昆山市性病门诊就诊妇女性传播疾病感染情况分析

目的了解性病门诊就诊妇女性传播疾病(STD)感染状况.方法对2003年1月1日～12月31日到昆山市疾病预防控制中心门诊部初诊女性患者进行STD感染状况调查,取宫颈分泌物检测解脲支原体(UU)、沙眼衣原体(CT)、淋球菌(NG)等;取阴道分泌物检测念珠菌、阴道毛滴虫及细菌性阴道病,同时采血做梅毒快速血浆反应素试验(RPR).结果 STD的检出率为35.98%,STD构成比为非淋菌性宫颈炎44.10%、尖锐湿疣31.03%、淋病20.77%、梅毒3.59%、生殖器疱疹0.51%;阴道炎的总检出率为25.46%,其中霉菌18.08%、滴虫4.80%、细菌性阴道病2.58%.结论昆山市STD仍处于稳定的增长过程.     

宫颈炎阴道炎支原体感染及药敏分析

目的:了解女性生殖道宫颈炎、阴道炎支原体感染的状况及其药敏情况。方法:采用法国生物梅里埃公司提供的支原体IST试剂盒对2180例拟诊为宫颈炎、阴道炎患者的宫颈和阴道分泌物标本进行支原体培养及药敏检测。结果:2180例宫颈炎、阴道炎患者中,1031例患者支原体培养阳性,阳性率为47.3%,其中单一解脲支原体(UU)阳性者711例(32.6%),单一人型支原体(MH)阳性者148例(6.8%),UU和MH混合阳性者172例(7.9%);支原体感染以20岁~30岁年龄组最高,占68.1%;药敏试验结果显示,对原始霉素敏感率为98.2%、对交沙霉素敏感率为94.3%、对强力霉素敏感率为85.2%、对红霉素耐药率为75.1%、对氧氟沙星耐药率为41.8%、对四环素耐药率为50.1%。结论:由支原体引起的女性生殖道宫颈炎、阴道炎不容忽视,同时把支原体作为常规检测并进行药敏试验对指导临床治疗及合理用药均具有重要意义。     

The relationship of bacterial vaginosis, candida and trichomonas infection to symptomatic vaginitis in postmenopausal women attending a vaginitis clinic

Objective: To estimate the prevalence of bacterial vaginosis, Candida albicans, and Trichomonas vaginalis infections in a population of postmenopausal women with symptoms of vaginitis seen at a vaginitis clinic either as self-referred or clinician referred patients. Methods: A cross-sectional study of 148 postmenopausal women (cases) and 1564 controls of reproductive age attending a vaginitis clinic. C. albicans and T. vaginalis infections were diagnosed by culture techniques. Bacterial vaginosis was diagnosed on the basis of clinical findings. Results: Fifty-six (37.8%) postmenopausal women and 834 (53.3%) controls were diagnosed with T. vaginalis or C. albicans infection, or bacterial vaginosis, or mixed infection (odds ratio (OR) 0.53, 95% confidence interval (CI) 0.37–0.75). C. albicans and T. vaginalis infection were diagnosed in 34.1% (534/1564) and 1.92% (30/1564) of women of childbearing age and in 3.5% (20/148) and 10.8% of postmenopausal women, respectively. (P < 0.05 for both comparisons). The prevalence of bacterial vaginosis was similar between the two groups (14/148 in postmenopausal patients and 210/1564 in controls of reproductive age; P = 0.22). Conclusions: Among postmenopausal women attending a vaginitis clinic, a defined diagnosis of bacterial vaginosis, C. albicans or T. vaginalis infection can be made in about one third of such patients. Concerning the two thirds of symptomatic women lacking such a microbiologic diagnosis, alternative causes (e.g., estrogen deficiency, nonanaerobic bacterial infections, local irritants or allergenes, and dermatologic conditions) need to be considered.     

