Method for the diagnosis of aerobic vaginitis


The invention relates to medicine, namely to gynecology, and is intended for the diagnosis of aerobic vaginitis. Determine the presence of clinical symptoms: discomfort, symptoms of inflammation, discharge. Microscopic examination of vaginal smears detect leukocyte reaction, the presence of intermediate layers of cells of the epithelium, the presence of single forms of lactobacilli in the presence of krupnoyacheistoy coccal flora. Conduct pH-metry vaginal discharge and linetest. When the pH value from 4.5 to 5.5 and negative aminoate diagnose aerobic vaginitis. The method allows us to simplify diagnostics and to improve its accuracy. 6 Il., 1 PL.

The invention relates to medicine and can be widely used in the diagnosis of sexually transmitted infections.

The doctrine of vaginal infections for a long time. Upon detection of Trichomonas vaginal secretion appeared vulvovaginal disease trichomoniasis, upon detection of yeast cells group - vulvovaginal candidiasis. But women are bothered by something "other". And here in 1892 scientists were asked to name the disease of the vagina caused especifica the agents. The intensive development of Microbiology this pathology since 1955 became known as vaginitis caused by Haemophilus int., and since 1963 - vaginitis, caused by Corynebacterium spp. In 1980, is referred to as nonspecific diseases of the vagina bacterial vaginosis. Scientific knowledge does not stand still, and in 1982, scientists have found that in some cases the pathological condition of the vagina does not occur such a state as inflammation (characterized by the presence of pain, swelling, heat and redness), and therefore suggested the name of anaerobic vaginosis, then in 1983 - nonspecific (bacterial) vaginosis.

Known bacterial vaginosis and method of diagnosis R. Amsel (Amsel) by detecting the key cells, homogeneous creamy vaginal discharge (vaginal discharge), determination of vaginal pH and conduct of the amine test. In women with bacterial vaginosis, producing amines flora raises pH 4.5 (Adaskevich VP of sexually transmitted Diseases. - Vitebsk, 1997, S. 173).

On Amsalu bacterial vaginosis is a polymicrobial clinical syndrome characterized by specific abnormalities of vaginal discharge and violation of the vaginal environment, which lactalia Bacteroides, Peptococcus, Gardnerella vaginalis, Mobiluncus spp, Micoplasma hominis. For the diagnosis of bacterial vaginosis Amsel suggested, as mentioned above, the following criteria: 1) abundant, homogeneous, frothy vaginal discharge, 2) the acidity of vaginal secretions pH 4.5, 3) smell (linetest positive), 4) presence of key cells microscopic examination of stained smears.

At least three of the above criteria may serve as a basis for diagnosis of bacterial vaginosis.

A set of proposed criteria can be characterized not only one disease - bacterial vaginosis. The proposed diagnosis may be applicable when the acidity of the vaginal (vaginal) allocations where the parameters specified pH just above the norm. (To date, the authors have accurately identified the status of acidity of the vagina: pH 5,0-8,0 observed in trichomoniasis, vulvo-vaginal candidiasis pH is 4.0 to 5.0, chlamydia pH 5.0 (see Glazkova L. K., N. Gerasimov.M. Bacterial vaginosis. Methodical manual. Edition 2nd revised and expanded, Yekaterinburg, 1996, S. 14-15, PL.1). Therefore, the statement that in bacterial vaginosis pH more than 4.5 today does not match the action is Evo-vaginal trichomoniasis, but the presence of key cells in most cases, inherent only in bacterial vaginosis. Thus, for the diagnosis of other diseases, vulvo-vaginal diseases requires a few other more detailed and specific features. This position has led us to propose diagnostic criteria aerobic vaginitis.

