Blake D R, Duggan A, Quinn T, Zenilman J, Joffe A
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Pediatrics. 1998 Oct;102(4 Pt 1):939-44. doi: 10.1542/peds.102.4.939.
Given that highly sensitive urine-based nucleic acid amplification tests may eliminate the need for speculum exam to diagnose gonorrhea and chlamydia cervicitis, we sought to determine if vaginal infections could be diagnosed without using a speculum.
Matched pairs of vaginal specimens were collected from participants before and during speculum exam for diagnosis of trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis. Females age 12 to 22 years presenting to the Johns Hopkins adolescent primary care clinics who required a pelvic examination were eligible to participate. A convenience sample of 686 patients was recruited between July 1995 and August 1996. Paired vaginal specimens were evaluated with blinded microscopic evaluation. Analysis consisted of: 1) comparison of collection method sensitivities; and 2) assessment of proportions of infections detected by one method that were also detected by the other method.
Sensitivities of speculum and nonspeculum collection methods were 75% and 77% (difference = -2%; 95% confidence interval, -11%, 7%) for trichomoniasis, 64% and 68% (difference = -4% [-10%, 3%]) for bacterial vaginosis, and 85% and 80% (difference = 5% [-12%, 22%]) for vulvovaginal candidiasis. The speculum method identified 88% (trichomoniasis), 90% (bacterial vaginosis), and 81% (vulvovaginal candidiasis) of infections detected by the nonspeculum method. The nonspeculum method identified 91% (trichomoniasis), 95% (bacterial vaginosis), and 76% (vulvovaginal candidiasis) of infections detected by the speculum method.
Vaginal infections can be adequately diagnosed without a speculum. Once urine-based diagnosis of gonorrhea and chlamydia becomes well established, it may be possible to perform evaluations for uncomplicated genitourinary complaints without using a speculum.
鉴于高灵敏度的尿液核酸扩增检测可能无需使用窥器检查来诊断淋病和衣原体宫颈炎，我们试图确定不使用窥器能否诊断阴道感染。
在进行窥器检查之前和期间，从参与者处采集配对的阴道标本，用于诊断滴虫病、细菌性阴道病和外阴阴道念珠菌病。年龄在12至22岁、前往约翰霍普金斯青少年初级保健诊所且需要进行盆腔检查的女性有资格参与。1995年7月至1996年8月期间招募了686例患者的便利样本。对配对的阴道标本进行盲法显微镜评估。分析包括：1）比较采集方法的灵敏度；2）评估一种方法检测到的感染中也被另一种方法检测到的比例。
对于滴虫病，窥器和非窥器采集方法的灵敏度分别为75%和77%（差异=-2%；95%置信区间，-11%，7%）；对于细菌性阴道病，分别为64%和68%（差异=-4%[-10%，3%]）；对于外阴阴道念珠菌病，分别为85%和80%（差异=5%[-12%，22%]）。窥器方法检测出非窥器方法检测到的感染中的88%（滴虫病）、90%（细菌性阴道病）和81%（外阴阴道念珠菌病）。非窥器方法检测出窥器方法检测到的感染中的91%（滴虫病）、95%（细菌性阴道病）和76%（外阴阴道念珠菌病）。
不使用窥器也能充分诊断阴道感染。一旦基于尿液的淋病和衣原体诊断得以确立，对于无并发症的泌尿生殖系统疾病主诉，可能无需使用窥器进行评估。
