广州地区性病门诊细菌性阴道病的现状调查

为了解广州地区性病门诊女性患者细菌性阴道病（BV）的发病情况，用BV快速检测方法和诊断标准方法对2000年性病门诊725例女性患者进行检测；并对确诊的BV患者做淋球菌、衣原体、支原体、滴虫和念珠菌检测。结果725例病人确诊为BV者131例，患病率为18．07％（131／725）。131例BV患者中有113例合并其它病原菌感染。其合并感染率为86．26％（113／131）。其中解脲支原体(Uu)占首位（38．93％），其次为淋球菌（14．50％），第3为Uu、Mh混合感染（9．90％）。BV快速检测方法阳性预测价值不高（57．60％），不能用于确诊。     

300例不孕症女性阴道微生态状况分析

目的:了解不孕女性阴道微生态状况,探讨不孕症患者进行阴道菌群微生态评价的临床意义。方法:选取不孕症女性300例取阴道分泌物进行微生态评价,以同期389例生育年龄的体检妇女作为对照。结果:不孕女性阴道假丝酵母菌阳性率7.7%(23例),阴道毛滴虫阳性率0%(0例);Nugent评分:正常89.1%(267例),BV中间型4.7%(14例),BV 6.2%(19例);阴道优势菌以革兰阳性大杆菌为主,占83.2%(249例),革兰阳性球菌0.7%(2例),革兰阴性短杆菌16.1%(49例);微生态失调的发生率34.0%(102例)。结论:不孕女性中BV、VVC的患病率和阴道菌群异常的发生率不高于健康体检女性,原发不孕与继发不孕之间、单纯管性因素不孕与单纯男性因素不孕之间阴道微生态的状况也无显著性差异。     

295例女性门诊病人阴道带菌情况调查

阴道念珠菌病是一种常见的粘膜念珠菌感染。在育龄妇女中发病率很高，有报道７５％的育龄妇女一生中至少有过一次此菌的感染，而且，其中４５％的妇女有重复感染史［１］。为了解妇产科病人阴道带菌情况及阴道念珠菌病的发病情况，从１９９２年７月至１９９３年１２月，我们在南京市玄武医院妇产科，对门诊女病人进行阴道带菌情况的调查，共调查了２９５例，其结果如下。一、资料和方法病例选择：２９５例女性门诊病人（妇科１８７例，其中阴道瘙痒者８１例，白带异常者２８例．月经不调者３１例，子宫肌瘤及卵巢肿瘤者１３例，外阴阴道炎１…     

细菌性阴道病患者及性伴临床资料分析

目的了解细菌性阴道病(BV)的发生和性伴之间的关系。方法收集59例BV患者及40名性伴的相关临床资料以及性病病原体的检测结果并进行分析。结果59例BV患者及性伴多数都存在多次不洁性行为的病史,50%以上的BV患者有支原体感染、25%的有衣原体感染,约25%的合并阴道真菌感染,约25%的患尖锐湿疣,40名性伴也有相似的情况。BV组患者的人型支原体(MH)和衣原体感染率高于非BV组。结论细菌性阴道病的发生与自身或性伴不洁性行为有关,患有BV的女性患者更易感染各种性病病原体。     

细菌性阴道病及甲硝唑治疗对妊娠结局的影响

<正>细菌性阴道病(bacterial vaginosis,BV)是一种性传播疾病,是由于阴道菌群失调,阴道内乳杆菌减少,加德纳菌及多种厌氧菌增殖,引起的内源性混合性感染。妊娠期细菌性阴道病产生磷脂酶、前列腺素,容易发生胎膜早破、宫内感染、绒毛膜羊膜炎和产后子宫内膜炎。~1BV占阴道感染的40%~50%,远高于阴道常见的真菌或滴虫感染。~2 Goldenbeng等~3报道,妊娠合并BV者高达30%~68%,已成为育龄妇女最常见的阴道感染。本文观察妊娠合并BV甲硝唑治疗后对妊娠结局的影     