Also known vaginitis caused by aerobic microorganisms, and a method for its diagnosis, including 1) microscopy of native (wet) drugs, 2) seeding samples of the vaginal secretion, 3) determining the concentration of lactate, succinate and cytokines in swabs from the vagina, 4) the presence of clinical signs such as redness, inflammation, vaginal discharge yellow and pain in the vagina during intercourse. Diagnosis aerobic vaginitis set if: 1.1 the detection of Trichomonas and mobiluncus, 1.2 no smears lactic acid bacteria and the presence of cocci or large bacilli, 1.3 the presence of parabasal epithelial cells (vaginal epithelial represented by cells parabasal layers - more than 5 layers), 1.4 the presence of vaginal leukocytes in the epithelium of the vagina, 3.1 reduced lactate concentrations and the absence of production of succinate mucous membrane of the vagina, 4.1 available clinches the act). In addition, aerobic vaginitis is characterized in contrast to bacterial vaginosis the presence of strong local immune response with production of interleukin and inhibitory factor leukemia. Vaginitis caused by aerobic microorganisms, is an independent nosological form that is distinct from bacterial vaginosis and characterized by an abnormal composition of the vaginal microflora (Aerobic vaginitis is an entity with abnormal vaginal flora that is distinct from bacterial vaginosis. Dondtrs GGG, Vereecken A, Bosmans E, et al. Dept of Obstetrics & Gynecology, Univ Hospital Gasthuisberg, Katholieke Universiteit, Leuven, Belgium. Int J STD &AIDS 2001; 12 suppl 2:68. Abstract information of STIs, 2001, No. 5, S. 52).

Thus, aerobic vaginitis is an independent disease, associated with the propagation of aerobic microorganisms, mainly represented by Streptococcus group b and E. coli. Aerobic vaginitis differs from bacterial vaginosis, in particular, that induces local immune response. Infection of the lower genital organs in women, due to the aerobic flora and specifically localized at the level of the vagina is called aerobic vaginitis. Currently, in order to diagnose aerobic vaginitis, required bacteriological you the Phnom medical institutions, and the method of determining the quantitative content of the microorganism per 1 ml separable own secret only major diagnostic centers dermatological profile.

The objective of the invention is an improved method for the diagnosis of aerobic vaginitis.

The technical result that will be achieved from the use of the proposed technical solution, is to simplify, shorten and cheapen the diagnosis of aerobic vaginitis for more rapid diagnosis and appointment of adequate antibiotic therapy.

The technical result is achieved by the fact that aerobic vaginitis characterized by the presence of clinical symptoms (discomfort in the lower genital tract, focal or diffuse hyperemia of the mucous of the vagina, vaginal homogeneous aqueous and/or non-foamed PUR secretions), leukocyte reaction of 10 or more in a single field of view, a large number of intermediate cells of the epithelium, the presence of single forms of lactobacilli or their complete absence in the presence of krupnorazmernoj coccal flora and vaginal acidity detachable 4.5, further characterized by a negative aminoester and, is Satie smear from the mucous membrane of the vagina, microscopy of vaginal smears and pH-metry vaginal discharge (vaginal discharge), after pH-metry additionally spend minutest and microscopy of vaginal smears performed on the stained samples.

The essence of the invention consists in a new set of clinical signs, methods and diagnostic techniques for diagnosis in a variety of settings including outpatient environment.

The establishment of clinical symptoms (discomfort, focal or diffuse hyperemia of the mucous of the vagina, homogeneous aqueous and/or dense non-foamed PUR allocations); the identification of microscopic examination of leukocyte reaction of 10 or more in a single field of view, a large number of intermediate cells of the epithelium (more than 5 layers), the presence of single forms of lactobacilli or their complete absence in the presence of krupnorazmernoj coccal flora and the absence of any specific cells (gonococci, Trichomonas, yeast, "key"); pH from 4.5 to 5.5 and negative minutest allows easy accessible and affordable ways and methods in a short time to establish the correct diagnosis and appropriate adequate treatment. As minielite a basis for establishing diagnosaurus vaginitis.

The proposed diagnostic method most accurately describes typical symptoms include itching, burning, dysuria, United under the notion of discomfort in the genital area and dyspareunia, allows to isolate the clinical symptoms of inflammation (focal or diffuse hyperemia of the mucous of the vagina) and exudation (allocation homogeneous, thick and/or viscous non-foamed PUR) in the genital tract of women, laboratory confirmed with microscopy leukocyte reaction and the presence of intermediate vaginal epithelium (more than 5 layers). The maximum period of diagnosis from 30 minutes to one day.

