性行為與復發性念珠菌陰道炎有關


  Dec. 22, 2003--根據一項發表於十二月婦女健康期刊的前瞻性世代試驗結果顯示,口交和用口水手淫是造成復發性念珠菌陰道炎的風險因子。
  
  來自安納寶市密西根大學的第一作者Barbara D. Reed醫師在新聞稿中表示,許多醫師和許多女性相信女性罹患復發性酵母菌感染是因為他們的伴侶在性交期間將酵母菌傳回給他們,這項研究駁斥了這種想法,這項研究顯示復發性感染的風險是與其他事件有關,也許就是婦女對於酵母菌的免疫反應。
  
  Reed醫師的研究小組追蹤安納寶市地區兩所基層照護診所中登記的148位白念珠菌陰戶陰道炎的婦女與其中78位的男性伴侶。
  
  在一年的追究期內,33位婦女發展至少一次以上的念珠菌陰戶陰道炎,研究人員採用來自婦女舌頭、排泄物、陰戶及陰道或是來自她的伴侶的舌頭、排泄物、尿液與精液的念珠菌種培養並無法預測復發。
  
  女性復發性陰戶陰道炎的風險因子為最近以口水手淫 (危害比[HR], 2.66;95%信賴區間[CI], 1.17-6.06),最近的口交(HR, 2.94; 95% CI, 1.12 - 7.68)和每天攝取二份或以上的麵包(P<.05),另外也包含婦女第一次性交的年齡、一生的性伴侶數,與上個月的陰道性交或肛交同樣無法預測出陰道炎的復發。
  
  造成伴侶復發的男性風險因子為前一個月內以口水手淫(HR, 3.68; 95% CI, 1.24 - 10.87),和第一次性交的年紀較輕(HR, 0.83; 95% CI, 0.71 - 0.96)。
  
  Reed醫師表示,我們不能說口交對每個人都有問題,但是假如婦女正有復發性酵母菌感染,那些行為會使她有增加的風險。
  
  這項研究限制包括只有39%的婦女有至少四次的追蹤回診,另外也只有一半的男性伴侶接受問卷及抽樣,合併男性與女性的分析中評估因子的檢力有限、男性樣本的自我收集和經由女性及伴侶所表示的頻率及活動不同所證實的性行為不正確回憶。
  
  作者表示,口水用於陰戶陰道區域會破壞酵母菌與其他固有的有機物及免疫成分的平衡,而使人容易受到酵母菌感染,這項被確認的風險可能與婦女及她們伴侶的免疫特質有關,復發性陰戶陰道炎與性行為及婦女及她們伴侶的免疫特性之間關係的進一步評估已被確認。

Sexual Behaviors Linked to Rec

By Laurie Barclay, MD
Medscape Medical News

Dec. 22, 2003 — Oral sex and masturbating with saliva are risk factors associated with recurrent Candida vaginitis, according to the results of a prospective cohort trial published in the December issue of the Journal of Women's Health.

"Many physicians, and many women, believe that women get recurrent yeast infections because their partner passes the yeast back to them during intercourse. This study refutes that belief," lead author Barbara D. Reed, MD, MsPH, from the University of Michigan at Ann Arbor, says in a news release. "This study suggests the risk for recurrent infections is related to something else — perhaps the woman's immune response to the yeast."

Dr. Reed's group followed 148 women with Candida albicans vulvovaginitis and 78 of their male sexual partners enrolled at two primary care practices in the Ann Arbor area.

Within one year of follow-up, 33 women developed at least one additional episode of Candida vulvovaginitis. Candida species cultured from the woman's tongue, feces, vulva, and vagina or from her partner's tongue, feces, urine, and semen did not predict recurrence.

Female risk factors for recurrent vulvovaginitis were recent masturbation with saliva (hazard ratio [HR], 2.66; 95% confidence interval [CI], 1.17 - 6.06), recent cunnilingus (HR, 2.94; 95% CI, 1.12 - 7.68), and ingestion of two or more servings of bread per day (P < .05). The woman's age at first intercourse, lifetime number of partners, and frequency of vaginal or anal intercourse in the previous month did not predict recurrence.

Male risk factors associated with recurrence in his partner were masturbation with saliva in the previous month (HR, 3.68; 95% CI, 1.24 - 10.87), and younger age at first intercourse (HR, 0.83; 95% CI, 0.71 - 0.96).

"We're not saying that oral sex is a problem for everyone, but if a women is experiencing recurrent yeast infections, those activities put her at an increased risk," Dr. Reed says.

Study limitations include only 39% of the women returning for at least four follow-up visits, only half of the male partners submitting questionnaires and specimens, limited power to assess factors in the combined male/female analysis, self-collection of male specimens, and inaccurate recall of sexual activities, evidenced by the disparity in the reported frequency of activities between the women and their partners.

The authors suggest that application of saliva to the vulvovaginal area may disrupt the balance of Candida to other resident organisms and immune components, predisposing to yeast infection. "The risks identified may be related to immune characteristics of the women and their partners," the authors write. "Further evaluation of the association between recurrent Candida vulvovaginitis, sexual activities, and immune characteristics of women and their partners is warranted."

The National Institute of Allergy and Infectious Diseases funded this study.

J Women's Health. 2003;12:000-000

Reviewed by Gary D. Vogin, MD

    
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