细菌性阴道病诊断方法的研究进展

细菌性阴道病是导致育龄期妇女白带异常的常见原因,未经治疗或治疗不及时可致多种并发症.目前细菌性阴道病病因尚不明确,诊断以Amsel临床标准或Nugent评分法为主,但均存在主观性较强、费时费力、需要有相应知识的技术人员操作的缺点.近年来对细菌性阴道病快速检测及分子生物学诊断研究有了较大进展,主要以细菌定量为诊断依据,尚需进一步检验其诊断效能,尚未广泛应用于临床.     

细菌性阴道病病因学研究进展

细菌性阴道病是育龄期妇女最常见的阴道感染性疾病。在过去的50年中已经发现多种能够引发BV的危险因素。然而,由于BV的复杂性以及缺乏可靠的动物模型,其病因至今为止仍不清楚。本文综述了BV病因学主要理论的进展:BV相关生物膜、正常阴道微生物群和宿主的免疫反应,BV是多种因素相互作用的结果。近年来有报道BV菌群对甲硝唑的耐药,BV的复发率也在不断增高,了解各种因素在BV的发病中的作用对于预防和治疗都有着重要作用。     

Prevalence of bacterial vaginosis in adolescent girls

The age-related increase in the prevalence of bacterial vaginosis was determined in adolescent virginal and sexually active girls aged 13 to 18 years. Higher rates were recorded for girls with two or more sexual partners. Considering the potential spectrum of consequences of bacterial vaginosis, preventive strategies are required in this age group, not only for bacterial vaginosis but also for other sexually transmitted diseases.     

Treatment of bacterial vaginosis with lactobacilli.

60 women with bacterial vaginosis were entered into a double blind, placebo-controlled treatment trial with lyophilized Lactobacillus acidophilus. The lactobacilli used were producing H2O2. Immediately after completion of treatment, 16 out of 28 women who were treated with lactobacilli had normal vaginal wet smear results, in comparison to none of the 29 women treated with placebo. All women harboured Bacteroides at inclusion. Bacteroides was eliminated from the vagina of 12 out of 16 healthy women after treatment. Only three of the women who received the Lactobacillus suppository were free of bacterial vaginosis after the subsequent menstruation.     

Personal digital assistants used to document compliance of bacterial vaginosis treatment

OBJECTIVE: The objective of this study was to estimate patient compliance with oral and vaginal metronidazole treatment of bacterial vaginosis using personal digital assistants (PDAs) and paper diaries. GOAL: The goal of this study was to assess a novel compliance documentation approach. STUDY: After each dose of intravaginal or oral metronidazole, 71 subjects recorded the time on a paper diary and answered questions on a PDA. All PDA entries were unknowingly time-date-stamped. Subjects returned for 2- and 6-week posttreatment examinations. Compliance was calculated using a repeated-measures multivariate analysis of variance (ANOVA). RESULTS: Mean patient compliance rates within the oral metronidazole group were greater with the paper diary compared with the PDA (68.3% and 50.0%, respectively, P = 0.001). The observed rate of compliance agreement for PDA versus paper diary was 69.0% (kappa = 0.4). The majority of noncompliant subjects reported they were compliant with the PDA and paper diary. CONCLUSIONS: PDAs could more accurately document true compliance rates and could be reasonable instruments to assess compliance in intravaginal antimicrobial drug or contraceptive trials.     

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.     

When is bacterial vaginosis not bacterial vaginosis?--a case of cervical carcinoma presenting as recurrent vaginal anaerobic infection.

Vaginal anaerobic infection is the most common cause of vaginal discharge in women. We present a case of recurrent vaginal anaerobic infection and cervical carcinoma and discuss the association of the two conditions. More frequent cytology/colposcopy may be indicated in women who give a history of recurrent or persistent vaginal anaerobic infection.     

The value of Gardnerella-vaginalis-culture in bacterial-vaginitis- score-confirmed bacterial vaginosis

The relative value of a semiquantitative Gardnerella vaginalis culture for the diagnosis of bacterial vaginosis (BV) was studied in 113 women attending a STD clinic. The standard diagnosis of BV was based on the BV score, which is a 10-point grading system to evaluate gram-stained vaginal samples objectively and reproducibly. The sensitivity of G. vaginalis culture for the diagnosis of BV was 28%, while the specificity was 89%. The positive and the negative predictive values were 50% and 76% for G. vaginalis culture in our population. Our data suggest that G. vaginalis culture cannot be recommended for the routine diagnosis of BV. However, G. vaginalis culture will detect asymptomatic women with high vaginal colonization with G. vaginalis. Further studies are needed to find whether these women are at risk of developing BV.     

