Chandeying V, Skov S, Kemapunmanus M, Law M, Geater A, Rowe P
Department of Obstetrics-Gynaecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand.
Sex Transm Infect. 1998 Jun;74(3):194-201. doi: 10.1136/sti.74.3.194.
(1) To compare the effectiveness of two clinical protocols for the management of vaginal discharge in the situations where no laboratory facilities are available but speculum examination is possible and where basic laboratory facilities are available. (2) To determine clinical and simple laboratory indicators for diagnosis of patients with vaginal discharge in the local setting.
Alternate allocation of subjects to one of two management protocols.
Women presenting to university gynaecology outpatients department with a complaint of vaginal discharge.
Subjects were alternately allocated management according to one of two protocols: one without (group A) and one with (group B) immediate access to results of basic laboratory tests. Full clinical assessment including speculum examination and microbiological assessment for infection with gonorrhoea, chlamydia, candida, trichomonas, and bacterial vaginosis was performed on all women. Follow up assessment of clinical and microbiological response was performed 1-2 weeks later.
At initial assessment, both groups were similar in all respects except that more group B women had inflammation of the vulva. The prevalences of various conditions were: candidiasis 22%, bacterial vaginosis 38%, trichomoniasis 4%, chlamydia 4%, gonorrhoea 0.4%. There was no association between any demographic characteristic and diagnosis of cause of the discharge. Both protocols resulted in clinically and statistically significant improvements for women with candidiasis, bacterial vaginosis, and trichomoniasis. There were no clinically important differences in outcomes between the two protocols. The sensitivities and specificities of various indicators were: curd-like vaginal discharge for candidiasis, 72% and 100%; homogeneous vaginal discharge for bacterial vaginosis or trichomoniasis, 94% and 88%; absent or scanty lactobacilli for bacterial vaginosis, 99% and 68%; > 20% clue cells for bacterial vaginosis, 81% and 99%; visible endocervical mucopus for chlamydia or gonorrhoea, 36% and 86%; microscopic endocervical mucopus for chlamydia or gonorrhoea, 64% and 69%.
Both protocols were equally effective in managing women with abnormal vaginal discharge. Simple clinical indicators for candidiasis, bacterial vaginosis, or trichomonas as in protocol A are sufficiently sensitive and specific for use in situations with no laboratory support. A modification to protocol A could increase detection of bacterial vaginosis at basic health service level. Further work is needed to identify appropriate indicators for infection with chlamydia or gonorrhoea.
（1）比较在没有实验室设施但可进行窥器检查的情况下以及有基本实验室设施的情况下，两种临床方案对白带异常的治疗效果。（2）确定当地环境中白带异常患者诊断的临床和简单实验室指标。
将受试者交替分配到两种治疗方案之一。
因白带异常到大学妇科门诊就诊的女性。
受试者根据两种方案之一交替分配治疗：一种方案不（A组），另一种方案（B组）可立即获得基本实验室检查结果。对所有女性进行全面的临床评估，包括窥器检查以及对淋病、衣原体、念珠菌、滴虫和细菌性阴道病感染的微生物学评估。1至2周后进行临床和微生物学反应的随访评估。
在初始评估时，除了B组更多女性有外阴炎症外，两组在各方面均相似。各种疾病的患病率分别为：念珠菌病22%，细菌性阴道病38%，滴虫病4%，衣原体4%，淋病0.4%。任何人口统计学特征与白带异常病因诊断之间均无关联。两种方案对念珠菌病、细菌性阴道病和滴虫病患者均产生了临床和统计学上的显著改善。两种方案的结果在临床上无重要差异。各种指标的敏感性和特异性分别为：念珠菌病的凝乳状白带，72%和100%；细菌性阴道病或滴虫病的均质白带，94%和88%；细菌性阴道病的乳酸杆菌缺失或稀少，99%和68%；细菌性阴道病的线索细胞>20%，81%和99%；衣原体或淋病的可见宫颈黏液脓性分泌物，36%和86%；衣原体或淋病的显微镜下宫颈黏液脓性分泌物，64%和69%。
两种方案在治疗白带异常女性方面同样有效。方案A中念珠菌病、细菌性阴道病或滴虫病的简单临床指标在没有实验室支持的情况下使用时具有足够的敏感性和特异性。对方案A进行修改可在基本卫生服务水平提高细菌性阴道病的检出率。需要进一步开展工作以确定衣原体或淋病感染的合适指标。
