尿道炎（urethritis）與子宮頸炎（cervicitis）為常見的生殖泌尿道感染症狀，經由性接觸傳染為男性尿道炎為常見的感染途徑，其中又以淋病雙球菌（Neisseria gonorrhoeae）與砂眼披衣菌（Chlamydia trachomatis）兩者為最常見的致病微生物，而感染淋病雙球菌與砂眼披衣菌的後遺症包括不孕症、骨盆腔發炎與子宮外孕等。而感染性傳染疾病者相較於無感染性傳染疾病者有較高的機會感染愛滋病毒；同樣地，愛滋病患比非愛滋病患者有較高的機會感染性傳染疾病，並會有較差的癒後。因此站在公共衛生立場上，防治性傳染疾病與愛滋病，兩者間有相輔相成作用存在。
　　根據衛生署疾病管制局的資料顯示，台灣地區淋病通報個案數，由1995的159個，上升至2003年1626個，顯示台灣地區淋病通報個案有攀升的現象，但實際上台灣地區的淋病感染率是確實在上升，還是因為近幾年衛生單位逐漸重視淋病的通報，才使醫療機構逐漸重視淋病的通報，但目前無法瞭解真實原因。
　　因此本研究將嘗試在台南都會區建立定點醫師監測系統來監測性傳染疾病的流行情況，利用感染性傳染疾病後常見的臨床表徵「尿道炎」與「子宮頸炎」，來作為性傳染疾病調查的篩選標準，並選擇以淋病雙球菌與砂眼披衣菌兩者來探討台南都會區性傳染疾病的流行情況，進一步比較同期法定淋病通報個案數與本研究淋病陽性個案數是否不同。本研究採取非侵入性的尿液檢體，並使用高敏感度（sensitivity）、高特易度（specificity）的多重引子聚合酉每 連鎖反應（multiplex polymerase chain reaction）進行實驗室檢測。另外，本研究亦嘗試以郵寄問卷方式，瞭解影響台南縣市醫護人員通報淋病的意願之相關因素。
　　本研究與台南市六家基層診所合作，合作診所科別為家醫科、婦產科、泌尿科、內科暨皮膚科暨泌尿科，建立台南都會區尿道炎與子宮頸炎之定點醫師監測系統， 2003年10月20日至2004年5月11日止，總共收案人數為317位。其中診斷為尿道炎有107人（34.5%），子宮頸炎為198人（63.9%），另外有5名（1.6%）病患同時診斷為尿道炎及子宮頸炎。利用多重引子聚合酉每 連鎖反應進行實驗室檢測後，男性尿道炎病患淋病雙球菌陽性率為52.8%，砂眼披衣菌陽性率為3.5%；女性尿道炎病患淋病雙球菌陽性率為15.4%，砂眼披衣菌陽性率為3.8%。子宮頸炎病患淋病雙球去陽性率為1.5%，砂眼披衣菌陽性率為6.3%。另外，有一名病患同時被檢測出有淋病雙球菌與砂眼披衣菌，佔總人數的0.3%。在感染淋病雙球菌之危險因子多變項分析中，依性別分層後，女性三個月內性伴侶數為「2個以上（含2個）」者，相較於單一性伴侶者有較高的機會感染淋病雙球菌，其OR值為28.50（95% C.I.:0.97-841.06）。在感染砂眼披衣菌之危險因子多變項分析中，回答「不清楚性伴侶是否有生殖泌尿道症狀者」，相較於回答「性伴侶沒有生殖泌尿道症狀」者有較高的機會感染砂眼披衣菌，其OR值為6.41（95% C.I.:1.59-25.92）。
　　在淋病通報系統問卷調查部分，2004年4月16日至2004年7月16日止，一共回收93份，回收率為14.2%，由於回收的問卷樣本數太小，因此將只進行描述性分析。在調查法定性傳染疾病通報系統的認知部分，有23.3%的受訪者錯置淋病的法定傳染病歸屬種類者。針對受訪時間的過去三個月內，受訪者所屬的醫療院所其淋病通報實際情形調查，扣除「從未發現病例」的族群後，對基層診所而言未通報淋病的原因主要為「沒有採集病患的檢體」、「不知道要通報」與「病患隱私會因此受到侵犯」。針對何種方式可以增進醫療院所通報淋病的意願部分，對基層診所而言，「保障病患隱私權」、「提供相關採撿器具」與「補助相關採撿費用」為前三大因素。
　　對應疾病管制局的的統計週數為92年第43週至92年第53週與93年第1週至93年第20週，此段期間台南縣市通報淋病的個案數為67位，本研究的淋病檢測陽性個案為48位，並屬於未通報個案。因此，現行的法定淋病通報系統，所呈現出的淋病個案數，至少低估了41%的個案數。
　　現行的法定淋病通報系統與性病定點醫師通報監測網尚無法提供台灣地區完整的性傳染疾病流行病學資料，對於制訂衛生政策與推動性傳染疾病防治皆有困難度，因此目前台灣地區應設立完善的性傳染疾病之定點醫師監測系統，用以收集完整與正確的性傳染疾病流行病學資料。同時，衛生單位應定期向醫療院所宣導法定傳染病通報的定義、方式與其重要性。