女性性传播疾病中阴道念珠菌带菌情况分析

目的：了解女性性病患者阴道念珠菌的带菌情况。方法：对422例女性性病患者作阴道分泌物革兰氏染色检查念珠菌，并同时检测淋球菌（NG）、解脲支原体（UU）、人型支原体（MH）、沙眼衣原体（CT）。结果：女性性病患者的阴道念珠菌带菌率为35．1％。在混合感染中，念珠菌合并UU感染率为13．7％，合并NG、MH、CT的总感染率为7．8％。结论：女性性病患者的阴道念珠菌带菌率高于健康育龄妇女，并以合并UU感染最常见。     

细菌性阴道病492例分析

细菌性阴道病(BV)是由多种细菌(加特纳菌、棒状杆菌、嗜血杆菌)感染引起的一种疾病，可通过性交传播，是性病门诊的常见病、多发病。现将2002年6月～2003年6月我院性病门诊的1042例女性病人就诊情况报道如下。     

女性生殖道解脲脲原体感染与细菌性阴道病的关系

目的探讨解脲脲原体(UU)感染和细菌性阴道病(BV)的相互关系。方法对本院性病门诊2008年6月～2009年1月本院性病门诊就诊的1491例患者进行了UU和BV的检测。UU阳性的696例纳入观察组,UU阴性795例作为对照组,调查两组BV的阳性率,并对年龄、职业分布、避孕方式和阴道清洁度等因素进行分析。结果观察组BV的阳性率(22.41%)明显高于对照组BV的阳性率(11.45%);观察组BV的阳性率先随着年龄的增加而增高,至31～40岁到达高峰,随后又随着年龄的增长而降低,对照组中BV的阳性率随着年龄的增长而降低,与年龄呈负相关;职业分布在两组间差异无显著性意义。观察组中采用屏障避孕法BV的检出率明显比非屏障避孕法低。观察组BV阳性患者以阴道清洁度Ⅲ度和阴道清洁度Ⅳ度为主,对照组中BV患者以阴道清洁度Ⅱ度为主。结论女性生殖道UU感染可以增加BV的发病率;屏障避孕法可以降低UU患者BV的发病率;女性生殖道UU感染合并BV感染时,阴道清洁度下降。     

性病门诊就诊妇女中3种阴道感染的研究

为了解性病门诊中就诊妇女阴道感染的检出率、临床表现、疗效及性传播性，在5家性病门诊选择具有阴道分泌物异常主诉、初诊、年龄在16岁或以上、既往2周内未用过抗生素的妇女作为研究对象。取泌尿生殖道标本，应用常规实验室检查方法，检测淋球菌、沙眼衣原体、阴道毛滴虫、白念珠菌及细菌性阴道病。用常规治疗方法观察治疗效果。结果在649例女性中，共检出淋病123例（19．0％），衣原体感染130例（20．0％），滴虫感染63例（9．7％），念珠菌病143例（22．0％），细菌性阴道病109例（16．8％），另有205例未检出上述病原体。单一病原体感染为325例，一种以上病原体复合感染119例。3种阴道感染中，具有典型阴道分泌物性状者为36．7％－64．3％，对常规治疗的临床治愈率为46．3％－72．9％。滴虫病（OR＝6．67，P＜0．05）和细菌性阴道病（OR＝2．23，P＜0．05）分别与未坚持使用安全套有关。但是如果剔除合并宫颈感染的病例，则无这种相关性。表明在性病门诊就诊妇女中，阴道感染比宫颈感染更多见，复合感染也常见。阴道感染的临床表现不典型，对常规推荐治疗的疗效不理想，需要密切随访。阴道感染与性传播的危险因素无显著相关性。     

应用乳铁蛋白试验鉴别诊断女性生殖道感染及其对细菌性阴道病的病理生理学提示

乳铁蛋白(lactoferrin)是临床标本中多形核中性粒细胞(PMN)的标记。该文作者研究了应用乳铁蛋白乳胶凝集试验(LFLA)鉴别诊断女性生殖道感染的可能性。 方法:用LFLA对确诊为有生殖道感染的女性患者的阴道分泌物进行乳铁蛋白半定量测定。纳入研究的生殖道感染包括外阴阴道念珠菌病、阴道毛滴虫病和细菌性阴道病(BV)。淋球菌和沙眼衣原体生殖道感染者被排外。同时,在体外,将无BV及其它STD病史者血液中分离的PMN加入阴道分泌物中观察8小时以     