黄芪提取物局部治疗萎缩性阴道炎68例分析

目的　探讨中药黄芪提取物 (主要成分为蕊异黄酮 ,属植物雌激素类 )治疗萎缩性阴道炎的效果和机理。方法　 6 8例萎缩性阴道炎患者明确诊断 ,年龄 (6 2± 7.2 )岁 ,以中药黄芪浓缩提取液均匀涂抹阴道壁 ,并留置带药棉球于阴道穹隆部 ,隔日 1次 ,每 10次为 1疗程 ,重者连续治疗 2疗程 ,观察用药前后自觉症状改善情况、阴道健康评分、血清促卵泡生成素 (HFSH)和雌二醇 (E2 )水平、阴道脱落细胞成熟指数 (MI)及免疫组化法测定雌激素受体 (ER)的表达并进行比较分析。结果　 4 9例 (77.3% )用药 3次以上自觉症状好转 ,1疗程痊愈 ;14例(2 1.97% ) 1疗程结束时明显见效 ,2疗程痊愈 ;5例 (0 .73% )第 2疗程结束时明显见效。总痊愈率 99.2 7%。 2治疗后阴道健康评分为 (13.4± 7.5 )分 ,与治疗前 [(5 .2± 0 .4 )分 ]比较明显升高 ,P <0 .0 5。 3治疗后血清 FSH[(5 7.17± 12 .93) m IU/m l]和 E2 水平 [(2 0 .15± 8.2 6 ) pg/Ml]均较治疗前 [(5 8.37± 12 .75 ) m IU /ml,(19.6 3±8.72 ) pg/ml]无明显改变 ,P >0 .0 5。4治疗前 MI无角化细胞或以基底细胞为主 ,治疗后基底细胞明显减少或消失 ,出现角化细胞或角化前细胞 ,以中型细胞为主。5治疗后 ER阳性细胞表达率为 85 .3% ,与治疗前 (13.2 % )比较 ,P<0 .0 1     

Convergent-Divergent Validity and Correlates of the Day-to-Day Impact of Vaginal Aging Domain Scales in the MsFLASH Vaginal Health Trial

IntroductionClinical research and management of postmenopausal vaginal symptoms have been limited by the lack of validated measures for assessing symptom impact.AimTo evaluate convergent-divergent validity of the Day-to-Day Impact of Vaginal Aging (DIVA) questionnaire among postmenopausal women with moderate-to-severe vulvovaginal symptoms and identify demographic and clinical factors associated with greater symptom impact.MethodsWe examined baseline data from postmenopausal women with moderate-to-severe vulvovaginal itching, pain, irritation, dryness, or pain with intercourse in a randomized trial of vaginal estradiol, moisturizer, or placebo. In addition to completing the DIVA questionnaire, participants rated the severity of their most bothersome vulvovaginal symptom, underwent assessment of vaginal pH and epithelial cytology, and completed other self-report measures including the Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), and Patient Health Questionnaire-8 for depression (PHQ-8).Main Outcome MeasureThe main outcome measures were the unadjusted correlations and multivariable-adjusted associations with 4 DIVA domain scales designed to assess symptom impact on day-to-day activities, sexual functioning, emotional well-being, and body image/self-concept on a scale of 0 to 4.ResultsAmong 301 women, we detected moderately strong correlations between the DIVA emotional well-being scale and PHQ-8 scores (Pearson correlation coefficient [r] = 0.39) and strong correlations between the DIVA sexual functioning scale and FSFI and FSDS scores (r > 0.50). No significant correlations were detected between any DIVA scales and vaginal pH or epithelial cytology. In adjusted linear-regression analyses, greater vulvovaginal symptom severity was associated with worse DIVA scores for emotional well-being, sexual functioning, and self-concept/body image (average 0.3- to 0.5-point higher DIVA score for each 1-point difference in vulvovaginal symptom severity). Depression symptoms were associated with worse DIVA scores for activities of daily living and emotional well-being (0.2- to 0.4-point higher DIVA score for each 5- point worsening of PHQ-8 score). Women reporting recent sexual activity had lower symptom impact on sexual functioning and self-concept/body image domains (−0.3- to −0.4-point lower DIVA score with weekly sexual activity).Clinical ImplicationsFindings suggest that the impact of postmenopausal vaginal symptoms on functioning and well-being is greater in women with co-morbid depression symptoms and less frequent sexual activity, independent of symptom severity.Strengths & LimitationsStrengths include the multicenter sample and wide array of measures. Results may not generalize to women with mild symptoms.ConclusionOur results support the construct validity of the DIVA questionnaire for clinical practice and research and indicate that depression and lower frequency of sexual activity are markers of greater impact of postmenopausal vaginal symptoms on multiple dimensions of functioning and quality of life.Hunter MM, Guthrie KA, Larson JC, et al. Convergent-Divergent Validity and Correlates of the Day-to-Day Impact of Vaginal Aging Domain Scales in the MsFLASH Vaginal Health Trial. J Sex Med 2020;17:117–125.     