　　Gonorrhea, caused by Neisseria gonorrhoeae, is one of the national notifiable diseases in Taiwan and the numbers of reported cases increase dramatically in the past decade. However, it is unclear if the marked increase of gonorrhea reported results from an improvement of the reporting system or is due to an outbreak. Since urethritis and cervicitis are the most common clinical manifestations of genital gonococcal infection, therefore, we would establish an active surveillance system on urethritis and cervicitis coupling with a highly sensitive and specific diagnostic method to evaluate the current gonorrhea national notifiable reporting system in Tainan, Taiwan in order to better understand the epidemiology of gonorrhea in this area. We would also identify the factors to affect health care workers to report gonorrhea cases to CDC by questionnaire.
　　This study included three parts. First, 6 clinics whose specialty are urology, gynecology, internal medicine or family medicine were invited to form the urethritis and cervicitis sentinel surveillance network. Patients of these 6 clinics with urethritis or cervicitis were recruited and were asked to provide first void urine specimens. The etiology of diseases was determined by the in-house multiplex polymerase chain reaction for the detection of N. gonorrhoeae and Chlamydia trachomatis in the urine specimen. In addition patient’s demographic characteristics and sexual behaviors were obtained by an anonymous questionnaire. Second, an anonymous mailed questionnaire was designed to understand factors to affect the reporting in the gonorrhea national notifiable system from points of view of the local health care workers. Third, we compared N. gonorrhoeae positive cases in this study with the reported gonorrhea cases from CDC in Tainan to understand the hidden epidemic of gonorrhea in the community.
　　We collected 317 patients diagnosed with urethritis or cervicitis from the physician based sentinel surveillance system during October in 2003 to May in 2004. There were 107(34.5%) urethritis cases, 198(63.9%) cervicitis cases and 5 cases with both diagnoses. The N. gonorrhoeae positive rate was 44.4% in individuals with urethritis and 1.5% in those with cervicitis. The chlamydial positive rate was 3.5% in individuals with urethritis and 6.3% in those with cervicitis. One (0.3%) patient was with both pathogens. Using multiple logistic regression to analyze the risk factor of infection, we found that “having multiple sexual partners” was the risk factor for gonorrheal infection in females and “having a sexual partner with genitourinary symptoms” was the risk factor for chlamydial infection.
　　The response rate of the mailed questionnaire was 14.2%. We found that 23.3% of respondents misclassified the gonorrhea’s category in the national notifiable diseases. Second, “not collecting patient’s specimen”, “not knowing that gonorrhea is the notifiable disease” and “worrying the encroachment of patient’s privacy” were the most frequent reasons which led physicians not to report gonorrhea cases. Third, “ensuring the protection of patient’s privacy”, “providing materials for laboratory diagnosis” and “providing the subsidy for laboratory diagnosis” were the most frequent reasons that can increase physician’s willingness to report gonorrhea cases.
　　In our study, we found an additional 48 N. gonorrhoeae positive cases in Tainan besides the 67 cases reported to Taiwan CDC during the same period of time. Therefore, at least a 41% underestimation of gonorrhea cases was observed in this area. Our results demonstrated that significant cases of gonorrhea were due to the current practice of gonorrhea national notifiable system. Therefore, we strongly suggest that the Department of Health should improve the current gonorrhea national notifiable surveillance system by using high sensitivity and specificity of nucleic acid amplification diagnostic assays to detect gonococcal infection and providing the subsidy for laboratory diagnosis.

