiology Public Health College of Harbin Medical University 18 人群分布 population Distribution 发病率不断上升，发病人群广泛 近些年，女性病例逐年升高，男女比例差距逐渐减小， 可能与女性就诊人数增加，诊断水平提高有关 性活跃人群为感染性病的危险人群 年龄 STD 好发于性活跃人群 性别 多数发病以男性为多

Department of Epidemiology Public Health College of Harbin Medical University 19 图 25-3 Age distribution of STDs in 2000

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Department of Epidemiology Public Health College of Harbin Medical University 21 第二节 流行过程 epidemic process 传染源 source of infection 传播途径 route of transmission 人群易感性 herd susceptibility 图 25-4

Department of Epidemiology Public Health College of Harbin Medical University 22 一、传染源 source of infection 性病病人及病原携带者 高危人群 卖淫嫖娼者 吸毒人员 嫖客等 “ 桥梁人群 ”  Patient of STDs and carrier  High risk population Prostitution person Drug abuser  “Bridge person” for patron of brothel

Department of Epidemiology Public Health College of Harbin Medical University 23 二、传播途径 Route of Transmission 性行为传播 非性行为的直接接触传播 医源性传播和血源感染 垂直传播 日常生活接触传播  Transmission with sexual behavior  Direct contact  Medical practice and blood infection  Vertical transmission  Daily life contact

Department of Epidemiology Public Health College of Harbin Medical University 24 性病传播方式 （ Mode of transmission ） 非婚性接触 (72.03%)>>>> 配偶传播 (17.98%)>>> 间接传播 (9.8%)>> 母婴传播 (0.16%)> 血液传播 (0.03%)

Department of Epidemiology Public Health College of Harbin Medical University 25 三、人群易感性 herd susceptibility 没有年龄、性别差异 无先天性免疫力 无稳固的后天获 得性免疫力  No age, gender difference  No innate immunity  No stable acquired immunity

Department of Epidemiology Public Health College of Harbin Medical University 26 第三节 影响流行过程的因素 Factory influence epidemic process 生物学因素 社会因素  Biological factors  Social factors

Department of Epidemiology Public Health College of Harbin Medical University 27 一、生物学因素 Biological factors 无症状感染或不典型临床表现 人群因对 STD 病原体缺乏特异性免疫力 至今尚无有效针对 STD 的人工免疫方法

Department of Epidemiology Public Health College of Harbin Medical University 28 二、社会因素 social factors 人口流动 嫖娼、卖淫 吸毒、贩毒 淫秽文艺作品 健康教育不充分 性病医疗市场混乱 行为因素  Population migration  Prostitution ， to go whoring;  Drug abuse, drug smuggling  Sexual literature  Not enough health education  Mess of medical market for STDs  Behaviors

Department of Epidemiology Public Health College of Harbin Medical University 29 第四节 艾滋病 AIDS 概述 outline 病原学 etiology 艾滋病的分期 stage 危害 harm 流行概括及流行特征 outline and features of epidemic 图 25-5

Department of Epidemiology Public Health College of Harbin Medical University 30 一、概 述 outline 艾滋病亦称获得性免疫缺陷综合征 （ acquired immunodeficiency syndrome ， AIDS ） 定义 由人类免疫缺陷病毒 （ human immunodeficiency virus ， HIV ）感染引起的以 T 细胞免 疫功能缺陷为主的一种免疫缺陷病。

Department of Epidemiology Public Health College of Harbin Medical University 31 二、病原学 etiology 攻击 CD4+T 淋巴细胞 逆转录病毒科、慢病毒属， RNA 病毒 血清学分型： HIV-1 ， HIV-2 图 25-6 图 25-7

Department of Epidemiology Public Health College of Harbin Medical University 32 图 25-8

Department of Epidemiology Public Health College of Harbin Medical University CD4 CXCR4 Binding Fusion & Entry Nuclear localization & entry Reverse transcription Integration Infection gp120 p24 Viral RNA RT & other virion proteins 图 25-9

Department of Epidemiology Public Health College of Harbin Medical University Expression gp120 p24 Viral RNA RT & other virion prteins Budding Assembly Viral Gene Transcription Translation Post-translational processing Cellular Activation 图 25-10

