Donders Gilbert G G, Ravel Jacques, Vitali Beatrice, Netea Mihai G, Salumets Andres, Unemo Magnus
Gynecol Obstet Invest. 2017;82(6):607-616. doi: 10.1159/000478982. Epub 2017 Oct 10.
The diagnosis of vulvo-vaginal complaints has always been enigmatic in obstetrics and gynecology. Patients with clear, pathognomonic symptoms end up with a proper diagnosis and treatment most of the time, but unfortunately we are now living in a world where women reach out to the Internet and readily get all information as to which disease their symptoms correspond to and also find the appropriate treatment "over-the-counter." Because of this trend, we as specialists are increasingly confronted with patients with complex and combined conditions. At the same time, extremely sensitive and accurate diagnostic tools are now being developed at a rapid pace, allowing the physicians to diagnose vulvo-vaginal disease with a substantially increased precision. Moreover, many of these molecular biology (MB)-based tests have become so common and affordable that self-sampling and self-testing are no longer utopia. On the other hand, too much information that is too readily available and that is too affordable also encompasses pitfalls, leading to gross overtreatment and psychological burden. As experienced caregivers, we should supervise these evolutions, define their place and proper use as diagnostic tools, utilize their potential as ad hoc tools to follow-up treatment efficacy and guide how such tools can be used for responsible self-testing. In the present paper, responding to the need for appropriate, quality assured and accessible tests for vulvo-vaginitis and the huge potential delivered by the rapidly developing MB methods, we recommend the need for a broad and regular discussion forum, composed of both clinical and technical experts and opinion makers, in order to match the needs with the huge opportunities and ideally combine the initiatives and forces into the same direction. This forum should then translate conceived strategies into regularly updated, evidence-based national and international guidelines.
在外科学和妇科学领域，外阴阴道疾病的诊断一直是个难题。大多数情况下，有明确、特征性症状的患者最终能得到正确的诊断和治疗，但不幸的是，如今我们生活在这样一个世界里：女性通过互联网就能轻易获取所有信息，知道自己的症状对应哪种疾病，还能找到“非处方”的合适治疗方法。由于这种趋势，我们作为专科医生越来越多地面对患有复杂合并症的患者。与此同时，极其灵敏和准确的诊断工具正在迅速发展，使医生能够以大幅提高的精确度诊断外阴阴道疾病。此外，许多基于分子生物学（MB）的检测方法已经变得非常普遍且价格亲民，以至于自我采样和自我检测不再是空想。另一方面，太容易获取且价格过于低廉的过多信息也存在陷阱，会导致过度治疗和心理负担。作为经验丰富的护理人员，我们应该监督这些发展，确定它们作为诊断工具的地位和正确用途，发挥它们作为临时工具的潜力以跟踪治疗效果，并指导如何负责任地进行自我检测。在本文中，为了满足对外阴阴道炎进行适当、质量有保证且可及的检测的需求，以及应对快速发展的分子生物学方法所带来的巨大潜力，我们建议需要一个广泛且定期的讨论论坛，该论坛由临床和技术专家以及意见领袖组成，以便将需求与巨大机遇相匹配，并理想地将各项举措和力量汇聚到同一方向。然后，这个论坛应将构思好的策略转化为定期更新的、基于证据的国家和国际指南。