第一節 英文文獻（依字母排序）
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Dai Xiuqin, & Hou-Hua, S. Surveillance of antibiotic
resistance of Neisseria gonorrhoeae isolates in China, 1993-
1998. Sex Transm Dis., 29(4), 242-245. 2002 Apr.

YT, v. D. The epidemiology of Neisseria gonorrhoeae in
Europe. Microbes Infect., 1(6), 455-464. 1999 May.

第二節 中文文獻（依筆畫排序）

王任賢，高雄市女性性病罹患率調查，衛生署科技計畫DOH86-DC-015，1997

王任賢，高雄市女性性病罹患率調查，衛生署科技計畫DOH87-DC-
1022，1998

中國衛生部，全國性病痲瘋病控制中心網頁，
http://www.ncstdlc.org/

台北市立性病防治所，「大陸暗娼淋病感染率比台灣私娼高五倍」，
台北市立性病

防治所新聞稿，2002年5月17日

台北市立性病防治所檢驗組，「性病七合一篩檢服務」，台北市立性
病防治所新聞

稿，2003年8月14日

台北市立性病防治所檢驗組，「性防所與您攜手合作建構更完整的性
病通報監測

網」，台北市立性病防治所新聞稿，2004年5月13日

台南市戶政生活服務網，
http://tnhr.tncg.gov.tw/population/population.htm

台南市衛生局，台南市暨各區公私立醫療院所數及各類病床數、救護
車概況，

http://www.tnchb.gov.tw/Default1.htm

張上淳，法定傳染病通報定義，院內感控雜誌，第十卷第二期，124-
131頁，1990年4月

張安隆，「尿液披衣菌、淋病篩檢，免除您上診療台的恐懼」，台北
市立性病防治

所新聞稿，2003年6月11日

張銘芳，婦產科門診病人砂眼披衣菌感染之流行病學研究，陽明大學
公共衛生研究所碩士論文，1988年

陳豪勇等，最新醫用微生物學，藝軒圖書出版社，台北，1999年九月

許雲霞，台北地區婦女感染生殖道披衣菌之流行病學調查-以婦科門
診及私娼婦女為例，國防醫學院公共衛生研究所碩士論文，1997年

溫大啟、江漢聲、吳建志、林楨旺、江萬煊，台灣地區男性淋病尿道炎和抗青黴素淋病的流行現況，北醫學報，20：49-53，1991年6月

楊順晴，婦女感染生殖道披衣菌之流行病學調查：以尿液為檢體篩檢
披衣菌感染可行性之評估及婦女感染披衣菌危險因子之分析，國防醫
學院公共衛生研究所碩士論文，2000年

衛生署網站，http://www.doh.gov.tw/NewVersion/index.htm

衛生署疾病管制局，防疫資料庫

衛生署疾病管制局，疫情報導，1998-2003年

衛生署疾病管制局，傳染病防治法法規輯要，2001年2月

衛生署疾病管制局，傳染病疫情監視及預警體系實施辦法，2004年6
月25日修

正發佈

衛生署疾病管制局，法定傳染病監視系統通報定義，
http://www.cdc.gov.tw

蔡淑芬、趙秀琳、吳聰能，台灣地區法定及報告傳染病監測系統之歷
史嚴格，公共衛生，第22卷第4期：273-283頁，1996年1月

劉淑芬、徐嫦娥、趙秀琳，台灣地區醫療院所對傳染病監視系統之態
度與執行調查研究，公共衛生，第23卷第3期：135-145頁，1996年10月