The diagnostic method is carried out as follows.

Diagnosis aerobic vaginitis is a physician, dermatologist or Ob-GYN outpatient reception or professional examinations.

1. The doctor carefully conduct a survey with details of complaints, clinical examination data to be entered in the medical record.

2. Preparation of the vaginal smear and subsequent microscopy painted, for example, methylene blue on ZIL-Nilsson or Gram of the drug.

2.1. Fence vaginal discharge (secret) for subsequent microscopy carry out the multiple applications.

2.2. Deposition taken of material is carried out on two clean, dry and bulleted slides as follows. The glass is closer to the short side is applied with a sterile probe drop detachable vagina, then smear the drop on the glass. The smear is dried in the air. Dried smear should be uniform and thin. In this form the smear is ready for painting.

2.3. Staining of fixed drug: (a) one glass is colored with methylene blue for ZIL-Nilsson,

b) another glass stained by Gram.

2.4. Microscopy of stained vaginal smear carried out at different magnification in the light microscope.

3. The description of the General physical properties of vaginal discharge (amount, color, odor, texture, acidity) is recorded in the medical record.

3.1. Determination of pH (acidity) of vaginal discharge is carried out by sampling a sterile cotton swab material (vaginal discharge) from the vaults in the middle third of the posterior wall of the vagina and placed in a test tube with distilled water in an amount of 1 ml Then the test tube is placed a standard indicator paper (pHydron, USA with a scale measuring from 4.5 to 7 and Merck, USA with the appropriate division 3, the result after removing sterile vaginal mirrors single use, on which there is a vaginal discharge. Then medical pipette prilisaetsa a few drops of 10% KOH solution. The odor speaks of the presence of anaerobic microorganisms that produce amines. Under aerobic vaginitis smell is not observed, i.e. minutest negative, and consequently, the disease is caused by micro-organisms with aerobic type of breathing, the metabolism of which no derivatives of amine compounds.

The result of the comparison of data obtained with our proposed diagnostic criteria can be diagnosed aerobic vaginitis (without bacteriological confirmation).

The invention is illustrated by the following examples.

Example 1. Patient S., aged 27. I went to the doctor the dermatologist complaining of the following clinical signs: hemorrhagic discharge from the genital tract, abdominal pain, frequent urination. These symptoms are disturbed in the course of one year. Have repeatedly asked for medical assistance to the gynecologist for the place of residence of sexually transmitted infections (STIs), was found in a smear on flora was observed elevated leukocytes. Was diagnosed with Colpitis unclear etiology. Prescribed therapy drugs the

During the inspection were identified: focal hyperemia of the mucosa of the vulva and vagina; OTDELENIE homogeneous, thin, watery consistency, gray-yellow, non-foamed PUR. The mucosa of the cervix clean, detachable - Muco-prozrachnoe. The PH of the vaginal discharge of 5.2. Aminoet - negative. The quantitative content of leukocytes in vaginal smear 15-30 in the field of view, clusters of squamous epithelium.

Was diagnosed: Aerobic vaginitis. Chronic course.

Was assigned adequate treatment and during the control study, conducted one month after treatment, clinical signs aerobic vaginitis was not confirmed.

Example 2. Patient I., 37 years. Asked for examination before surgery for polycystic ovaries. Special had no complaints. Over the last six months of antibiotic therapy was not given. Other STIs are completely excluded. During the inspection were identified: weak diffuse hyperemia of the mucosa of the vagina; discharge not abundant, homogeneous, thin, gray-yellow, not frothy. The mucosa of the cervix clean; detachable Muco-transparent. the pH of the vaginal discharge 4,6, aminoet - negative. The quantitative content of the blood in vagina the CSOs adequate treatment of clinical signs of aerobic vaginitis was not confirmed.

