Internal Medicine, Thomas Jefferson University, Jefferson Women's Primary Care, 700 Walnut Street 2nd Floor, Philadelphia, PA 19106, USA.
Med Clin North Am. 2023 Mar;107(2):299-315. doi: 10.1016/j.mcna.2022.10.009. Epub 2022 Dec 26.
Vaginal symptoms are one of the most common reasons women consult with physicians and can significantly impact quality of life. The differential diagnosis of vaginal discharge includes physiologic discharge, vaginitis, cervicitis, and pelvic inflammatory disease (PID). Vaginitis is inflammation of the vagina, most commonly caused by bacterial vaginosis (BV), vulvovaginal candidiasis, and trichomoniasis infections. Cervicitis is an inflammation of the cervix and typically caused by Chlamydia trachomatis and Neisseria gonorrhoeae. PID is infection of the female upper genital tract, involving the uterus, fallopian tubes, ovaries, and/or pelvic peritoneum and usually caused by Chlamydia trachomatis, Neisseria gonorrhoeae, and bacterial vaginosis-associated pathogens. A pelvic exam should be performed for any woman presenting with vaginal discharge to confirm the diagnosis and rule out an upper tract infection. BV and vulvovaginal candidal infections only require treatment if symptomatic and do not require partner therapy, whereas treatment and partner therapy is recommended for sexually transmitted illnesses, such as trichomoniasis, chlamydia and gonorrhea. Vaginitis may be uncomfortable, but rarely leads to serious long-term consequence, but pelvic inflammatory disease can lead to serious long-term sequelae, including increased risk for ectopic pregnancy, infertility, and chronic pelvic pain.
阴道症状是女性就诊医生的最常见原因之一，会显著影响生活质量。阴道分泌物的鉴别诊断包括生理性分泌物、阴道炎、宫颈炎和盆腔炎（PID）。阴道炎是阴道的炎症，最常见的病因是细菌性阴道病（BV）、外阴阴道假丝酵母菌病和滴虫病感染。宫颈炎是宫颈的炎症，通常由沙眼衣原体和淋病奈瑟菌引起。PID 是女性上生殖道的感染，涉及子宫、输卵管、卵巢和/或盆腔腹膜，通常由沙眼衣原体、淋病奈瑟菌和与细菌性阴道病相关的病原体引起。对于任何出现阴道分泌物的女性，都应进行盆腔检查以确认诊断并排除上生殖道感染。如果出现症状，BV 和外阴阴道假丝酵母菌感染仅需治疗，而不需要伴侣治疗，而对于性传播疾病，如滴虫病、衣原体和淋病，则推荐进行治疗和伴侣治疗。阴道炎可能会引起不适，但很少导致严重的长期后果，但盆腔炎可导致严重的长期后果，包括异位妊娠、不孕和慢性盆腔疼痛的风险增加。
