常见阴道感染的抗生素应用

阴道感染性疾病是妇科常见病,规范治疗将有助于提高疾病治愈率,减少复发,提高患者生存质量。文章总结了滴虫阴道炎、外阴阴道假丝酵母菌病、细菌性阴道病、萎缩性阴道炎、需氧菌阴道炎及阴道混合感染6种常见阴道感染性疾病的抗生素规范治疗方案。     

阴道混合感染研究进展

阴道感染性疾病是常见的妇科疾病,根据病因可分为十余种,其中以细菌性阴道病、外阴阴道假丝酵母菌病、滴虫性阴道炎、需氧菌性阴道炎、萎缩性阴道炎最为常见。随着对阴道炎症认识的深入,混合感染逐步引起人们的重视。阴道混合感染是由两种或两种以上病原体引起的阴道感染,病原体都可造成异常的局部环境而引起相应的症状和     

细菌性阴道病的诊断与治疗

细菌性阴道病的诊断与治疗中山医科大学孙逸仙纪念医院（５１０１２０）冯华英邝健全细菌性阴道病（ｂａｃｔｅｒｉａｌｖａｇｉｎｏｓｉｓ，ＢＶ）是由阴道加德纳菌（Ｇａｒｄｎｅｒｅｌａ）与某些厌氧菌混合感染引起的，曾称非特异性阴道炎（ｎｏｎｓｐｅｃｉｆｉｃｖａ...     

念珠菌外阴阴道炎的诊断

念珠菌外阴阴道炎是常见的妇科炎性疾病。一般认为阴道念珠菌可分为两种情况 ,一种为无症状的带菌者或称为阴道寄居 ,一种为有症状的阴道炎。最近有人提出外阴阴道念珠菌病这个名词 ,外阴阴道念珠菌病包括无症状的阴道寄居及有症状的阴道炎 ,同时强调了外阴念珠菌感染。念珠菌外阴阴道炎一般以阴道为主 ,可同时合并外阴炎 ,但偶尔可见到念珠菌外阴炎单独存在。大多数念珠菌外阴阴道炎的症状、体征典型 ,容易作出诊断 ,对症状及体征不典型者 ,诊断较困难。念珠菌外阴阴道炎要根据有无诱发因素、临床表现、实验室检查而作出诊断。1　诱发因素…     

女性生殖道感染的诊断与处理

主要讨论内容:1·女性生殖道微环境与生殖道感染2·滴虫性阴道炎的诊断与治疗3·外阴阴道假丝酵母菌病的诊断与治疗4·细菌性阴道病的诊断与治疗5·宫颈炎症的诊断与治疗6·盆腔炎性疾病的诊断与治疗7·女性生殖道衣原体和支原体感染8·女性生殖道感染的病征处理薛凤霞教授生殖道感染(reproductive tract infection,RTI)是妇产科常见的感染,WHO给予的定义是由正常存在于生殖道的微生物或外界微生物在医疗操作中或在性接触中进入生殖道引起的感染。生殖道感染是个广义的概念:包括内源性、医源性感染和性传播感染(sexual transmitted infec…     

细菌性阴道病的诊治及相关问题

细菌性阴道病（bacterial vaginosis,BV）为阴道正常菌群失调导致的厌氧菌混合感染。既往也称为非特异性阴道炎、嗜血杆菌阴道炎、棒状杆菌阴道炎和加德纳氏菌阴道炎。Gardner和Duke在1955年首先描述了本病的临床特点和特征性的线索细胞（cluecell）。1984年在瑞典召开的国际学术会议上正式命名为细菌性阴道病。     

细菌性阴道病的治疗进展

细菌性阴道病曾有过多种名称，包括非特异性阴道炎，加德纳杆菌性阴道炎，厌氧性阴道炎等，1984年在瑞典召开的专题国际学术会议上决定使用细菌性阴道病名称。该病是生育年龄妇女最常见的阴道感染，国内资料显示细菌性阴道病占外阴、阴道感染的40％～50％，是阴道感染性疾病中发病率最高的，远多于阴道滴虫和霉菌感染，即使保守估计，我国细菌性阴道病患者也多达数千万人。     