Predictors of bacterial vaginosis in adolescent women who douche

OBJECTIVE: Risk factors for bacterial vaginosis (BV) include douching and sexual activity, although the exact cause of BV is unknown. GOAL: The goal of this study was to determine the relative significance of douching as a risk factor for BV. STUDY DESIGN: Two hundred fifty adolescent women who regularly douched were enrolled into a randomized douching intervention trial. Behavioral questionnaires and testing for sexually transmitted diseases and BV were performed. Associations between baseline characteristics and behaviors were compared for teens who were BV-positive and BV-negative at baseline. RESULTS: Positive correlates of BV included multiple partners, recent sexual intercourse, douching after menses, recent douching, and gonorrhea. Of these, douching after menses showed the strongest association (odds ratio, 5.11; 95% confidence interval, 1.99-13.15) in a multivariate analysis. CONCLUSIONS: Douching after menses was strongly correlated with BV; however, difficulty remains in trying to evaluate douching and sexual behavior independently.     

甲硝唑联合克林霉素在细菌性阴道炎患者中的应用效果探讨

目的:探讨甲硝唑联合克林霉素治疗细菌性阴道炎的临床疗效和安全性.方法:选择2010年1月～2011年12月在我院妇产科治疗的108例细菌性阴道炎患者为研究对象,随机将本研究入选患者分为对照组和实验组,对照组仅给予甲硝唑进行抗感染治疗,而实验组则在对照组治疗的基础上加用克林霉素对患者进行治疗,比较对照组和实验组的临床疗效、药物不良反应的发生情况及复发率.结果:实验组患者治疗总有效率(90.74%)明显高于对照组的(70.37%),而实验组患者治疗复发率(7.41%)明显低对照组的(25.93%),实验组和对照组患者间治疗总有效率和治疗复发率差异有显著性(P>0.05),但是实验组和对照组患者间不良反应发生率差异无显著性(P>0.05).结论:甲硝唑联合克林霉素是治疗细菌性阴道炎一种临床疗效确切的治疗方案,该方案具有不良反应少及复发率低等特点.     

Efficacy of povidone-iodine vaginal suppositories in the treatment of bacterial vaginosis

A prospective, randomized clinical trial was performed to study the efficacy of povidone iodine (Betadine) suppositories for the treatment of bacterial vaginosis (BV) in comparison to capsules containing lactobacilli (D?derlein Med). Seventy patients with BV included in the study were randomly assigned to be either treated with povidone iodine suppositories or lactobacilli. Patients were treated once a day for 5 days. Initial examinations took place on the first day of the study with follow-up examinations on days 8 and 15. The examinations included clinical parameters, patient evaluation, secretion screens, and quantitative and qualitative microbiological tests of vaginal flora. Both treatment groups showed improvement of clinical parameters, condition of secretions and subjective state of health. At day 15 there was a trend towards a better efficacy of the treatment with povidone iodine but this was not significant. However, patients with acute BV treated with povidone iodine had significantly better scores after 15 days. Both treatments were well tolerated. The microbiological examinations showed an increase of the mean number of lactobacilli in the vagina on day 8 after initiation of treatment with lactobacilli, but a decrease on day 15. Contrary to that the lactobacilli counts from patients treated with povidone iodine suppositories decreased after the first week but increased in the second one. Potentially pathogenic germs, e.g. Gardnerella, Bacteroides and Enterobacteria were reduced in a higher extent and with a longer lasting effect after treatment with povidone iodine suppositories than with capsules containing lactobacilli. The results of this study show that native lactobacilli rapidly re-colonize after the antiseptic treatment with povidone iodine. Therefore, there is no need to use lactobacilli in addition.     

