Pheifer T A, Forsyth P S, Durfee M A, Pollock H M, Holmes K K
N Engl J Med. 1978 Jun 29;298(26):1429-34. doi: 10.1056/NEJM197806292982601.
To assess the cause of nonspecific vaginitis, we performed a prospective case-control study of vaginal flora and a randomized unblinded trial of different therapies. Haemophilus vaginalis was isolated from 17 to 18 women with signs of vaginitis but only one of 18 normal matched controls (P less than 0.002). The concentration of anaerobic bacteria in vaginal washings also was increased in patients. Clinical improvement and eradication of H. vaginalis occurred in one of seven patients given sulfonamide vaginal cream, two of 15 given oral doxycycline, nine of 27 given oral ampicillin, and 80 of 81 given oral metronidazole. On the seventh day of therapy signs of nonspecific vaginitis persisted in 31 of 31 with, and in two of 92 without, persistent H. vaginalis infection (P less than 0.001). These data suggest the causal role of H. vaginalis in nonspecific vaginitis, possibly in concert with vaginal anaerobes. The widespread use of sulfonamide creams is inappropriate. Metronidazole is effective, but its efficacy must be weighed against its possible toxicity.
为评估非特异性阴道炎的病因，我们对阴道菌群进行了一项前瞻性病例对照研究，并对不同治疗方法进行了一项随机非盲试验。从17至18名有阴道炎体征的女性中分离出阴道嗜血杆菌，但18名正常匹配对照中只有1人分离出该菌（P小于0.002）。患者阴道冲洗液中厌氧菌浓度也升高。给予阴道磺胺乳膏治疗的7名患者中有1人、口服强力霉素治疗的15名患者中有2人、口服氨苄青霉素治疗的27名患者中有9人、口服甲硝唑治疗的81名患者中有80人临床症状改善且阴道嗜血杆菌被清除。在治疗的第7天，31名有持续性阴道嗜血杆菌感染的患者中有31人、92名无持续性阴道嗜血杆菌感染的患者中有2人仍有非特异性阴道炎体征（P小于0.001）。这些数据表明阴道嗜血杆菌在非特异性阴道炎中可能起因果作用，可能与阴道厌氧菌协同作用。广泛使用磺胺乳膏是不合适的。甲硝唑有效，但必须权衡其疗效与其可能的毒性。
