Clinical diagnosis of bacterial vaginosis

Bacterial vaginosis (often called nonspecific vaginitis or gardnerella vaginitis) is an incompletely understood disease whose initial diagnosis is often one of exclusion made when no trichomonads, yeast, or evidence of cervicitis is found during the initial examination of a woman complaining of a vaginal discharge. To increase the accuracy of the initial diagnosis, specific criteria were used before the clinical diagnosis of bacterial vaginosis was made. The presence of three of the following four criteria was necessary: 1) vaginal pH greater than 4.5; 2) clue cells on the saline wet mount; 3) thin, homogeneous-appearing discharge; or 4) positive potassium hydroxide "whiff test." A study on 100 consecutive women presenting to the emergency department with vaginal symptoms was done. Of those women meeting the criteria, 93% (54/58) obtained relief of their symptoms by treatment with metronidazole. Of those women not meeting the criteria, only 24% (10/42) were cured (P less than .001). The sensitivity, specificity, and total error rates of these criteria were 84, 89, and 14%, respectively.     

Diagnosis and Treatment of Genitourinary Syndrome of Menopause

Genitourinary syndrome of menopause (GSM), formerly referred to as vulvovaginal atrophy or atrophic vaginitis, is a common chronic condition that requires a collaborative treatment plan between a health care provider and a woman to relieve symptoms and improve quality of life. Many women are not aware that symptoms can be controlled with treatment. Current treatment options approved for GSM include vaginal moisturizers, lubricants, and hormones. For women with GSM symptoms that are unresponsive to nonhormonal therapy, low-dose vaginal estrogen therapy is the preferred pharmacologic treatment. Clinicians should be trained to routinely ask appropriate questions during the history to elicit sufficient information to assess for GSM. Physical examination findings may further confirm suspicion of GSM.     

各种阴道炎的临床及实验室诊断特征分析

目的探讨各种阴道炎及混合感染的临床、实验室特征,为正确诊断各种阴道炎提供依据。方法通过对阴道不适、阴道分泌物异常阴道炎表现的就诊患者785例分析,结合其临床体征、症状及相关实验室检查,诊断阴道炎：即需氧菌性阴道炎（AV）、细菌性阴道炎（BV）、细菌溶解性阴道炎（溶胞性阴道炎CV）、阴道假丝酵母菌病（VVC）、滴虫性阴道炎（TV）。分析各种阴道炎及其混合感染诊断特征。结果各种阴道炎分泌物性状、气味、阴道PH值及清洁度有明显不同,其合并感染时亦显著不同,需仔细辨别。结论下生殖道感染中阴道炎的感染类别较多,易合并感染,应特别注意其诊断和鉴别诊断的特征,为临床诊断及合理用药提供重要依据。     

莫西沙星联合补充阴道用益生菌治疗需氧菌性阴道炎的疗效及对复发的影响

目的对莫西沙星联合补充益生菌治疗需氧菌性阴道炎（AV）的疗效及对复发的影响进行探讨。 方法以2020年2月~2021年3月枣庄市妇幼保健院妇科及生殖科、滕州市妇幼保健院妇科及生殖科就诊、经诊断为单纯需氧菌阴道炎的患者124例进行回顾性研究，根据治疗方法不同分为：莫西沙星治疗组共65例，莫西沙星治疗组联合阴道用乳杆菌胶囊59例。比较治疗前后2组患者pH值、AV评分及其白介素-8（IL-8）、白介素-1β（IL-1β）炎症指标。同时，比较2组患者症状情况缓解情况以及复发情况。 结果莫西沙星组和联合用药组2组治疗后的pH值、AV评分、IL-8、IL-1β均低于治疗前，其中联合用药组显著优于莫西沙星组，差异具有统计学意义（P＜0.05）。治疗后，2组患者具有临床症状的患者数量均下降，但2组有症状患者的比例差异无统计学意义（P＞0.05）。联合用药组治疗有效率为83.05%，显著高于莫西沙星组的67.69%（P＜0.05）。第二次随访时，莫西沙星组患者有7例发生了复发，联合用药组患者共2例发生了复发，2组比较复发率相近，差异无统计学意义（P＞0.05）。 结论莫西沙星联合使用阴道用益生菌胶囊可有效治疗需氧菌阴道炎，可降低AV评分和pH值，改善临床症状，为需氧菌阴道炎的治疗提供了新的思路。     