Variability of bacterial vaginosis over 6- to 12-month intervals

OBJECTIVES: To examine variability in bacterial vaginosis (BV) over 6- to 12-month intervals. STUDY DESIGN: One thousand one hundred ninety-three women were followed for a median of 3 years with serial vaginal swab Gram stains for BV. Discrete time hazard models were fit to identify independent risk factors for BV. RESULTS: Women with BV at study entry were categorized as having normal flora at the next visit 20% of the time, and women with normal flora at study entry were categorized as having BV at the next visit 20% of the time. Among women with initially normal flora, factors associated with BV were black race, lower education, a history of BV, a history of chlamydial/gonococcal cervicitis, and lack of monogamy. CONCLUSION: About one fifth of women with normal flora develop BV over a given 6- to 12-month interval, and the modifiable risk factors of cervicitis and lack of monogamy contribute to the development of BV.     

Glycosidase and proteinase activity of anaerobic gram-negative bacteria isolated from women with bacterial vaginosis

BACKGROUND: It is known that glycosidases and proteases are produced by the anaerobic gram-negative bacteria associated with bacterial vaginosis (BV). We hypothesized that these enzymes enzymatically degrade mucins, thereby destroying the mucus gel that otherwise helps protect against sexually transmitted pathogens, including HIV. GOAL: The goal was to determine glycosidase and protease production by vaginal bacteria associated with BV and to compare these with symptoms and signs of abnormal discharge and to test vaginal fluid viscosity. STUDY DESIGN: The anaerobic gram-negative rods recovered from the vaginas of 153 women with normal flora, intermediate flora, or BV were tested for production of sialidase, fucosidase, galactosidase, glucosaminidase, and glycine and arginine aminopeptidases. RESULTS: Women with BV had higher frequencies and concentrations of bacteria producing mucin-degrading enzymes than did women with intermediate and normal flora (P < 0.001). Women with higher concentrations of bacteria producing mucin-degrading enzymes were more likely to have a thin discharge associated with BV (P < 0.001). The viscosity of diluted vaginal fluid samples from women with BV was significantly lower than those from women with normal flora (P = 0.001). CONCLUSION: These data support the hypothesis that BV organisms degrade the protective mucus gel.     

What is normal vaginal flora?

OBJECTIVE: To observe the composition of the vaginal flora of healthy women over time, and in relation to hormonal changes, sexual activity, and hygiene habits. DESIGN: A longitudinal surveillance of the vaginal flora over an eight week period. SUBJECTS: 26 female health care workers in local genitourinary medicine clinics. METHODS: The participants were anonymised. They filled in diary cards daily. Blind vaginal swabs were self-taken two-seven times weekly. A smear was air-dried for later Gram staining. The swabs were also cultured for Candida spp, Gardnerella vaginalis, anaerobes, Mycoplasma hominis and Ureaplasma urealyticum. RESULTS: Of 26 subjects, only four had normal vaginal microbiology throughout. One woman, who was not sexually active, had bacterial vaginosis (BV) throughout and nine (35%) had intermittent BV. Candidiasis was found intermittently in eight women (31%), and eight had normal microscopy. U urealyticum was isolated intermittently in 40% of women with BV, 25% with candida, and 50% with normal microscopy. Many women were symptomatic, but symptoms correlated poorly with microbiological findings. All but two women were sexually active; however, more women with BV were exposed to semen. BV seemed to be related to frequent use of scented soap, and there appeared to be an additive effect of clothing and hygiene factors. CONCLUSIONS: Our study raises doubts about what should be regarded as normal vaginal flora. It calls into question the significance of finding BV or U urealyticum on a single occasion in asymptomatic women, or of finding normal flora in symptomatic women. The effect of external factors on the vaginal flora deserve further study.     

Vaginal douching and development of bacterial vaginosis among women with normal and abnormal vaginal microflora

OBJECTIVES: To evaluate the relationship between douching and bacterial vaginosis (BV) among women with and without prior abnormal vaginal flora. STUDY DESIGNS: 1193 women had vaginal swabs obtained for Gram stain for BV, culture for vaginal microflora, and DNA amplification for Neisseria gonorrhoeae and Chlamydia trachomatis at baseline and 6, 12, 24, and 36 months. Self-reported douching was queried every 6 months. RESULTS: In cross-sectional analyses, douching at least once per month was associated with BV among women who had BV at the immediately preceding visit but not among women with normal or intermediate flora. In prospective analyses, douching increased the risk of acquisition for BV among women with intermediate flora (adj. HR 1.5, 95% CI 1.1-2.4) but not among women with normal flora. CONCLUSIONS: Douching appeared to be associated with BV among women with already imbalanced flora but not among women with normal flora.     

