Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis
Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis
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DOI：
10.1007/s00404-010-1498-x
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发表时间：
2010-11-01
影响因子：
2.6
通讯作者：
Turan, Mehmet Cem
中科院分区：
文献类型：
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作者：
Buyukbayrak, Esra Esim;Kars, Bulent;Turan, Mehmet Cem
本研究的目的是比较目前的诊断临床和实验室方法的妇女外阴阴道分泌物投诉。次要结果是确定在我们的设置感染的患病率，并寻找外阴阴道感染和易感因素之间的关系，如果present.Premenopausal妇女申请到我们的妇科门诊阴道分泌物投诉前瞻性地纳入研究。每例患者均通过阴道分泌物直接观察、湿片检查、嗅味试验、阴道pH检测和衣原体快速抗原检测进行临床评价。每例患者还通过阴道分泌物培养和革兰氏染色进行微生物学评价。将临床诊断与微生物诊断（金标准）进行比较。以敏感性、特异性、阳性预测值（ppv）和阴性预测值（npv）衡量诊断准确性。460例患者纳入研究。89.8%的患者接受了临床诊断，而只有36%的患者接受了微生物诊断。临床诊断对微生物培养结果的敏感性、特异性、ppv、npv分别为95%、13%、38%、82%。培养中最常见的微生物是念珠菌属（17.4%）和加德纳菌（10.2%）。临床上最常见的诊断是混合感染（34.1%）、细菌性阴道病（32.4%）和真菌感染（14.1%）。症状不能预测实验室结果。诱发因素（糖尿病，阴道冲洗的做法，存在的宫内节育器和口服避孕药的使用）没有被发现是统计学上重要的影响因素阴道infecties.Clinical诊断的基础上结合症状与办公室为基础的测试提高诊断的准确性，但是不够的。最有效的方法还包括实验室检测作为辅助诊断是在问题或治疗失败。
The purpose of the present study was to compare the current diagnostic clinical and laboratory approaches to women with vulvovaginal discharge complaint. The secondary outcomes were to determine the prevalence of infections in our setting and to look for the relation between vulvovaginal infections and predisposing factors if present.Premenopausal women applying to our gynecology outpatient clinic with vaginal discharge complaint were enrolled prospectively into the study. Each patient evaluated clinically with direct observation of vaginal secretions, wet mount examination, whiff test, vaginal pH testing and chlamydia rapid antigen test. Each patient also evaluated microbiologically with vaginal discharge culture and gram staining. Clinical diagnosis was compared with the microbiological diagnosis (the gold standard). Diagnostic accuracy was measured with sensitivity, specificity, positive (ppv) and negative predictive values (npv).460 patients were included in the study. 89.8% of patients received a clinical diagnosis whereas only 36% of them had microbiological diagnosis. The sensitivity, specificity, ppv, npv of clinical diagnosis over microbiological culture results were 95, 13, 38, 82%, respectively. The most commonly encountered microorganisms by culture were Candida species (17.4%) and Gardnerella vaginalis (10.2%). Clinically, the most commonly made diagnoses were mixed infection (34.1%), bacterial vaginosis (32.4%) and fungal infection (14.1%). Symptoms did not predict laboratory results. Predisposing factors (DM, vaginal douching practice, presence of IUD and usage of oral contraceptive pills) were not found to be statistically important influencing factors for vaginal infections.Clinical diagnosis based on combining symptoms with office-based testing improves diagnostic accuracy but is insufficient. The most effective approach also incorporates laboratory testing as an adjunct when a diagnosis is in question or treatment is failing.