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.     

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。     

阴道炎性疾病治疗的过度与不足

阴道炎性疾病是妇科门诊的常见疾病,包括外阴阴道假丝酵母菌病、滴虫阴道炎、细菌性阴道病、需氧菌性阴道炎、阴道混合感染等。在临床工作中存在由于诊断不确切或对诊治规范理解不透彻,或者对混合感染认识不足,而导致不同程度的过度治疗和治疗不足。文章对常见的阴道炎性疾病治疗过度与不足的原因及如何预防进行了探讨。     

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。     

混合性阴道炎诊治专家共识(2021版)

混合性阴道炎是由两种或两种以上的致病微生物导致的阴道炎症,在临床上比较常见,其较单一阴道炎症诊治困难,且常伴随着复杂阴道微生态环境的存在。本专家共识针对4种常见的阴道炎症(细菌性阴道病、阴道毛滴虫病、外阴阴道假丝酵母菌病和需氧菌性阴道炎)而制定。混合性阴道炎有症状不典型、病程较长和易复发等特点。诊断时多采用阴道微生态检测方法,诊断要点:(1)同时存在至少两种病原体或同时满足两种或以上阴道炎症的诊断标准;(2)同时存在两种或以上阴道炎症相应的症状和体征,需要同时药物治疗。治疗目标为采用综合性用药方案,杀灭病原体,保护阴道有益菌群并增强其功能。治疗原则为针对不同病原,选择规范的抗菌药物,尽量减少不必要的抗菌药物的使用;建议除了对于各种感染的治疗外,强调对于阴道微生态失调的纠正。     

细菌性阴道病快速检测结果分析

目的:了解来院就诊患者细菌性阴道病的情况。方法:分泌物涂片革兰氏染色法观察霉菌、滴虫,细菌性阴道病(BV)快速检测卡判断细菌感染情况。结果:观察1500例妇科就诊患者中细菌性阴道病(BV)阳性占42.3%,霉菌阳性占12.6%,滴虫阳性占2.6%。结论:细菌导致的阴道炎症在阴道炎中占主要的比例,高于霉菌和滴虫。利用细菌性阴道病联合检测卡可以快速做出诊断,并为临床正确用药提供依据。     

高危型人乳头瘤病毒与女性下生殖道感染联合检测专家共识

女性下生殖道感染是妇科常见疾病,包括阴道炎和子宫颈炎。常见的下生殖道感染包括：细菌性阴道病、需氧菌性阴道炎、外阴阴道假丝酵母菌病、阴道毛滴虫病以及由淋病奈瑟菌、衣原体、支原体等引起的子宫颈炎等。     

纳米银妇女外用抗菌凝胶治疗细菌性阴道炎78例临床分析

目的:应用纳米银妇女外用抗菌凝胶治疗细菌性阴道病,探讨其疗效及作用机理。方法:选择妇科门诊就诊的细菌性阴道炎患者150例,实验组78例采用纳米银妇女外用抗菌凝胶,对照组72例采用甲硝唑凝胶治疗。结果:实验组和对照组总有效率分别为100%、91.67%,两组比较差异有统计学意义(P0.01),纳米银妇女外用抗菌凝胶治疗细菌性阴道炎疗效优于对照组。结论:纳米银妇女外用抗菌凝胶治疗细菌性阴道病,疗效显著。     

国产硝呋太尔制霉素阴道软胶囊治疗阴道炎的临床研究

目的 评价国产硝呋太尔制霉素阴道软胶囊治疗滴虫性阴道炎、细菌性阴道病、外阴阴道念珠菌病的临床疗效和安全性。方法 随机盲法平行对照多中心临床试验，进口麦咪康帕阴道栓为对照药。结果 有效病例为滴虫性阴道炎62例、细菌性阴道病65例、外阴阴道念珠菌病65例，各适应证的试验组及对照组受试者的临床症状、体征及妇科实验检查在用药前后均有明显改善（P〈0．01），各适应证的总有效率为90．0％～96．8％，试验组与对照组的疗效相似（P〉0．05），无严重不良事件发生，对肝肾功能血尿常规等均无影响，仅个别患者有轻微的阴道局部的刺激症状。结论 临床试验结果提示，国产硝呋太尔制霉素阴道软胶囊是一种可供选择的、能用于治疗细菌性阴道病、滴虫性阴道炎及外阴阴道念珠菌病的阴道局部药物。     