Prevalence of bacterial vaginosis in lesbians and heterosexual women in a community setting

OBJECTIVES: High prevalence of bacterial vaginosis (BV) has been reported in lesbians but most studies were based in sexually transmitted infection clinic settings; therefore, we wished to determine the prevalence and risk factors of BV in lesbians and heterosexual women in a community setting in the UK. METHODS: A cross-sectional study recruiting lesbian women volunteers from community groups, events, clubs and bars. Heterosexual women were recruited from a community family planning clinic. They self-swabbed to create a vaginal smear, which was Gram-stained and categorised as BV, intermediate or normal flora. They completed a questionnaire about age, ethnic group, smoking, genital hygiene practices and sexual history. RESULTS: Of 189 heterosexuals and 171 lesbians recruited, 354 had gradeable flora. BV was identified in 43 (25.7%) lesbians and 27 (14.4%) heterosexuals (adjusted OR 2.45, 95% CI 1.25 to 4.82; p = 0.009). Concordance of vaginal flora within lesbian partnerships was significantly greater than expected (27/31 (87%) couples, kappa = 0.63; p<0.001). Smoking significantly increased the risk of BV regardless of sexuality (adjusted OR 2.65; p = 0.001) and showed substantial concordance in lesbian partnerships but less than for concordance of flora. CONCLUSIONS: Women who identified as lesbians have a 2.5-fold increased likelihood of BV compared with heterosexual women. The prevalence is slightly lower than clinic-based studies and as volunteers were recruited in community settings, this figure may be more representative of lesbians who attend gay venues. Higher concordance of vaginal flora within lesbian partnerships may support the hypothesis of a sexually transmissible factor or reflect common risk factors such as smoking.     

Longitudinal association between hormonal contraceptives and bacterial vaginosis in women of reproductive age

OBJECTIVES: This study examined whether hormonal contraceptive use is associated with diagnosis of bacterial vaginosis (BV) over 1 year.STUDY DESIGN: A total of 3,077 women of reproductive age were recruited from gynecologic and family planning clinics for a 1-year prospective longitudinal study. Data collected over 5 visits included demographics, health and hygiene behaviors, and gynecological exams. Gram stains were used to quantify vaginal flora.RESULTS: There was a decreased risk of overall BV prevalence among oral contraceptive users (odds ratio, OR 0.76; confidence interval, CI 0.63-0.90) and among those using hormonal injection/implant (OR 0.64; CI 0.53-0.76). An increased risk for BV prevalence (OR 1.38; CI 1.11-1.71) and incidence (OR 1.43; 1.02-2.07) was observed among those subjects who had tubal ligation. Greater remission of BV was found among those using hormonal injection or implant (OR 1.67; CI 1.23-2.27) whereas less remission occurred among those subjects who had tubal ligation (OR 0.56; CI 0.39-0.80).CONCLUSIONS: Hormonal contraceptive use is associated with a decreased risk of BV.     

A randomized, double-blind clinical trial of vaginal acidification versus placebo for the treatment of symptomatic bacterial vaginosis

BACKGROUND AND OBJECTIVES: Vaginal acidification has been suggested as a means of normalizing the vaginal flora. GOAL: The purpose of this study was to determine the effectiveness of an acetic acid-based vaginal gel in the treatment of bacterial vaginosis (BV). STUDY DESIGN: Forty-four patients with BV were enrolled in a randomized, double-blind clinic trial. Of these, 29 were evaluable. Patients were randomized to receive either 5 mL acetic acid gel (n = 14) or placebo gel (n = 15) intravaginally twice daily for 7 days. Clinical criteria and vaginal Gram stain scores were compared between the initial visit and at 2 weeks after initiating therapy. RESULTS: No significant differences were noted when comparing drug and placebo in terms of subjective or clinical improvement or improvement in Gram stain smears for bacterial vaginosis. CONCLUSION: Vaginal acidification with an acetic acid gel formulated to pH 3.9 to 4.1 was ineffective therapy for bacterial vaginosis.     