混合性阴道炎的诊治辨析

混合性阴道炎指同时存在至少两种病原体分别或协同地造成阴道异常的局部环境,从而引起相应的临床症状和体征。在临床工作中存在着对混合性阴道炎认识不足,从而导致诊断不确切,引发不同程度的过度治疗和治疗不足。关于混合性阴道炎的诊断应紧扣各自阴道炎的诊断标准来综合判断,进而针对性用药。     

常见阴道感染对精子的影响北大核心CSCD

目前全世界有超过8000万不孕不育患者,其中女性生殖道感染导致的不孕不育已引起高度重视[1]。育龄期女性常见的阴道感染包括细菌性阴道病(BV)、需氧菌性阴道炎(AV)、阴道毛滴虫病(TV)和外阴阴道假丝酵母菌病(VVC),若不及时治疗,可导致严重的并发症,如流产、早产、胎膜早破、绒毛膜羊膜炎、盆腔炎性疾病等[2]。阴道感染不仅可引起局部炎性反应、免疫应答、氧化应激及细胞毒性因子的过度表达,而且还可经性接触感染男性泌尿生殖道,进而通过不同的机制对精子的质量参数(如浓度、运动、活力、形态)、膜结构及功能完整性、DNA片段和染色体整合产生不利影响,严重时可导致精子死亡[3],这些病理性改变与女性不孕及不良胚胎质量有关[3-4]。本文主要围绕常见阴道感染的致病菌对精子的不利影响进行综述。     

常见阴道炎症的治疗进展

阴道炎症是妇科常见病,约占妇科门诊患者的1／3左右,最常见的有滴虫性阴道炎,外阴阴道假丝酵母菌病。细菌性阴道病及萎缩性阴道炎。临床上约50％以上的阴道炎为混合性感染。规范阴道炎症的治疗,对提高治愈率,降低复发率具有重要意义。阴道炎症的治疗,除选择适当抗生素外,还需注意阴道微生态的平衡。     

2 066例妇女阴道微生态失调构成情况分析

目的：了解妇科门诊妇女阴道微生态平衡失调者白带异常检出率、构成比和年龄分布情况。方法：收集2009年11月—2010年1月在中南大学湘雅二医院妇科门诊就诊的有明显症状妇女的阴道分泌物,采用革兰染色及阴道pH试纸方法检测,同时以问卷方式采集受试者基本资料,并进行相应的统计学处理。结果：4 025例患者中有2 066例白带检测异常,总检出率为51.33%,其中外阴阴道假丝酵母菌病占28.99%,细菌性阴道病占8.57%,滴虫性阴道病为2.03%,混合性阴道炎为0.48%,未定义及未分类的阴道微生态失调为59.92%。阴道微生态失调妇女各年龄构成中＜21岁组为2.4%,21～岁组为32.7%,31～岁组为38.2%,41～岁组为21.7%,＞50岁组为5.0%。各种阴道微生态失调的中位数年龄中除混合性阴道炎位于21～30岁,其他均位于31～40岁。结论：阴道微生态平衡失调中外阴阴道假丝酵母菌病构成比明显高于细菌性阴道病、滴虫性阴道炎及混合性阴道炎。外阴阴道假丝酵母菌病、细菌性阴道病、滴虫性阴道炎及混合性阴道炎均好发于生育期年龄女性。除上述阴道炎症外,尚有大部分阴道微生态失调需要定义。     