鹿寨县女性人群阴道分泌物检测结果分析

目的 了解鹿寨县女性人群阴道分泌物分布情况、阴道炎发病情况以及采取的相应预防措施.方法 对1 298例妇科门诊患者阴道分泌物采用CTB法做滴虫、念珠菌、纤毛菌、淋球菌、加特纳球杆菌检测,对其相关资料进行统计分析.结果 1 298例女性检出病原体523例,阳性率占40.29%.其中念珠菌222例,占首位(17.10%);其次加特纳球杆菌202例,占15.56%;毛滴虫、纤毛菌、淋球菌阳性者分别为43例(3.31%)、56例(4.31%)、1例(0.07%);清洁度以Ⅲ、Ⅳ为主,病原菌阳性率分别为60.09%、77.42%;二重感染以念珠菌+加特纳球杆菌为主,占51.28%;不同年龄组阴道炎发生率分别为22.13%、71.23%、60.13%、35.29%,20～39岁组念珠菌性阴道炎和细菌性阴道炎发生率最高,与其他组比较差异有统计学意义(P<0.05).结论 该地区女性常见阴道炎为念珠菌性阴道炎、细菌性阴道炎和非特异性阴道炎,以青壮年、围绝经期及绝经期女性多见,应加强对其开展健康教育.     

Bacterial Vaginosis: A Review of Treatment,Recurrence, and Disparities

Bacterial vaginosis recurrence is common, and although easily treated, it can quickly recur. This review details some of the identified biologic mechanisms that result in recurrence or treatment failure and also discusses other types of vaginitis that can co-occur, mimic bacterial vaginosis, or both, and advises the clinician on diagnosis and treatment. Bacterial vaginosis increases the risk for acquiring sexually transmitted infections, including human immunodeficiency virus, which is important to note because there are still significant racial disparities in the rates of new human immunodeficiency virus diagnosis between African American and white women. Adequately treating bacterial vaginosis may help to narrow this gap.     

Diagnosis and treatment of atrophic vaginitis

Up to 40 percent of postmenopausal women have symptoms of atrophic vaginitis. Because the condition is attributable to estrogen deficiency, it may occur in premenopausal women who take antiestrogenic medications or who have medical or surgical conditions that result in decreased levels of estrogen. The thinned endometrium and increased vaginal pH level induced by estrogen deficiency predispose the vagina and urinary tract to infection and mechanical weakness. The earliest symptoms are decreased vaginal lubrication, followed by other vaginal and urinary symptoms that may be exacerbated by superimposed infection. Once other causes of symptoms have been eliminated, treatment usually depends on estrogen replacement. Estrogen replacement therapy may be provided systemically or locally, but the dosage and delivery method must be individualized. Vaginal moisturizers and lubricants, and participation in coitus may also be beneficial in the treatment of women with atrophic vaginitis.     

1600例阴道炎的病原菌分析

目的探讨阴道炎感染情况及其病原菌分布状况,有利于对育龄妇女的健康教育。方法采用直接涂片和细菌培养等方法 ,对受检女性阴道分泌物进行病原菌检测。结果 2346例受检者中有1600例存在阴道炎,其病原菌的检出率为68.2%。其中细菌、真菌、滴虫的感染率较高,分别为24.4%、24.6%和16.9%。各年龄组间真菌和细菌的感染率差异无统计学意义(P0.05)。20～28岁和29～38岁年龄段妇女支原体和衣原体感染率显著高于其他年龄段,差异有统计学意义(P0.05)。结论阴道炎的感染率较高,病原菌呈多样性分布。计划生育和保健机构应加强对育龄妇女的健康教育,使其减少疾病,健康生活。     

Evaluating Vaginal Discharge: Distinguishing Normal Physiological Discharge,Vaginitis, and Cervicitis

Vaginal discharge is a common symptom that leads individuals to see a health care provider. Clinical evaluation by a health care provider helps distinguish between normal physiological discharge, vaginitis, and cervicitis. Carefully evaluating symptoms, performing a physical examination, and using office-based or laboratory testing assist in properly diagnosing the cause of vaginal discharge. Etiologies for vaginitis and cervicitis include noninfectious and infectious causes.     

Atrophic vaginitis: signs, symptoms, and better outcomes

Atrophic vaginitis is a common finding in women with low estrogen states. Many women believe their symptoms are expected signs of aging. NPs can provide therapeutic options to improve vaginal health and quality of life. This article reviews physiology, clinical manifestations, signs, symptoms, and treatment methods for atrophic vaginitis.     

