Ferris D G, Hendrich J, Payne P M, Getts A, Rassekh R, Mathis D, Litaker M S
Medical Effectiveness Education and Research Program, Medical College of Georgia, Augusta 30912, USA.
J Fam Pract. 1995 Dec;41(6):575-81.
The traditional diagnosis of vaginitis incorporates patient symptoms, clinical findings observed during vaginal examination, and laboratory analysis of vaginal fluid. The purpose of this study was to evaluate routine clinician-performed office laboratory diagnostic techniques for women with abnormal vaginal symptoms, and to compare these results with those obtained by a DNA hybridization test for Trichomonas vaginalis, Gardnerella vaginalis, and Candida species.
The study included 501 symptomatic women who were between the ages of 14 and 67 years. Three vaginal specimens were obtained for saline wet mount, potassium hydroxide (KOH) prep, amine "sniff", pH, and nucleic acid hybridization (T vaginalis, G vaginalis, and Candida sp) tests. Clinicians and medical technicians independently evaluated the wet mount, KOH prep, amine, and pH tests. A medical technician processed the DNA tests according to manufacturer's protocol.
Of 499 subjects for whom complete data were available, vulvovaginal candidiasis was diagnosed in 20.0%, vaginal trichomoniasis in 7.4%, and bacterial vaginosis in 52.1%. Fourteen percent of subjects had multiple vaginal infections. The sensitivity and specificity of clinician microscopically diagnosed vulvovaginal candidiasis, vaginal trichomoniasis, and bacterial vaginosis were 39.6% and 90.4%, 75.0% and 96.6%, and 76.5% and 70.8%, respectively. The sensitivity and specificity of the DNA probe diagnosis of the same types of vaginitis were 75.0% and 95.7%, 86.5% and 98.5%, and 95.4% and 60.7%, respectively. When only women with multiple vaginal infections were considered, the percentages of correct clinician diagnoses for vulvovaginal candidiasis, vaginal trichomoniasis, and bacterial vaginosis were 49.3%, 83.6%, and 59.7%, respectively. For the DNA probe test, the percentages of correct diagnoses were 72.9%, 92.9%, and 90.0%, respectively.
Primary care clinicians demonstrated a high specificity but low sensitivity when identifying vaginal trichomoniasis and vulvovaginal candidiasis by microscopic techniques. Correct microscopic diagnosis of bacterial vaginosis was even more difficult for clinicians, as was the diagnosis of multiple vaginal infections. Clinicians were not as accurate as the DNA probe test in diagnosing vaginal infections. Clinicians need more education in the laboratory diagnosis of vaginitis. Clinicians should carefully scrutinize each microscopic slide, systematically examine the slide for each type of vaginitis, and consider specimen pH and the presence of leukocytes, Lactobacillus organisms, or amine odor as additional clues to infection.
阴道炎的传统诊断方法包括患者症状、阴道检查时观察到的临床体征以及阴道分泌物的实验室分析。本研究的目的是评估临床医生常规进行的门诊实验室诊断技术在诊断有异常阴道症状女性中的应用，并将这些结果与通过DNA杂交试验检测阴道毛滴虫、加德纳菌和念珠菌属所获得的结果进行比较。
该研究纳入了501名年龄在14至67岁之间有症状的女性。采集三份阴道标本用于生理盐水湿片、氢氧化钾（KOH）涂片、胺试验、pH值测定以及核酸杂交（检测阴道毛滴虫、加德纳菌和念珠菌属）试验。临床医生和医学技术人员分别对湿片、KOH涂片、胺试验和pH值测定进行评估。医学技术人员按照制造商的方案进行DNA检测。
在可获得完整数据的499名受试者中，外阴阴道念珠菌病的诊断率为20.0%，阴道毛滴虫病为7.4%，细菌性阴道病为52.1%。14%的受试者患有多种阴道感染。临床医生通过显微镜诊断外阴阴道念珠菌病、阴道毛滴虫病和细菌性阴道病的敏感性和特异性分别为39.6%和90.4%、75.0%和96.6%、76.5%和70.8%。DNA探针诊断相同类型阴道炎的敏感性和特异性分别为75.0%和95.7%、86.5%和98.5%、95.4%和60.7%。仅考虑患有多种阴道感染的女性时，临床医生对外阴阴道念珠菌病、阴道毛滴虫病和细菌性阴道病的正确诊断率分别为49.3%、83.6%和59.7%。对于DNA探针检测，正确诊断率分别为72.9%、92.9%和90.0%。
基层医疗临床医生通过显微镜技术识别阴道毛滴虫病和外阴阴道念珠菌病时显示出高特异性但低敏感性。临床医生正确显微镜诊断细菌性阴道病甚至更困难，诊断多种阴道感染也是如此。临床医生在诊断阴道感染方面不如DNA探针检测准确。临床医生在阴道炎的实验室诊断方面需要更多培训。临床医生应仔细检查每张显微镜载玻片，系统地检查玻片以查找每种类型的阴道炎，并将标本pH值以及白细胞、乳酸杆菌或胺味的存在视为感染的额外线索。