各种阴道炎的实验室检查

多种病原体可引起女性生殖道感染,常见的病原体有:真菌、寄生虫、病毒、衣原体、支原体、原虫、细菌等。涉及的疾病有:阴道假丝酵母菌病、滴虫阴道炎、细菌性阴道病等常见病;也包括淋病、尖锐湿疣、生殖器疱疹等经典的性病。在这些阴道炎的病原诊断和临床治疗中,准确、及时的实验室检查具有十分重要的作用,有时具有决定的意义。一般而言阴道炎取材方便,但选择实验室检查的项目则需因病而异。1　常规涂片检查假丝酵母菌阴道病、滴虫阴道炎、细菌性阴道病等为最常见的阴道炎症,取阴道分泌物涂片检查是最常用、最方便且有效的实验检查方法…     

蓝氧妇科生殖道康复治疗仪治疗阴道炎100例

目的：观察蓝氧妇科生殖道康复治疗仪治疗阴道炎的,临床疗效。方法：使用蓝氧妇科生殖道康复治疗仪对100例阴道炎患者进行治疗。结果：100例阴道炎患者中,一次性治愈98例,治愈率98％,好转2例,经二次治疗痊愈。结论：应用蓝氧妇科生殖道康复治疗仪,治疗女性阴道炎,疗效明显,缩短用药疗程,提高治愈率并且安全经济、无毒副作用,是临床上值得推广的治疗方法。     

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.     

兴文县12613例妇女病普查结果分析

目的：了解本县妇女病患病情况,加强妇女病普查普治,制定有效的干预措施。方法：对2013年6—11月份我县12613例妇女病普查结果进行回顾性分析。结果：妇女病普查率10．63％,以生殖道感染为首住。妇女常见病前3位是：宫颈炎占48．26％、阴道炎占28．31％,乳腺疾病占23．88％。结论：妇女病普查率低,加强妇女病普查普治工作,加强健康教育,增强妇女自我保健意识,对降低疾病的患病率,促进妇女身体健康有重要意义。     

不同微生物检验方法对妇科念珠菌阴道炎患者阴道分泌物检验的效果

目的 分析不同微生物检查方法对妇科念珠菌阴道炎患者阴道分泌物检验的效果.方法 选取198例疑似妇科念珠菌阴道炎患者,均取阴道分泌物先后开展涂片镜检法和真菌培养法,以病理结果作为金标准,对比两种微生物检验方法对妇科念珠菌阴道炎的诊断准确性、敏感性、特异性,并分析检测时间、误诊率和漏诊率.结果 病理结果显示阳性80例,阴性...     

阴道微生态的临床研究及意义

目的:研究人群的阴道微生态状况,为阴道炎症的防治提供新思路。方法:采用整群二级抽样方式,随机抽取313例符合条件的育龄妇女进行调查及阴道微生态检测(其中阴道炎症74例),采用成组病例对照法进行分析。结果:阴道微生态失调者阴道pH值4.4,明显高于阴道微生态正常者4.0(t=6.3581,P<0.01),但并未超出阴道正常酸性环境范围;各类阴道炎症患者的阴道pH均值增高更为明显(P均<0.01),且均超出了阴道正常的酸性环境范围。微生态失调者阴道乳杆菌和H2O2(+)检出率均明显低于微生态正常者(P均<0.01),而阴道炎症者此两项指标降低更为明显(P均<0.01),且阴道炎症患者乳杆菌检出率明显低于无阴道炎症妇女(27.0%vs74.9%,P<0.01)。阴道乳杆菌检出率降低幅度越大,患常见阴道炎症的相对危险度就会越高(P均<0.01)。结论:阴道pH值升高可作为阴道微生态异常状况的预警信号;阴道乳杆菌检出率可作为阴道健康状况的监测指标或阴道炎症治疗后的康复指标。     

Efficacy and tolerance of metronidazole and miconazole nitrate in treatment of vaginitis.