纠正菌群失调在治疗孕妇复发性念珠菌性阴道炎的价值

目的:观察延华胶囊用于孕妇复发性念珠茼性阴道炎的疗效。方法:随机选取120例复发性念珠菌性阴道炎的妊娠妇女,采用达克宁栓治疗作为对照组(n=60),每天一次400mg阴道用药,连续14d,采用延华胶囊和达克宁栓联合治疗为治疗组(n=60),延华胶囊0.5g,1次/d阴道上药,连用7d.而后用达克宁栓400mg,1次/d阴道上药,连用7d,比较两组疗效。结果:治疗组治愈率为81.7％,对照组治愈率65％,两组治愈率比较差异有显著性,两组有效率分别为95％和83.3％,差异有显著性(P<0.05)。结论:延华胶囊和达克宁栓联合治疗孕妇复发性念珠菌性阴道炎有显著疗效。     

达克宁栓治疗孕期念珠菌性阴道炎疗效探讨

目的:探讨妊娠期念珠菌性阴道炎最佳治疗方法。方法:将定期产检的180例患病孕妇随机分三组。达克宁组,制霉菌素组和苏打水擦洗阴道组。同时观察三组的临床疗效。结果:达克宁组有效率93.33%(56例),制霉菌素组80.17%(49例),阴道擦洗组50.83%(35例)。三组疗效比较差异有显著性意义(P<0.05),达克宁组疗效最优。结论:达克宁栓阴道放药疗效显著,无明显副作用,孕妇易接受,方法简单,用药时间短,是治疗孕期念珠菌性阴道炎较佳的疗法。     

保妇康栓联合雌激素软膏治疗糖尿病性阴道炎的临床效果及对患者阴道微环境的影响

目的 研究保妇康栓联合雌激素软膏治疗糖尿病性阴道炎的临床效果及对患者阴道微环境的影响.方法 回顾性选取2018年1月至2020年1月本院收治的78例糖尿病性阴道炎患者作为研究对象,依据治疗方法将其分为雌激素软膏联合保妇康栓治疗组(联合治疗组)、雌激素软膏单独治疗组(单独治疗组),各39例.比较两组患者治疗前、后的阴道炎...     

壳聚糖妇科栓治疗念珠菌阴道炎、细菌性阴道病临床观察

目的：观察壳聚糖妇科栓治疗念珠菌阴道炎、细菌性阴道病的临床疗效。方法：126例念珠菌阴道炎随机分为观察组（63例）使用壳聚糖妇科栓治疗，对照组（63例）使用达克宁栓治疗；120例细菌性阴道病随机分为观察组（60例）使用壳聚糖妇科栓治疗，对照组（60例）使用甲硝唑栓治疗。比较治疗前后症状、体征、实验室检查情况。结果：壳聚糖妇科栓治疗念珠菌阴道炎、细菌性阴道病的有效率分别为90．2％、79．9％，与常规药物达克宁栓、甲硝唑栓的治疗效果差异无统计学差异（P〉0．05）。结论：壳聚糖妇科栓治疗念珠菌阴道炎、细菌性阴道病安全、有效，不易产生耐药性，易为患者接受，其优势在于无完善的实验室检查情况下，仍可对患者进行治疗。     

Evaluation and Management of Vaginitis

Vaginitis is a common concern for women across the lifespan. Vaginal symptoms may impact quality of life, and clinicians are challenged in the evaluation and management of bacterial vaginosis, Candida vaginitis, trichomoniasis, desquamative inflammatory vaginitis, and genitourinary syndrome of menopause.     

臭氧液阴道冲洗在治疗念珠菌阴道炎中的效果观察

[目的]研究臭氧液进行阴道冲洗在治疗念珠菌阴道炎中的效果。[方法]将300例念珠菌阴道炎病人随机分成实验组和对照组。实验组用臭氧液冲洗阴道并同时给予克霉唑泡腾片阴道塞药,每天1次,7 d为1个疗程;对照组不用臭氧液冲洗,余同实验组,两组病人治疗后停药5 d复查。[结果]实验组总有效率98.67%高于对照组94.67%。[结论]臭氧阴道冲洗辅助克霉唑泡腾片阴道塞药治疗念珠菌阴道炎效果好、疗效快。     

非淋菌性阴道炎支原体培养及药敏分析

目的 了解非淋菌性阴道炎患者支原体感染率与其对9种抗生素的敏感情况,以指导临床诊断和合理用药.方法 采集妇科门诊非淋菌性阴道炎患者阴道分泌物230例进行支原体培养及药敏实验.结果 230例标本中支原体感染率为49.1%,解脲脲原体(Uu)感染率为39.6%,人型支原体(Mh)感染率为3.0%,Uu和Mh混合感染率为6.5%;支原体对多西环素、米诺环素、克拉霉素和交沙霉素敏感性较高,对左氧氟沙星敏感性较低.结论 泌尿生殖系统支原体感染率高,四环素类可作为临床支原体治疗的首选药物.     

