Nwankwo Theophilus Ogochukwu, Aniebue Uzochukwu Uzoma, Umeh Uchenna Anthony
Department of Obstetrics and Gynaecology, University of Nigeria Nsukka, Nsukka, Enugu States, Nigeria.
Curr Infect Dis Rep. 2017 Jan;19(1):3. doi: 10.1007/s11908-017-0558-9.
This review aims to determine the effectiveness of the use of syndrome diagnosis in the evaluation of vaginitis and to make suggestions based on the review findings.
Vaginal discharge as the main symptom of vaginitis is unspecific. A randomized study of symptom-based diagnosis and treatment of vaginitis in the USA favored symptoms used for treatment; however, this was only a pilot study. Hence, a population-based study is necessary to validate these findings. Most of the study that assessed treatment of vaginitis in pregnancy reported low diagnostic sensitivity and specificity for bacterial vaginosis and vaginal candidiasis and a wide range for trichomonas vaginalis reflecting ineffectiveness of syndrome-based treatment in pregnancy. A systematic review of the web for relevant literature was made, and appropriate articles were extracted and reviewed. Sensitivity, specificity, and positive values were used, where applicable to determine effectiveness. Forty-three full articles and abstracts were reviewed. Studies that validated or applied WHO algorithm for treatment of vaginitis reported high sensitivity (91.5-100%) but moderate to low specificity (0-27.5%) among women with vaginal symptoms. Studies that focused on symptoms for diagnosis of the three main etiologic agents of vaginitis reported low sensitivity and specificity, while such studies in pregnancy reported sensitivity and specificity ranging from 35.4 to 54% for TV, 11 to 100% for BV, and 0 to 56.2% for trichomonas vaginalis, bacterial vaginosis, and vaginal candidiasis, respectively. Studies that added point of care test reported higher sensitivity and specificity and positive predictive value. The use of WHO syndrome-based algorithm or its modification for treatment of vaginitis though moderately effective has the potential for overtreatment and physician error. Point of care testing and laboratory investigation are essential for productive intervention especially in pregnancy.
本综述旨在确定综合征诊断在阴道炎评估中的有效性，并根据综述结果提出建议。
以阴道分泌物作为阴道炎的主要症状缺乏特异性。美国一项基于症状的阴道炎诊断与治疗的随机研究倾向于采用症状进行治疗；然而，这只是一项初步研究。因此，有必要开展一项基于人群的研究来验证这些发现。大多数评估妊娠期阴道炎治疗的研究报告称，细菌性阴道病和阴道念珠菌病的诊断敏感性和特异性较低，滴虫性阴道炎的诊断范围较广，这反映出基于综合征的治疗在妊娠期效果不佳。对网络上的相关文献进行了系统综述，提取并审阅了合适的文章。在适用的情况下，使用敏感性、特异性和阳性值来确定有效性。共审阅了43篇全文和摘要。验证或应用世界卫生组织（WHO）阴道炎治疗算法的研究报告称，有阴道症状的女性中敏感性较高（91.5 - 100%），但特异性为中度至低度（0 - 27.5%）。专注于阴道炎三种主要病原体诊断症状的研究报告敏感性和特异性较低，而妊娠期此类研究报告滴虫性阴道炎的敏感性和特异性分别为35.4%至54%，细菌性阴道病为11%至100%，阴道念珠菌病为0至56.2%。增加即时检验的研究报告了更高的敏感性、特异性和阳性预测值。使用基于WHO综合征的算法或其改良方法治疗阴道炎虽然有一定效果，但存在过度治疗和医生误诊的可能性。即时检验和实验室检查对于有效干预至关重要，尤其是在妊娠期。
