Schaaf V M, Perez-Stable E J, Borchardt K
Department of Health Policy and Administration, School of Public Health, University of California, Berkeley.
Arch Intern Med. 1990 Sep;150(9):1929-33.
The etiology of vaginitis can be difficult to prove. To determine the relationship between clinical criteria (symptoms and signs) and three causes of vaginitis, we prospectively evaluated 22 criteria in 123 unselected symptomatic patients. Diagnoses of Candida albicans and Trichomonas vaginalis infection were based on culture. Bacterial vaginosis was defined by the presence of 3 of 4 clinical criteria. Only 49% of our patients received diagnoses, and itching was the only symptom more frequently noted among those with diagnoses. Symptoms did not differ among the three infections, and lack of vaginal odor in yeast infection was the only significantly different physical sign. Yeast and trichomonads were seen on microscopy in 63% and 75% of culture-positive specimens. Bacterial vaginosis had no significant clinical criteria beyond those that defined the diagnosis. We conclude that presenting symptoms and signs in vaginitis evaluation have limited value, and that half of the women with vaginitis may lack a microbiologic diagnosis.
阴道炎的病因可能难以证实。为了确定临床标准（症状和体征）与阴道炎的三种病因之间的关系，我们前瞻性地评估了123例未经挑选的有症状患者的22项标准。白色念珠菌和阴道毛滴虫感染的诊断基于培养结果。细菌性阴道病由4项临床标准中的3项存在来定义。我们的患者中只有49%得到了诊断，瘙痒是唯一在确诊患者中更常出现的症状。三种感染的症状并无差异，酵母菌感染中无阴道异味是唯一显著不同的体征。在63%培养阳性的标本中显微镜下可见酵母菌，75%可见滴虫。除了用于定义诊断的标准外，细菌性阴道病没有显著的临床标准。我们得出结论，在阴道炎评估中出现的症状和体征价值有限，并且一半的阴道炎女性可能缺乏微生物学诊断。