Bacterial vaginosis (BV) and the risk of incident gonococcal or chlamydial genital infection in a predominantly black population

OBJECTIVE: The objective of this study was to assess in prospective data whether bacterial vaginosis (BV) is associated with gonococcal/chlamydial cervicitis. STUDY: A total of 1179 women at high risk for sexually transmitted infections was followed for a median of 3 years. Every 6 to 12 months, vaginal swabs were obtained for Gram stain, culture of microflora, and Neisseria gonorrhoeae and Chlamydia trachomatis. A Gram stain score of 7 to 10 based on the Nugent criteria categorized BV. RESULTS: Baseline BV was associated with concurrent gonococcal/chlamydial infection (adjusted odds ratio, 2.83; 95% confidence interval [CI], 1.81-4.42). However, the association between BV and subsequent, incident gonococcal/chlamydial genital infection was not significant (adjusted relative risk [RR], 1.52; 95% CI, 0.74-3.13). Dense growth of pigmented, anaerobic Gram-negative rods (adjusted RR, 1.93; 95% CI, 0.97-3.83) appeared to elevate the risk for newly acquired gonococcal/chlamydial genital infection. CONCLUSIONS: BV was common among a predominantly black group of women with concurrent gonococcal/chlamydial infection but did not elevate the risk for incident infection.     

Bacterial vaginosis in women attending STD clinic: diagnostic criteria and prevalence of Mobiluncus spp.

The diagnostic criteria of bacterial vaginosis (BV) and the prevalence of Mobiluncus spp as detected by monoclonal antibodies were investigated in all new women patients attending the sexually transmitted disease (STD) clinic in Uppsala during a four month period. Of 455 patients, 164 fulfilled the generally accepted criteria for BV, but in 57 of them simultaneous infection with a recognised pathogen was diagnosed. BV was thus the only clinical diagnosis in 107 (24%) of the women. The sniff test and clue cells in the wet smear were the two criteria most relevant for the diagnosis of BV. The sniff test was positive in 95% (156) of the 164 patients with BV and negative in all other cases. The corresponding figure for the clue cells was 98% (160 of 164), but clue cells were also detected in 19 patients without BV. Though 99% (162) of women with BV had a vaginal pH of more than 4.5, so did 83 women without BV. Only 59% (96) of women fulfilling the criteria of BV had a characteristic discharge. Mobiluncus spp were present in 20% (90) of the 455 women and in 50% (53) of the 107 women with BV only. Of the 90 Mobiluncus spp isolates, M curtisii comprised 44% (40), M mulieris 34% (31), and both strains together 21% (19). Mobiluncus spp were detected with monoclonal antibodies in 35 women who had no motile curved rods on wet smear microscopy. Furthermore, Mobiluncus spp were often detected in women infected with recognised pathogens, as well as in a few women without signs of genital infection.     

Interrelationships of bacterial vaginosis and cervical inflammation.

BACKGROUND: Women with cervicitis frequently have bacterial vaginosis (BV). Prior studies have suggested that BV is involved in the pathogenesis of cervicitis. GOALS: To delineate the association of BV and cervicitis and to determine whether treatment of BV results in increased resolution of cervicitis. STUDY DESIGN: Women with clinically diagnosed cervicitis and BV received doxycycline and ofloxacin and were randomized to treatment with metronidazole gel or placebo. Resolution of BV and cervicitis was assessed. RESULTS: Metronidazole gel was associated with resolution of BV. Resolution of cervicitis was associated with use of metronidazole gel versus placebo (24/27 [88.9%] versus 15/24 [62.5%]; P = 0.03). When further stratified by resolution of BV, those whose BV resolved were more likely to have resolution of cervicitis than those with persistent BV. Although these trends persisted in multivariate analyses, they did not achieve statistical significance. CONCLUSION: Univariate analyses suggest an association between BV and cervicitis. An association between the use of metronidazole gel and resolution of cervicitis was demonstrated. Hypotheses regarding the latter include nonspecific antiinflammatory effects of metronidazole, its effect on BV flora, and its effect on a specific unrecognized pathogen.