阴道炎患者阴道分泌物病原学检查结果分析

目的了解大连地区女性阴道炎患者阴道分泌物病原体分布及药敏情况,为该病的诊治提供依据。方法对5 308例阴道炎患者的阴道分泌物常规及病原体检查结果进行统计分析。结果 5 308例阴道炎患者阴道分泌物常规检查发现,细菌性阴道炎810例,占15.3%,念珠菌阳性1 110例,占20.9%,滴虫阳性60例,占1.1%。其中3 526例进行了病原体检查,共检出病原体2 615株,包括支原体1 948株,占74.5%;衣原体136株,占5.2%;淋病奈瑟菌17株,占0.7%;念珠菌276株,占10.6%;革兰阳性球菌140株,占5.4%;革兰阴性杆菌98株,占3.7%。解脲脲原体对氧氟沙星、左氧氟沙星、司帕沙星、罗红霉素的敏感率较低,分别为7.8%、18.2%、26.3%、27.2%,对克拉霉素、多西环素、米诺环素的敏感性较高,分别为89.4%、99.8%、99.9%。人型支原体耐药性较强,较为敏感的抗菌药物仅有交沙霉素、多西环素和米诺环素,敏感率分别为75.3%、96.2%、97.3%,其余抗菌药物敏感率均小于7.0%。白色念珠菌对抗真菌药物普遍敏感。金黄色葡萄球菌对常用抗菌药物敏感性较高。24株无乳链球菌对青霉素全部敏感。未发现对达托霉素、利奈唑胺、万古霉素耐药的革兰阳性球菌。未发现对亚胺培南、美罗培南耐药的革兰阴性杆菌。结论引起阴道炎的病原体种类复杂,治疗女性阴道炎时,应根据病原体检查结果及药物敏感试验,合理选用抗菌药物。     

阴道炎五联检联合显微镜检查对常见阴道病的诊断价值

目的：探讨阴道炎五联检联合显微镜检查对常见阴道病的诊断及鉴别诊断价值。方法对4114例门诊患者阴道分泌物标本,分别用 LTS-V400阴道炎检测系统（五联检）与常规盐水涂片显微镜检查,并比较各年龄组常见阴道病患病率差异。结果在4114例标本中,滴虫阳性39例（0．95％）,真菌阳性195例（4．74％）,后者阳性率高于前者,差异具有统计学意义（P ＜0．05）。＞40～50岁年龄组滴虫、真菌、N-乙酰基-β-氨基半乳糖苷酶（NAG）、唾液酸酶（SNA）、白细胞酯酶（LE）阳性检出率最高（分别为1．95％、6．10％、14．15％、10．24％和46．34％）,＞50岁年龄组 H2 O2、pH ＞4．5和 pH ＜3．8阳性检出率最高（分别为85．43％、86．09％和0．66％）。其中滴虫、SNA、LE、H2 O2、pH＞4．5和 pH＜3．8的阳性检出率在不同年龄组差异均有统计学意义（P ＜0．05）。结论阴道炎五联检联合常规盐水涂片显微镜检查有助于滴虫性阴道炎、真菌性阴道炎及细菌性阴道病的诊断与鉴别诊断。     

妊娠期阴道内环境的改变与霉菌性阴道炎发病率的相关性研究

目的 探究妊娠期妇女阴道内环境的改变是否与妊娠期霉菌性阴道炎的发病有关。 方法 选取妇产科门诊2011年7月－2012年7月诊断的孕早期妇女166例（不包括已患有霉菌性阴道炎的患者）,选取阴道内环境改变的2个重要指标阴道内pH值及乳杆菌的量来判断是否为阴道内环境改变,采用前瞻性研究的方法,通过检查其阴道内环境是否改变而分组,其中阴道内环境改变组96例,阴道内环境正常组70例;pH值≤4.0组67例,pH值＞4.0组99例;乳杆菌减少组58例,乳杆菌正常组108例。计算每组霉菌性阴道炎的发病率。 结果 pH值≤4.0者发病率为17.9%（12/67）,pH值＞4.0者的发病率为6.1%（6/99）,两组差异有统计学意义（χ2=5.804,P=0.016）;乳杆菌减少者发病率25.9%（15/58）,乳杆菌正常者发病率2.8%（3/108）,两组差异有统计学意义（χ2=20.800,P=0.000）;阴道内环境改变者发病率16.7%（16/96）,阴道内环境正常者发病率2.9%（2/70）,两组差异有统计学意义（χ2=7.985,P=0.005）。在乳杆菌正常的妊娠期妇女中,pH值是否降低与霉菌性阴道炎的发病无关（χ2=0.000,P=1.000）。 结论 妊娠期阴道内环境改变（pH值降低及乳杆菌下降）与霉菌性阴道炎发病率相关,可针对此现象进行妊娠期霉菌性阴道炎的防治。