OBJECTIVE: To evaluate the efficacy and tolerability of a vaginal pessary containing 750 mg of metronidazole and 200 mg of miconazole nitrate used daily for 7 days in the treatment of vaginitis. METHODS: Ninety-two women with vaginitis participated in this phase 3 study using one vaginal pessary daily for 7 days. Gynecological and microbiological evaluations were carried out prior to and following treatment. RESULTS: Reductions occurred in symptoms and signs of vaginitis. Clinical cure rate was 87.7%, while the cure rates according to microscopy and Candida albicans culture were 81.8% and 73.9%, respectively. The cure rate for bacterial vaginosis was 75% and culture of Gardnerella vaginalis turned negative in 63.6% of cases following treatment. The medication was well tolerated. CONCLUSION: Use of a combination of 750 mg of metronidazole and 200 mg of miconazole in a single daily application was found to be effective in the treatment of the most common causes of vaginitis.     

Clinical evaluation of affirm VPIII in the detection and identification of Trichomonas vaginalis, Gardnerella vaginalis, and Candida species in vaginitis/vaginosis

OBJECTIVE: To compare the Affirm VPIII Microbial Identification Test for detection and identification of Candida species, Gardnerella vaginalis and Trichomonas vaginalis to clinical and microscopic criteria commonly used to diagnose vaginitis. METHODS: Women that were symptomatic for vaginitis/vaginosis and asymptomatic women being seen for routine obstetric or gynecological care were included in this study. Women treated with antibiotics or antifungals within one week or women who had douched within 24 hours were excluded. Two vaginal swab specimens were simultaneously obtained from each patient, one swab was placed in sterile physiological saline for immediate microscopic wet mount examination and KOH testing. The other swab was placed in the Affirm collection tube for Affirm VPIII testing based on previously demonstrated methods. RESULTS: The Affirm assay was significantly more likely to identify Gardnerella and Candida than wet mount. 190 (45%) were positive for Gardnerella by Affirm compared to 58 (14%) by wet mount; 45 (11%) were positive for Candida by Affirm compared to 31 (7%) by wet mount; and 30 (7%) were positive for Trichomonas by Affirm compared to 23 (5%) by wet mount. Symptomatic women were significantly more likely to be positive by Affirm only (23% vs. 10%), wet mount only (3% vs. 2%) or Affirm and wet mount (15% vs. 1%). Asymptomatic women were significantly more likely to be negative for Affirm and wet mount (43% vs. 5%). CONCLUSIONS: The Affirm VPIII test is a more sensitive diagnostic test for detection and identification of symptomatic vaginitis/vaginosis than conventional clinical examination and wet mount testing.     

Treatment of atrophic vaginitis with topical conjugated equine estrogens in postmenopausal Asian women.

OBJECTIVE: We investigated the effects of 2 months of treatment with topical estrogens on atrophic vaginitis and gynecological health in Asian women. STUDY DESIGN: Multicenter, open-label trial of 150 postmenopausal women age <70 years with atrophic vaginitis. Women applied conjugated equine estrogens (CEE) vaginal cream (0.625 mg/g) once daily on days 1-21 of two 28-day cycles. Changes in the vaginal maturation index (VMI) from baseline to days 21 (month 1) and 49 (month 2) were the primary outcome. Physiological changes were assessed by the Genital Health Clinical Examination (GHCE). RESULTS: The VMI was significantly improved (p < 0.001) from baseline at each assessment period. The significant improvement in GHCE from baseline after 1 month (p < 0.001) was maintained at 2 months. CONCLUSIONS: Vaginal treatment with CEE cream for 21 days of two consecutive 28-day cycles resulted in beneficial changes in the vaginal tissues and induced an overall genital health pattern more characteristic of the premenopausal state.