滴虫性阴道炎阴道局部细胞因子IL-2、IL-8、IL-13的变化

目的:检测滴虫性阴道炎(trichomanasvaginitis,TV)患者阴道局部细胞因子白介素-2(interleukine-2,IL-2)、白介素-8(interleukine-8,IL-8)及白介素-13(interleukine-13,IL-13)的变化,探讨它们在疾病及机体免疫防御机制中的作用。方法:选取生育年龄女性滴虫性阴道炎患者40例(TV组)为研究组,同期选取健康体检无阴道炎症的健康育龄女性66例为对照组,用ELISA法检测这2组人群中阴道局部IL-2、IL-8、IL-13及免疫球蛋白E(immunoglobinE,IgE)的水平。结果:(1)与健康对照组阴道局部IL-2(7.24pg/ml)、IL-8(1796.99pg/ml)、IL-13(22.54pg/ml)水平相比,滴虫性阴道炎患者阴道局部的IL-2为8.80pg/ml,有升高趋势(P=0.11);IL-8为7119.00pg/ml,IL-13为36.43pg/ml,均显著升高(P(0.001,P(0.001);(2)滴虫性阴道炎患者阴道局部IL-2/IL-13显著下降(P(0.001);(3)与健康对照组IgE水平(0.89IU/ml)相比,滴虫性阴道炎组(1.05IU/ml)显著升高(P=0.008)。结论:(1)滴虫性阴道炎时阴道局部IL-2有升高趋势,IL-13及IgE升高,提示阴道局部细胞免疫及体液免疫在抗滴虫感染中均起作用;(2)滴虫性阴道炎时阴道局部IL-8升高提示阴道局部粘膜的先天免疫应答在抗滴虫感染中起重要作用;(3)IL-2/IL-13下降提示可能出现了Th1/Th2细胞的免疫功能失衡。     

Frequency of infectious agents for vaginitis in non- and hysterectomized women

The frequency of infectious agents for vaginitis has shown varying results. Bacterial vaginosis and candidiasis are infections related to vaginal pH alteration. Vaginal pH is related to endocervical pH in pre- and post-menopaused women, and vaginal pH in hysterectomized women is more acidic than in non-hysterectomized women. The aim of this paper is to verify differences in Papanicolaou smear diagnoses of infectious agents in hysterectomized women. A retrospective study was conducted at Faculdade de Medicina do Triângulo Mineiro (public tertiary referral centre). A total of 1,579 Papanicolaou reports for each group (hysterectomized and non-hysterectomized) was analysed. Clue cells, Candida sp., Trichomonas vaginalis, cytolysis, coccobacilli and lactobacilli were diagnosed by cytological criteria (Papanicolaou’s method), statistical methods: the χ ² test and linear regression (significance level <0.05). Clue cells decrease with the age in both the groups and are more frequent in non-hysterectomized women with >59 years. There is an increased frequency of Coccobacilli and a decrease of lactobacillus as the age of women increases. The frequency of T. vaginalis is not influenced by hysterectomy but there is a decreased frequency between 40 years and 49 years old. Cytolysis was more frequent in women below 40 years old and between 50 years and 59 years old in both groups (P<0.009). Candida sp. is a less common finding between 40 years and 49 years old in both groups and more frequent in hysterectomized women with >60 years old (P=0.002). Our results showed that the presence of infectious agents for vaginitis in Papanicolaou findings is associated with age. The frequency of finding of Candida sp. in women above 60 years old may be influenced by hysterectomy.     

