关键词: 性传播疾病, 广东, 卫生保健调查, 医疗机构, 规范化诊疗, 服务质量, 标准化患者, 策略

Abstract: 【Abstract】 Objective To investigate the current status of diagnosis and treatment services for sexually transmitted diseases （STDs） in medical institutions in Guangdong province. Methods A survey was conducted on the current status of standardized STD diagnosis and treatment services in medical institutions in Guangdong province using 3 methods: （1） in 2019, 9 hospitals in Guangzhou were selected by stratified random sampling, and the ability of medical institutions and medical workers at different levels to provide standardized STD diagnosis and treatment services was investigated using the standardized patient-based method; （2） based on infectious disease surveillance data, medical records of patients with 4 common STDs （syphilis, gonorrhea, genital Chlamydia trachomatis infection, and/or genital herpes） were spot-checked in 2 hospitals in Guangdong province during 2021 - 2022, and the current status of the implementation of the national STD diagnosis and treatment guideline "Clinical Diagnosis, Treatment, and Prevention Guidelines for Sexually Transmitted Diseases" was investigated; （3） the current status of standardized STD diagnosis and treatment was investigated in 15 medical institutions in Guangdong province during 2018 - 2023 through document review, on-site inspections, and interviews. Results The survey using the standardized patient-based method showed several main issues in the STD diagnosis and treatment services provided by medical institutions in Guangzhou in 2019: （1） incomplete medical history collection and non-standard physical examinations; （2） lack of awareness of patient privacy protection; （3） discrimination against individuals infected with human immunodeficiency virus among some doctors. The spot check of medical records from STD clinics in 2 hospitals in Guangdong province during 2021 - 2022 revealed that physical examinations of the genital area were performed in 38 of 41 syphilis cases （92.68%）, 24 of 27 gonorrhea cases （88.89%）, 27 of 33 genital Chlamydia trachomatis infection cases （81.82%）, and 30 of 36 genital herpes cases （83.33%）; other STD tests were conducted in 32 （78.05%）, 12 （44.44%）, 16 （48.48%）, and 6 （16.67%） cases among the cases of the above 4 common STDs respectively; the proportions of patients receiving standardized treatment according to the national STD diagnosis and treatment guideline were 85.37% （35/41）, 25.93% （7/27）, 81.82% （27/33）, and 100.00% （36/36） among patients with the above 4 common STDs respectively. During 2018 - 2023, the treatment regimens for early and late syphilis in 15 medical institutions in Guangdong province all met the national STD diagnosis and treatment guideline; however, the treatment regimens for gonorrhea in 3 medical institutions and those for genital Chlamydia trachomatis infection in 4 medical institutions did not meet the guidelines, and there were some issues such as excessively long treatment courses and unnecessary combination treatment; all the 15 medical institutions′ laboratories could conduct serum non-specific antibody tests and specific antibody tests for syphilis, 12 could conduct smear tests and culture for the detection of gonococci, all the 15 medical institutions mainly used immunochromatography to detect genital Chlamydia trachomatis antigens, while only 4 could conduct nucleic acid amplification tests for genital Chlamydia trachomatis. Conclusions At present, the quality of standardized STD diagnosis and treatment services in Guangdong province needs to be improved. Strengthening standardized clinical diagnosis and treatment of STDs, laboratory construction, and preventive services should be focused in STD prevention and control in Guangdong province.

Key words: Sexually transmitted diseases, Guangdong, Health care surveys, Medical institutions, Standardized diagnosis and treatment, Service quality, Standardized patient, Strategy