自然人群HPV6/11感染经性传播动力学研究

Genital warts (GW) are the most common sexually transmitted infections with a substantial burden of disease in China. In recent years, migrant workers and their spouses had been recognized as a major contributor to sexual transmitted disease in China. The prevalence of GW was especially high in migrant workers and their spouses, however, the GW epidemiology research are scare in this group population and often hospital based studies. To date, few studies had been carried out to assess the epidemiology of GW in general population in China. HPV 6 and 11 accounted for over 90% of GW cases, and high risk sexual behavior are the primary route of HPV6/11 infection. It is important to understand the prevalence, incidence and natural history of HPV6/11 infection to assess the burden of GW. Knowledge about HPV6/11 transmission dynamics in heterosexual couples is important for GW prevention and control strategy. Our team had carried out a prospective study to assess the prevalence and incidence of GW and HPV prevalence in general population in Guangxi. This study plans to recruit HPV6/11 DNA positive individuals (index partners) in pervious study and their sexual partners. By following them for two year, to examine the concordance of HPV6/11 infection, the persistence infection rate and HPV6/11 transmission rates in couples, including female-to-male transmission and male-to-female transmission rate. These data from this study can elucidate sexual transmission dynamics of HPV6/11 in general population systematically and provide clues for GW prevention and control strategy.

尖锐湿疣是我国最常见的性传播疾病之一。近年来全国各地外出务工人员和留守配偶已成为不容忽视的性传播疾病高危群体，尖锐湿疣在外出务工人员及其配偶中尤为高发，但相关的研究极少且多基于性病皮肤病就医人群，罕有基于自然人群的流行病学研究资料。超过90%的尖锐湿疣由人乳头瘤病毒6型和/或11型（HPV6/11）感染引起，高危性行为是HPV6/11传播的主要危险因素。阐明自然人群的HPV6/11感染状况及配偶间经性传播动力学对于尖锐湿疣的预防控制具有重要意义。此前申请人依托单位已在广西柳州市城乡自然人群中开展HPV6/11及尖锐湿疣流行情况调查，本项目拟在此调查基础上，建立HPV6/11感染者及其固定性伴的前瞻性研究队列，以阐明HPV6/11感染者及其固定性伴之间的感染经性传播动力学，包括固定性伴间HPV6/11感染一致性、感染持续时间、男传女及女传男的概率等科学问题，为尖锐湿疣的防控策略制定提供依据。

尖锐湿疣是我国最常见的性传播疾病之一，超过90%的尖锐湿疣由人乳头瘤病毒6型和/或11型（HPV6/11）感染引起。阐明自然人群HPV6/11感染状况及配偶间经性传播动力学对于尖锐湿疣的预防控制具有重要意义。本项目基于依托单位前期在柳州市18-55岁自然人群中的队列，与广西柳州市疾病预防控制中心紧密合作，按计划开展并顺利完成以下两个亚组的队列研究：1）自然人群中HPV 6/11感染自然史及尖锐湿疣的研究；2）夫妻HPV 6/11感染的传播动力学研究。研究结果显示：1）自然人群中HPV 6/11的新发感染率，男性（2.0/1000人月，95% CI: 1.4-2.7）是女性（1.1/1000人月，95% CI: 0.8-1.6）的2倍，但清除率男性（111.7/1000人月，95% CI: 81.6-152.9）与女性（84.8/1000人月，95% CI: 58.6-122.9）差异无统计学意义，中位清除时间为6.5个月左右；女性HPV6/11新发感染率与年龄呈反比，而男性HPV6/11新发感染与年龄无关，男女性清除率均与年龄无关；性行为和卫生习惯是影响HPV感染的主要因素。2）自然人群尖锐湿疣患病率为0.15% (95%CI：0.06, 0.31），发病率为1.26 /1000人年(95%CI：0.16, 2.37），约为报告发病率的10倍。本人及其性伴性行为是影响尖锐湿疣发病的主要因素。3）夫妻间型特异性HPV感染一致率为15.5%(95% CI: 8.5-25.0），夫妻间传播率中，男传女为11.5/1000人月，女传男为11.3/1000人月，传播率相当，不管是男性还是女性，HPV传播主要发生在生殖器和生殖器之间，但女性肛周部位也是重要的传染源，而男性的肛周部位对女性各部位传播的效率较低。本研究阐明了自然人群HPV感染经性传播动力学、感染自然史及危险因素，为我国尖锐湿疣的预防与控制策略、疫苗免疫策略的制定提供科学依据。此外，本研究为HPV疫苗卫生经济学评价提供了重要的基础数据，尤其是我国男性HPV感染自然史的数据，可为相关专业进行卫生经济学评价提供可能性，从而确定最具成本效益的措施，为公共卫生服务供应决策者提供有效的数据。