114例MB麻风6个月联合化疗后随访3年细菌指数变化

目的:评价6个月联合化疗方案治疗MB麻风细菌指数变化.方法:采用世界卫生组织多菌型方案对新发114例查菌阳性麻风患者治疗6个月,并对观察治疗前后及随访3年中每年细菌指数的变化进行了分析.结果:114例麻风疗前平均细菌指数3.01,其中分别有108、97、88、83例完成治疗和1年、2年、3年随访.1例停止治疗后13个月复发.治疗结束、1年、2年和3年随访时平均细菌指数值分别为1.82、1.01、0.63和0.39.3年随访患者完成治疗、1年、2年和3年随访时细菌阴转率分别为19.28%、27.71%、46.99%和69.88%.结论:6个月联合化疗后随访3年,细菌阴转率持续上升.由于随访时间较短,且已有复发病例报告,对6个月联合化疗方案疗效需进一步随访观察.     

细菌性阴道病临床表现特征及其与解脲支原体的关系研究

目的:分析细菌性阴道病患者临床表现特征,探讨其与解脲支原体(Uu)的关系。方法:400例疑为细菌性阴道病患者入院时均对外阴、宫颈和阴道粘膜进行检查,采集阴道分泌物。依据阴道状况及分泌物情况对患者进行诊断,将其分为BV组和健康人群组。比较两组阴道临床症状特征和微生态(细菌培养情况及菌群密集度)特征,并进行解脲支原体培养,分析其与BV的关系。结果:250例细菌性阴道病患者主要临床症状:白带异味患者127例,占50.8%;发作时间14天至2年半,平均发作时间(3±6.1)月;白带增多者84例,占33.6%;外阴瘙痒者70例,占28%;64例无明显症状,占25.6%。阴道分泌物检查表明,186例(74.4%)分泌物呈均匀稀薄状,235例(94.0%)阴道pH值高于4.5,所有患者线索细胞呈阳性;139例(55.6%)氨性实验成阳性。与健康人群相比,BV组的pH值、Nugent评分、白带异味、白带增多、无显著症状、均质稀薄分泌物、阴道pH值高于4.5、氨性实验阳性(%)、线索细胞阳性比例患者百分比显著高于健康人群(P<0.05)。BV患者沙眼衣原体和人型支原体检出率分别为6.0%和41.6%,卡方检验表明其显著高于健康人群(P<0.05);BV组乳酸菌密集度较高,集中于0-Ⅰ级,阴道加特纳菌密集度增加,Ⅱ-Ⅳ级占77.6%,组间Ridit分析表明两组的乳酸菌密集度和阴道加特纳菌密集度差异差异具有统计学意义(P<0.05)。250例BV患者中,复发性BV共7例(2.8%)。250例细菌性阴道病患者中,190例(76.0%)解脲支原体呈阳性;150例健康人群中,90例(60.0%)呈解脲支原体阳,二者差异显著(χ2=8.69,P=0.00);215例人群菌量高于104ccu/mL,其中含172例(80%)BV患者,185例菌量低于104ccu/mL,合并BV阳性者78例(42.2%),二者差异显著(χ2=9.92,P=0.00)。经Logistic回归分析表明,BV阳性率与Uu检测菌量之间呈正相关,相关系数R2=0.99,P=0.01。结论:细菌性阴道病患者临床多表现为白带异常、阴道分泌物呈稀薄状、阴道pH值高于4.5和微生态失调,其解脲支原体阳性率较高,其量与BV发生率呈正相关,临床中应注意合并治疗。     

Should male consorts of women with bacterial vaginosis be treated?

Nitroimidazoles have been shown to be the drugs of choice to treat women with bacterial vaginosis, but the recurrence rate is high. Some workers have suggested that the recurrence of symptoms may in fact be reinfection by male consorts, but no controlled studies have been undertaken to confirm this. In an international, multicentre, randomised, double blind trial, the recurrence rate was studied in 241 women with a clinical diagnosis of bacterial vaginosis. All women were treated with 2 g metronidazole twice at an interval of two days. The patients were randomly allocated to two groups, one contained 123 women, whose consorts were given the same dose of metronidazole, the other consisted of 118 women whose consorts were given inert but identical placebo tablets. The women were evaluated at weeks 1, 4, and 12 after treatment. At week 1, the cure rate was 97% (115/119) in women whose consorts had been treated and 98% (111/113) in the others. At week 4 bacterial vaginosis had recurred in 17% (19/112) of women whose consorts had been treated and in 13% (14/106) of those whose consorts had received placebo. At week 12 the recurrence rates were 21% (20/95) in women with treated consorts, and 16% (15/95) in the others. The differences in recurrence rates between the two groups of women were not significant. In conclusion, treating the sexual partners of women with bacterial vaginosis does not seem to increase the cure rate.     

