Columbia University Irving Medical Center, New York, NY, USA.
Am Fam Physician. 2018 Mar 1;97(5):321-329.
Vaginitis is defined as any condition with symptoms of abnormal vaginal discharge, odor, irritation, itching, or burning. The most common causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. Bacterial vaginosis is implicated in 40% to 50% of cases when a cause is identified, with vulvovaginal candidiasis accounting for 20% to 25% and trichomoniasis for 15% to 20% of cases. Noninfectious causes, including atrophic, irritant, allergic, and inflammatory vaginitis, are less common and account for 5% to 10% of vaginitis cases. Diagnosis is made using a combination of symptoms, physical examination findings, and office-based or laboratory testing. Bacterial vaginosis is traditionally diagnosed with Amsel criteria, although Gram stain is the diagnostic standard. Newer laboratory tests that detect Gardnerella vaginalis DNA or vaginal fluid sialidase activity have similar sensitivity and specificity to Gram stain. Bacterial vaginosis is treated with oral metronidazole, intravaginal metronidazole, or intravaginal clindamycin. The diagnosis of vulvovaginal candidiasis is made using a combination of clinical signs and symptoms with potassium hydroxide microscopy; DNA probe testing is also available. Culture can be helpful for the diagnosis of complicated vulvovaginal candidiasis by identifying nonalbicans strains of Candida. Treatment of vulvovaginal candidiasis involves oral fluconazole or topical azoles, although only topical azoles are recommended during pregnancy. The Centers for Disease Control and Prevention recommends nucleic acid amplification testing for the diagnosis of trichomoniasis in symptomatic or high-risk women. Trichomoniasis is treated with oral metronidazole or tinidazole, and patients' sex partners should be treated as well. Treatment of noninfectious vaginitis should be directed at the underlying cause. Atrophic vaginitis is treated with hormonal and nonhormonal therapies. Inflammatory vaginitis may improve with topical clindamycin as well as steroid application.
阴道炎是指任何伴有异常阴道分泌物、异味、刺激、瘙痒或烧灼感等症状的病症。阴道炎最常见的病因包括细菌性阴道病、外阴阴道假丝酵母菌病和滴虫病。当明确病因时，细菌性阴道病约占 40%至 50%，外阴阴道假丝酵母菌病占 20%至 25%，滴虫病占 15%至 20%。非感染性病因，包括萎缩性、刺激性、过敏性和炎症性阴道炎，较为少见，约占阴道炎病例的 5%至 10%。阴道炎的诊断采用症状、体格检查结果以及门诊或实验室检查相结合的方式。细菌性阴道病传统上采用 Amsel 标准诊断，尽管革兰氏染色是诊断标准。检测阴道加德纳菌 DNA 或阴道液唾液酸酶活性的新型实验室检测方法与革兰氏染色具有相似的敏感性和特异性。细菌性阴道病采用口服甲硝唑、阴道用甲硝唑或阴道用克林霉素治疗。外阴阴道假丝酵母菌病的诊断采用临床体征和症状与氢氧化钾显微镜检查相结合的方式；也可进行 DNA 探针检测。培养有助于诊断非白假丝酵母菌引起的复杂性外阴阴道假丝酵母菌病。外阴阴道假丝酵母菌病的治疗包括口服氟康唑或局部唑类药物，尽管在怀孕期间仅推荐局部唑类药物。美国疾病控制与预防中心建议对有症状或有高危因素的女性进行核酸扩增检测以诊断滴虫病。滴虫病采用口服甲硝唑或替硝唑治疗，患者的性伴侣也应接受治疗。非感染性阴道炎的治疗应针对潜在病因。萎缩性阴道炎采用激素和非激素治疗。局部应用克林霉素和类固醇可能会改善炎症性阴道炎。