需氧菌性阴道炎及其混合感染的临床特征分析

目的 探讨需氧菌性阴道炎(AV)及其混合感染的临床特征,为AV的临床诊治提供帮助.方法 2008年4-12月,在天津医科大学总医院选取以外阴不适、阴道分泌物异常等阴道炎症状就诊的患者516例,联合其症状、体征及相关实验室检查诊断常见阴道炎,即AV、细菌性阴道病(BV)、外阴阴道假丝酵母菌病(VVC)、滴虫阴道炎(TV),分析AV及其混合感染的临床特征.结果 516例患者中,AV 76例,占14.7%(76/516),北中混合感染44例,占58%(44/76).在44例AV混合感染中,以合并BV多见,占45%(20/44);其次为合并VVC,占30%(13/44);合并TV占25%(11/44).单纯AV患者的常见症状主要为黄绿色稀薄脓性阴道分泌物(63%,20/32),其次为阴道分泌物增多(44%,14/32);阴道pH值常>4.5(84%,27/32),清洁度主要为Ⅲ～Ⅳ度(88%,28/32);细菌培养为粪肠球菌(6例)、链球菌(4例)等需氧菌.结论 AV是常见的下生殖道感染,易合并其他病原体感染,尤以合并BV、VVC及TV多见,混合感染时症状、体征不典型.在AV诊断中,注意有无合并其他阴道感染,并在诊断其他阴道感染时,注意是否合并AV.     

Clinical characteristics of aerobic vaginitis and its mixed infections

OBJECTIVE: To investigate clinical characteristics of aerobic vaginitis (AV) and its mixed infections for diagnosis efficiently. METHODS: From April 2008 to December 2008, 516 patients with vaginitis treated in Tianjin Medical University General Hospital were enrolled in this study. AV, bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), trichomonal vaginitis (TV), and cytolytic vaginosis (CV) were diagnosed based on symptoms, sign and vaginal discharge examination. RESULTS: Among 516 cases, AV cases were found in 14.7% (76/516), and AV was common vaginal infection. AV mixed infections was diagnosed in 58% (44/76), including mixed with BV (45%, 20/44), mixed with VVC (30%, 13/44), and mixed with TV (25%, 11/44). Those common symptom of AV were yellow vaginal discharge (63%, 20/32), more vaginal discharge (44%, 14/32). Vaginal pH value was usually more than 4.5 (84%, 27/32). Vaginal cleanliness mainly was grade III - IV (88%, 28/32). Six cases with enterococcus faecium and 4 cases with streptococci were frequently isolated. The symptom and sign of mixed AV infection was atypical. CONCLUSIONS: Aerobic vaginitis is a common lower vaginal infection and easily mixed with other pathogens, especially with BV, VVC or TV. When patients were diagnosed with AV or other vaginal infection, it should be mentioned whether those patients have mixed vaginal infection or AV.     

32 046名妇科门诊女性阴道微生态分布情况分析

Objective?To analyze the distribution and characteristics of female vaginal micro-ecology in gynecological clinic. Methods?From January 2015 to February 2020, 32 046 female outpatients were selected to conduct a retrospective analysis of the results of vaginal micro-ecology. Results?The vaginal micro-ecology of 2 790 patients(8.71%) was normal; however,the other 29 256 patients (91.29%) were abnormal, which including simple vaginitis in 7 417 cases(7 417/32 046, 23.14%) and the mixed vaginitis in 3 085 cases (3 085/32 046, 9.63%). The bacterial vaginosis (BV) occupied for 9.29%(2 976/32 046),which is the most common type among the simple vaginitis. The vulvovaginal candidiasis (VVC) occupied for 8.93%(2 863/32 046). Mixed vaginitis is given priority to BV and AV infection (2 016/32 046, 6.29%),followed by BV and VVC(649/32 046,2.03%). Vaginitis is closely related to age,the difference is statistically significant (P＝0.00). Conclusion?Vaginal evaluation system has outstanding advantages in the diagnosis of vaginitis, and can improve the diagnosis rate of mixed vaginitis.     

Desquamative inflammatory vaginitis: what is it?

