指导患者进行安全的性行为。过去 60 日内的所有性伴侣均应接受评估和可能要进行治疗。不鼓励预防性使用抗生素。[2]Martin DH, Bowie WR. Urethritis in males. In: Holmes KK, Sparling PF, Mardh P, et al., eds. Sexually transmitted diseases. 3rd ed. New York, NY: McGraw-Hill; 1999:833-845.
一些研究探讨了加快性伴疗法(将药物发给患者治疗其性伴侣)。 [
]In people with sexually transmitted infections, what are the best strategies for partner notification?http://cochraneclinicalanswers.com/doi/10.1002/cca.676/full显示答案 在美国,各州关于加快性伴疗法的法律有所不同。应联系当地卫生部门,确定这一做法在当地是否合法。[1]Workowski KA, Bolan GA; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64:1-137.http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htmhttp://www.ncbi.nlm.nih.gov/pubmed/26042815?tool=bestpractice.com[39]Hogben M. Partner notification for sexually transmitted diseases. Clin Infect Dis. 2007;44:S160-S174.http://cid.oxfordjournals.org/content/44/Supplement_3/S160.longhttp://www.ncbi.nlm.nih.gov/pubmed/17342669?tool=bestpractice.com[40]Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. 2005;352:676-685.http://content.nejm.org/cgi/content/full/352/7/676http://www.ncbi.nlm.nih.gov/pubmed/15716561?tool=bestpractice.com[41]The American College of Obstetricians and Gynecologists. Committee opinion no. 506: expedited partner therapy in the management of gonorrhea and chlamydia by obstetrician-gynecologists. Obstet Gynecol. 2011;118:761-766.http://www.ncbi.nlm.nih.gov/pubmed/21860319?tool=bestpractice.com[52]Centers for Disease Control and Prevention. Trends in sexually transmitted diseases in the United States: 2009 national data for gonorrhea, chlamydia and syphilis. 2010. http://www.cdc.gov/ (last accessed 10 October 2016).http://www.cdc.gov/std/stats09/trends2009.pdf 目前,这些做法尚有争议。尽管它们可以有效减少淋病和衣原体尿道炎的传播,但却失去了面对面接触、咨询、检测其他性传播疾病或发现药物过敏的机会。CDC: expedited partner therapy
应进行包括艾滋病毒和梅毒在内的其他性传播疾病的检查。具体确诊为衣原体感染、淋病或毛滴虫感染的男性应在治疗后 3 个月接受复查,因为据报道再感染率很高,无论其性伴侣是否接受过治疗。
妊娠女性应接受复查以确定是否治愈。复查优先选择使用核酸扩增试验,例如对尿道分泌物和/或尿沉渣进行连接酶链反应 (LCR) 或 PCR 检测。建议在治疗后 3-4 周进行衣原体感染治愈检测,并在第 3 个月进行复查。建议在第 3 个月进行淋病复查。[1]Workowski KA, Bolan GA; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64:1-137.http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htmhttp://www.ncbi.nlm.nih.gov/pubmed/26042815?tool=bestpractice.com
强烈建议对所有暴露于淋病奈瑟菌的新生儿预防性使用眼部抗微生物药物,且这在某些国家/地区是一项强制要求。[1]Workowski KA, Bolan GA; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64:1-137.http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htmhttp://www.ncbi.nlm.nih.gov/pubmed/26042815?tool=bestpractice.com