Sullivan A K, Straughair G J, Marwood R P, Staughton R C, Barton S E
St. Stephen's Centre, Department of HIV GU Medicine, The Chelsea and Westminster Hospital, London, UK.
J Eur Acad Dermatol Venereol. 1999 Jul;13(1):36-40.
To characterise the new patient referrals to a combined vulva clinic and to assess the role of genitourinary services within the clinic.
A case note review of all new patients attending a monthly, multidisciplinary vulva clinic over a 12-month period.
The mean age of the 135 women was 43 years (range 18-86 years). The majority of patients, 64 (47%), were referred by their general practitioner (GP). Using nurse and physician triage 85 (63%) patients were seen by a dermatologist, 55 (41%) by a genitourinary medicine physician, 38 (28%) by a gynaecologist and six (4%) by a psychosexual physician. Fifty-one (38%) women required a consultation by at least two specialties. Itch was the most frequent presenting symptom (70%) and 59 (44%) women had experienced symptoms for between 6 months and 2 years. A previous STD screen had been performed in only 57 (42%), which was negative in 45 (79%). The most frequent initial clinical diagnoses were lichen sclerosus (35, 26%), vaginal candidiasis (21, 16%), vulvodynia (16, 12%), lichen simplex chronicus (13, 10%) and Bowenoid papulosis (13, 10%). Thirty-eight (28%) women had microbiological investigations revealing 13/135 (10%) had vaginal candidiasis and two (2%) bacterial vaginosis, all symptomatic. A biopsy was performed in 32 (24%) confirming the initial diagnosis in 20 (63%) cases. Treatment was initiated in 101 (75%) women: 62 (46%) were prescribed steroid cream, 46 (34%) emollient cream and 22 (16%) treatment for candida infection. Fifty-three (39%) women received more than one treatment. 94 (70%) patients were followed-up in the vulval clinic, five (4%) in the genitourinary clinic and 12 (9%) by their GP.
Despite having genitourinary symptoms less than half the patients had been tested for infection prior to attending the clinic. More than a third of the patients, 46 (34%), were diagnosed with a genitourinary infection. There is a significant role for genitourinary services in the diagnosis, management and ongoing care of patients in a vulva clinic.
描述转诊至联合外阴诊所的新患者特征，并评估泌尿生殖服务在该诊所中的作用。
对在12个月期间每月就诊一次的多学科外阴诊所的所有新患者进行病历回顾。
135名女性的平均年龄为43岁（范围18 - 86岁）。大多数患者，即64名（47%），由其全科医生（GP）转诊。通过护士和医生分诊，85名（63%）患者由皮肤科医生诊治，55名（41%）由泌尿生殖医学医生诊治，38名（28%）由妇科医生诊治，6名（4%）由性心理医生诊治。51名（38%）女性需要至少两个专科的会诊。瘙痒是最常见的就诊症状（70%），59名（44%）女性有症状已持续6个月至2年。之前仅57名（42%）患者进行过性传播疾病筛查，其中45名（79%）结果为阴性。最常见的初始临床诊断为硬化性苔藓（35例，26%）、阴道念珠菌病（21例，16%）、外阴痛（16例，12%）、慢性单纯性苔藓（13例，10%）和鲍温样丘疹病（13例，10%）。38名（28%）女性进行了微生物学检查，发现135名中有13名（10%）患有阴道念珠菌病，2名（2%）患有细菌性阴道病，均有症状。32名（24%）女性进行了活检，20名（63%）病例活检结果证实了初始诊断。101名（75%）女性开始接受治疗：62名（46%）被开具类固醇乳膏，46名（34%）被开具润肤乳膏，22名（16%）接受念珠菌感染治疗。53名（39%）女性接受了不止一种治疗。94名（70%）患者在外阴诊所接受随访，5名（4%）在泌尿生殖诊所接受随访，12名（9%）由其全科医生随访。
尽管有泌尿生殖系统症状，但不到一半的患者在就诊前接受过感染检测。超过三分之一的患者，即46名（34%），被诊断患有泌尿生殖系统感染。泌尿生殖服务在外阴诊所患者的诊断、管理和持续护理中发挥着重要作用。