OBJECTIVE: To record the inflammatory patterns found in desquamative inflammatory vaginitis and to investigate further the existence of an idiopathic subset of this condition. STUDY DESIGN: This was a retrospective case note study of 11 women over a 12-month period who presented with symptoms of painful sexual intercourse and increased vaginal discharge. RESULTS: Examination of the vulva was usually normal or showed mild erythema and a thin purulent discharge. Examination of the vaginal wall showed erythema consistent with inflammation. A biopsy from the vaginal wall showed essentially 2 patterns of inflammation: either a lichenoid or a nonspecific mixed inflammatory infiltrate. Therapy with clindamycin and clobetasone propionate was largely effective. CONCLUSION: While this study does not fully answer the histology of desquamative inflammatory vaginitis, it does highlight the need for further study to identify whether there is an idiopathic subset of desquamative inflammatory vaginitis or whether it is erosive lichen planus.     

Expansion of altered vaginal flora states in vaginitis to include a spectrum of microflora

OBJECTIVE: To define the existence of 2 patterns of altered vaginal flora in symptomatic women identified on wet preparations that are not in the current vaginitis classification system. STUDY DESIGN: Testing of vaginal secretions from gynecologic patients at Mayo Clinic, Scottsdale, Arizona, who presented with vulvo-vaginal symptoms by vaginal pH, whiff testing, and saline and potassium hydroxide wet preparations. Over 14 years, approximately 5,000 samples were analyzed. Wet preparations were analyzed under low- (x 100) and high-power (x 400) phase-contrast microscopy. RESULTS: The first pattern has mixed bacteria with few or no lactobacilli, increased leukocytes and elevated pH. This pattern has a spectrum of severity, with the severe form meeting the diagnostic definition of desquamative inflammatory vaginitis. The mild-to-moderate form, termed inflammatory vaginitis, falls outside established diagnostic categories. The second pattern also has a spectrum of severity. The mild-to-moderate form, termed noninflammatory vaginosis, has mixed bacteria speckling squamous cells (but not obscuring edges), few or no lactobacilli, no leukocyte response and mildly elevated pH. This form differs from the severe form, which meets Amsel's criteria for bacterial vaginosis. CONCLUSION: The current classification system requires revision because it oversimplifies and ignores the full spectrum of altered vaginal microflora.     

女性阴道混合感染246例临床分析

目的通过微生态的检查,全面评估女性阴道混合感染的微生态状况,为临床诊断治疗提供良好的依据。方法 2009年11月至2010年2月,选择在北京大学第一医院妇科门诊就诊的246例阴道炎患者,观察患者的症状、体征及阴道分泌物pH值,经革兰染色后,在油镜下观察,进行阴道微生态(阴道菌群、乳杆菌分级、需氧菌和炎性反应等)状况评分。结果 246例患者中,单一感染143例(58.1%),混合感染103例(41.9%),细菌性阴道病(BV)+需氧菌阴道炎(A V)者57例(55.3%);外阴阴道假丝酵母菌病(VVC)+A V者25例(24.3%);滴虫阴道炎(TV)+AV者15例(14.6%);VVC+BV+AV者5例(4.9%),AV+单纯疱疹病毒(HSV)感染者1例(1.0%)。混合感染患者发生阴道灼痛(86.4%,89/103)增加,清洁度Ⅲ度(40.8%,42/103)、pH值偏高(pH值5.0者,20.4%,21/103),乳杆菌减少(乳杆菌Ⅲ者,64.1%,66/103)等,与单一感染患者比较,差异均有统计学意义(P0.05)。结论阴道混合感染的发生率很高,微生态检查是诊断中非常重要的手段。     

阴道微生态变化与宫颈人乳头瘤病毒感染的相关性研究进展

阴道微生态是一个独特、动态变化的灵敏体系,易受内源性和外源性因素的影响,由阴道微生物菌群、阴道解剖结构、局部免疫及机体的内分泌调节功能构成,核心是微生物菌群,优势菌是乳酸杆菌。研究认为阴道微生态的改变与人乳头瘤病毒(human papillomavirus,HPV)感染有一定的相关性,本文就阴道微生态失衡导致常见阴道炎如需氧菌性阴道炎、细菌性阴道炎、滴虫性阴道炎、外阴阴道假丝酵母菌病与宫颈HPV感染相关性进行阐述。