Example 3. Sick Hours, 26 years. He complained of abdominal pain. Considers himself sick for 4-5years, have addressed to the gynecologist, STI was not found, but noted increased leucocytes in a smear. Exhibited diagnosis of nonspecific vaginitis were treated for a variety of antibiotic therapy, but the effect of the treatment was unstable. During the inspection noted: diffuse hyperemia of the mucosa of the vulva and vagina; detachable homogeneous, dense, load and with poor, green with a putrid odor. The mucosa of the cervix clean; detachable - Muco-serous. Aminoet - negative, pH of the vaginal discharge was not possible to measure. The quantitative content of leukocytes in vaginal smear 40-80 in the field of view, clusters of polymorphic intermediate epithelium.

Was diagnosed: Aerobic vaginitis. Relapsing course. Acute stage.

After the treatment the presence of aerobic vaginitis was not confirmed.

Example 4. Patient P., aged 26. I went to the doctor the dermatologist complaining of discharge from the genital tract, which concerned the last six months and appear once a month in the middle of the menstrual cycle. When viewed cervical mucous and m is 0, aminoet - positive. Quantitative contents of leucocytes in a smear 5-6 in sight, flora rod.

Diagnosis: Healthy.

Example 5. Patient M., aged 35. I went to the doctor the dermatologist complaining of liquid discharge from the genital tract, itching, burning, dyspareunia. Considers herself a patient in 2-3 months. Sexual partner permanent, casual sex denies. Inspection of the mucosa of the cervix redness, vaginal mucosa bright diffuse hyperemia, discharge not rich, not frothy, gray-green. Aminoet - negative, pH of the vaginal secretions of 7.0. Quantitative contents of leucocytes in a smear 40-80 in the field of view, the flora is diverse with the presence of trichomonads.

Diagnosis: Urogenital trichomoniasis. A chronic course. To confirm the proposed diagnostic method we conducted a survey of the culture on the flora vaginal discharge is detected Trichomonaus vaginalis.

Example 6. Patient W., 31. I went to the doctor the dermatologist complaining of constant discomfort in the genital area, infertility. Considers herself a patient in the course of 1.5 months. Sexual partner permanent, casual sex denies. When viewed cervical mucosa m is strongly positive, the pH of the vaginal discharge of 6.2. Quantitative contents of leucocytes in a smear 3-7 in sight, flora is rich and varied.

Diagnosed with Bacterial vaginosis.

To confirm the proposed diagnostic method we conducted a survey of sowing on the microflora of the vaginal discharge, were sown Gardnerella vaginalis at a concentration of 10 CFU/ml and Mobiluncus at a concentration of 10 CFU/ml

The proposed diagnostic method is tested on 104 patients attending for examination by the dermatologist in the Ural scientific research Institute of dermatology and immunology. Of them, according to the proposed criteria, only 35 patients were diagnosed with Aerobic vaginitis, 44 patients diagnosed with Bacterial vaginosis and 25 patients the diagnosis of Urogenital trichomoniasis.

Thus, the proposed method for the diagnosis of aerobic vaginitis is significant (p - 0,02), criterion x - 7,817. Its use will simplify, speed up and reduce the cost of diagnosis aerobic vaginitis (excluding routine bacteriological culture), allows you to more quickly diagnose and prescribe appropriate antimicrobial therapy.

Comparative data Crete is opetceska characteristic of vaginal smears in various diseases sexually transmitted shown in Fig.1-6.

In Fig.1 presents unaffected (healthy) cell epithelium of the vagina and the presence of healthy coli lactic acid bacteria.

In Fig.2 - the overall picture in bacterial vaginosis.

In Fig.3 and 5 also presents the microscopic picture in bacterial vaginosis. On the epithelial cells of the vagina are visible accumulations of bacteria that are intermediate and top of the cell wall (Fig.5). In Fig.4 shows the presence of mobiluncus in the form of curved pale pink sticks.

In Fig.6 clearly shows that the epithelial cell has no clear boundaries, there are a large number of leukocytes and damaged lactobacilli.


Method for the diagnosis of aerobic vaginitis, including the establishment of clinical symptoms: discomfort, symptoms of inflammation, the presence of secretions, as well as identifying microscopic examination of vaginal smear leukocyte reaction, the presence of intermediate layers of cells of the epithelium, the presence of single forms of lactobacilli in the presence of Krupnova minutest and at pH 4.5-5.5 and negative aminoate diagnose aerobic vaginitis.


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