Vaginal leucocyte counts in women with bacterial vaginosis: relation to vaginal and cervical infections

OBJECTIVES: To evaluate whether an elevated vaginal leucocyte count in women with bacterial vaginosis (BV) predicts the presence of vaginal or cervical infections, and to assess the relation of vaginal WBC counts to clinical manifestations. METHODS: We retrospectively analysed the relation of vaginal leucocyte counts to vaginal and cervical infections and to clinical manifestations in non-pregnant women diagnosed with BV at an STD clinic visit. RESULTS: Of 296 women with BV studied, the median age was 24 years and 81% were African-American. Elevated vaginal leucocyte counts were associated with objective signs of vaginitis and cervicitis and also predicted candidiasis (OR 7.9, 95% CI 2.2 to 28.9), chlamydia (OR 3.1, 95% CI 1.4 to 6.7), gonorrhoea (OR 2.7, 95% CI 1.3 to 5.4), or trichomoniasis (OR 3.4, 95% CI 1.6 to 7.3). In general, as a screening test for vaginal or cervical infections, vaginal leucocyte count had moderate sensitivities and specificities, low positive predictive values, and high negative predictive values. CONCLUSIONS: An elevated vaginal leucocyte count in women with BV was a strong predictor of vaginal or cervical infections. Vaginal leucocyte quantification may provide an alternative approach to assessing need for empirical therapy for chlamydia and gonorrhoea, particularly in resource-limited high STD risk settings that provide syndromic management.     

白带涂片革兰氏染色法对细菌性阴道病诊断的探讨

目的:探讨对细菌性阴道病检测方法以降低漏诊率。方法:2009年7月至12月间随意抽查200例患者,白带涂片采用"金标准"Amsel、s法同时结合本院实验室建立的革兰氏染色法进行检测。结果:200例受检者Amsel、s标准检测出患者40例、革兰氏染色查出线索细胞31例,分别占20%和15.5%。计算乳酸杆菌和加德纳菌的数量变化阳性56例、临界状态10例,分别占28.0%和5.0%;乳酸杆菌和加德纳菌的数量变化以Amsel、s法为标准,革兰氏染色计算两种细菌的数量变化诊断细菌性阴道病(BV)的敏感性为92.5%,特异性88.1%。阳性检出率明显高于Amsel、s标准法(χ2=10.2,P0.005)。结论:目前使用传统的Amsel、s标准法因某些因素干扰而致漏诊,我院采用革兰氏染色计算乳酸杆菌和加德纳菌的数量变化可降低诊断细菌性阴道病的漏诊率。     

Diagnosis of bacterial vaginosis: need for validation of microscopic image area used for scoring bacterial morphotypes

BACKGROUND: The diagnosis of bacterial vaginosis (BV) is often made according to Nugent's classification, a scoring system based on bacterial counting of Gram stained slides of vaginal secretion. However as the image area of the microscope field will influence the number of morphotypes seen there is a need to standardise the area. METHODS: A graph intended for recalculation of number of bacterial morphotypes seen by the observer using 1000 x magnification from various microscope set-ups was constructed and applied to data sets typical for scoring BV. The graph was used in recalculation of Nugent scores, which were also compared with the Ison/Hay scores to evaluate the consequences for the diagnosis of BV. RESULTS: The observed image area differed by 300% among the investigated microscope set-ups. In two different data sets, one treatment study and one screening study, a considerable change in the number of women classified as intermediate was seen when the graph was used to standardise the image area. The recalculated numbers were also compared to the Ison/Hay classification. Weighted kappa indexes between the different methods were 0.84, 0.88, and 0.90, indicating that the methods are comparable. CONCLUSION: Because of the considerable differences among image areas covered by different microscope set-ups used in Nugent and Ison/Hay scoring, there is a need to standardise the area in order to reach comparable scores reflecting the diagnosis of BV in different laboratories. The differences in the intermediate group will have a considerable effect on the results from both treatment and prevalence studies, even though the kappa indexes indicate very good agreement between the methods used.