Frobenius W, Bogdan C
Frauenklinik, Universitätsklinikum Erlangen, Erlangen.
Mikrobiologisches Institut, Universitätsklinikum Erlangen, Erlangen.
Geburtshilfe Frauenheilkd. 2015 Apr;75(4):355-366. doi: 10.1055/s-0035-1545909.
The majority of uncomplicated vulvovaginal complaints (e.g. bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis) can be detected with uncomplicated basic infectiological tests and can usually be treated effectively without requiring further diagnostic procedures. Tests include measurement of vaginal pH, preparation and assessment of wet mount slides prepared from vaginal or cervical discharge, and the correct clinical and microbiological classification of findings. In Germany, at least in recent years, this has not been sufficiently taught or practiced. As new regulations on specialist gynecologic training in Germany are currently being drawn up, this overview provides basic information on gynecologic infectiology and summarizes clinically relevant aspects of recent microbiological findings on the physiology and pathology of vaginal flora. The clinical signs and symptoms of aerobic vaginitis, the pathogenesis of which is still not completely understood, are also reviewed. Finally, the symptoms, indications and risk factors for pelvic inflammatory disease (PID) are presented. In contrast to the above-listed infections, PID requires immediate culture of the pathogen from samples (e.g. obtained by laparoscopy) with microbiological diagnostic procedures carried out by specialist laboratories. A schematic summary of all pathologies discussed here is presented.
大多数单纯性外阴阴道疾病(如细菌性阴道病、外阴阴道假丝酵母菌病、滴虫病)可通过简单的基本感染学检查检测出来,通常无需进一步诊断程序即可有效治疗。检查包括测量阴道pH值、制备和评估由阴道或宫颈分泌物制成的湿片,以及对检查结果进行正确的临床和微生物学分类。在德国,至少近年来,这些内容没有得到充分的传授或实践。由于德国目前正在制定新的妇科专科培训法规,本综述提供了妇科感染学的基本信息,并总结了近期关于阴道菌群生理和病理的微生物学研究结果中与临床相关的方面。还对需氧性阴道炎的临床体征和症状进行了综述,其发病机制仍未完全明确。最后,介绍了盆腔炎(PID)的症状、指征和危险因素。与上述感染不同,PID需要立即从样本(如通过腹腔镜检查获取)中培养病原体,并由专业实验室进行微生物学诊断程序。本文给出了所有讨论的病理情况的示意图总结。