Intravaginal metronidazole gel versus metronidazole plus nystatin ovules for bacterial vaginosis: a randomized controlled trial

OBJECTIVE: We compared metronidazole 0.75% gel (containing 37.5 mg metronidazole per dose) with ovules containing metronidazole 500 mg and nystatin 100,000 U, for intravaginal treatment of bacterial vaginosis (BV). STUDY DESIGN: In a single-blinded trial, symptomatic women with BV by both Amsel and Nugent criteria were randomly assigned to gel or ovules, once nightly for 5 nights, and asked to return 3 times after treatment. Analyses were intent-to-treat. RESULTS: Of 151 women with BV by both criteria at enrollment, 138 (91%) returned at least once. Product limit estimates for persistence or recurrence of BV at 14, 42, and 104 days were 20% (95% CI 10%-29%), 38% (95% CI 25%-48%), and 52% (95% CI 37%-63%) after gel treatment, and 4% (95% CI 0%-9%), 17% (95% CI 7%-26%), and 33% (95% CI 21%-46%) after ovule treatment ( P = .01). Among women without BV at first follow-up, subsequent intercourse without condoms independently predicted subsequent recurrence ( P 相似文献   

Predictive value of the clinical diagnosis of lower genital tract infection in women

OBJECTIVE: We hypothesized that diagnostic approaches to lower genital tract infections are inaccurate and proposed this study to evaluate typical approaches. STUDY DESIGN: Clinical diagnoses were made with symptoms, direct observation, wet mount, vaginal pH, and amines in 598 women with genital complaints. Laboratory testing for N gonorrhoeae, yeast, T vaginalis, C trachomatis, and bacterial vaginosis by Gram stain. RESULTS: The most frequent symptoms were vaginal discharge (64%), change in discharge (53%), malodor (48%), and pruritis (32%). The infection rates were 46% bacterial vaginosis, 29% yeast, 12% trichomoniasis, 11% chlamydia or gonorrhea; 21% of the patients had no infection. The symptoms did not predict laboratory diagnosis. Clinical signs and symptoms with office-based tests and microscopy improved the accuracy of diagnoses. Amsel's clinical diagnosis of bacterial vaginosis was the most sensitive at 92%. The sensitivity of wet mount diagnosis of trichomoniasis was 62%, of yeast by microscopy was 22%, and of mucopus for the prediction of gonorrhea and/or chlamydia was 30%. CONCLUSION: Symptoms alone should not be used to direct treatment in instances in which resources permit more complete evaluation with office-based testing that includes microscopy. Treatment failures or diagnostic uncertainty should prompt specific laboratory testing.     

女童外阴阴道炎与血浆MBL水平及MBL基因外显子1多态性关系分析

目的:探讨女童外阴阴道炎与血浆甘露糖结合凝集素(MBL)水平及与其基因外显子1多态性关系。方法:外阴阴道炎(疾病组)女童44例,对照组女童59例,抽取静脉血2ml,静置2h以上,分离血浆和白细胞。血浆MBL浓度的检测采用ELISA法,MBL基因外显子1多态性分析采用序列分析法。统计分析采用SPSS软件(11.0版),遗传学分析采用SHF-SIS软件。结果:疾病组与对照组血浆MBL中位浓度分别为663ng/ml和1040ng/ml,疾病组MBL浓度显著低于对照组(Z=2.647,P=0.008)。序列分析显示,外显子1区所有样本+223(+52密码子)和+239(+57密码子)核苷酸位点无突变即无C和D型外显子发现;疾病组+230位点(+54密码子)的突变频率为0.205,对照组该位点的突变频率为0.169,两组的等位基因分布均符合Hardy-Weinberg平衡(P值分别为0.45和0.38),但两组间该位点的突变频率无显著性差异(χ2=0.412,P=0.521)。外显子1的型别与MBL浓度之间的关系是A/A>A/B>B/B,具有统计学意义(Z=6.093,P≈0.000)。所有个体外显子1区无新突变发现。结论:低血浆MBL浓度与女童外阴阴道炎的发生可能有一定的相关关系,MBL基因外显子1的多态性有待扩大样本数后进一步研究。