Department of Epidemiology Public Health College of Harbin Medical University 35 三、艾滋病的分期 Stage I 期 －急性感染期 II 期 －无症状感染期 III 期－艾滋病期 图 25-11

Department of Epidemiology Public Health College of Harbin Medical University 36 四、危害 Harm 影响人口质量和 人口结构 贫穷和不平等 危害家庭 偏见和歧视 卫生服务 社会经济和政治  Affect the quality and construction of population  Poor and unequal  Harmful to family  Prejudice and discrimination  Health service  Social economic and politics 图 25-12

Department of Epidemiology Public Health College of Harbin Medical University 37 五、流行概括及流行特征 outline and features of Epidemic AIDS 流行概括 outline of AIDS epidemic 传播途径 Route of transmission

Department of Epidemiology Public Health College of Harbin Medical University 38 国外艾滋病流行概括 2005 年估计全球尚存活的 HIV 感染者约 3860 万（成年 人约 3630 万，其中女性占 47.7% ，约 1730 万； 15 岁以 下儿童约 230 万）；新发生的 HIV 感染者约 410 万；当 年死于 AIDS 的人数约 280 万（ WHO) 东欧和中亚地区是目前全世界增长最快的地区 亚洲及太平洋地区 HIV 的感染率较低，但由于亚洲人 口较多， HIV 感染者的实际数量仍较大，且近年来东 亚、南亚和东南亚地区的流行都呈

Department of Epidemiology Public Health College of Harbin Medical University 39 图 25-13

Department of Epidemiology Public Health College of Harbin Medical University 40 国内艾滋病流行概括 第一阶段（ 1985 年～ 1988 年）输入散发期 第二阶段（ 1989 年～ 1994 年）局部流行期 第三阶段（ 1995 年至今） 广泛流行期 AIDS 疫情仍呈 趋势 流行地区广泛、地区差异大 三种传播途径并存，吸毒和性传播是新发感染的主要途径 AIDS 发病及死亡情况严重 AIDS 由高危人群向一般人群扩散 存在 AIDS 疫情进一步蔓延的危险

Department of Epidemiology Public Health College of Harbin Medical University 41 我国现在的流行情况 2002 年，艾滋病病毒感染者 9824 例，其中病人 1045 例， 死亡 363 例 中国艾滋病传播以经血途径为主，吸毒，占 63.7% 经性传播途径 占 8.1% 经采血、血浆 占 9.3%

Department of Epidemiology Public Health College of Harbin Medical University 42 图 25-14

Department of Epidemiology Public Health College of Harbin Medical University 43 传播途径 Route of transmission 异性及同性的性接触传播 Sexual contact transmission between same or different gender 医源性传播和血液感染 medical practice or blood infection 母婴垂直传播 maternal vertical transmission 图 25-15

Department of Epidemiology Public Health College of Harbin Medical University 44 第五节 预防策略与措施 Strategies and measurement 预防策略 prevention Strategies 预防措施 prevention measurement

Department of Epidemiology Public Health College of Harbin Medical University 45 一、预防策略 Strategies for Preventing 政府组织领导，部门各 负其责 积极推进法制化管理 开展性教育和 STD 防治 健康教育 开展 STD 和 AIDS 监测 工作  Government organize and lead, different section take charge of  drive the manage with law  Carry out health education on sex and prevention of STDs  Carry out surveillance of STDs and AIDs

Department of Epidemiology Public Health College of Harbin Medical University 46 Strategies for Preventing STDs  Abstain from sex or delay sex  Choose outer-course versus intercourse  Monogamy  Use Condoms and other barriers  Reduce the number of sexual partners  Do not have sex with “higher-risk” people  Do not share needles  Stay sober

Department of Epidemiology Public Health College of Harbin Medical University 47 二、预防措施 Measurement 传染源的控制 控制传播途径 保护易感人群 监 测 预防接种 正确处理性病和艾滋 病防治中的伦理问题  Control source of infection  Control rout of transmission  Protect susceptible population  Surveillance  Vaccination  Deal with ethics problem in prevention sexual and AIDs

Department of Epidemiology Public Health College of Harbin Medical University 48 谢 谢 Thank You