European Journal of Clinical Microbiology & Infectious Diseases ( IF 4.5 ) Pub Date : 2021-05-03 , DOI: 10.1007/s10096-021-04265-8 Marjan J Bruins 1 , Claudy Oliveira Dos Santos 1 , Roger A M J Damoiseaux 2 , Gijs J H M Ruijs 1
Vulvovaginitis is a common problem in the GP’s practice. Causes are bacterial vaginosis (BV), Candida infection and sexually transmitted infections (STIs). Only if empirical treatment fails, a vaginal swab is sent in for culture and BV detection. However, without culture essential, bacterial pathogens may escape diagnosis. Many molecular BV assays have recently appeared on the marketplace, all quite differing in price and targets. However, for years, the Nugent score has been the gold standard for BV detection. We analysed retrospectively 10 years of microbiology results of vulvovaginal swabs, focusing on less frequently reported bacterial pathogens, and assessed the characteristics of BV diagnostics. Vulvovaginal swabs sent in between 2010 and 2020 from > 11,000 GP patients with vulvovaginitis associated symptoms, but negative STI tests, were analysed. First cultures and repeat cultures after at least 6 months were included in four age groups: < 12, 12–17, 18–51 and > 51 years. Candida species and BV were most frequently found, with the highest prevalence in premenopausal women. Haemophilus influenzae, beta-haemolytic streptococci, Streptococcus pneumoniae and Staphylococcus aureus were isolated in 5.6% of all cultures, with the highest percentages in children and postmenopausal women. If empirical treatment of vulvovaginitis fails, bacterial culture should be performed to detect all potentially pathogenic microorganisms to obtain a higher rate of successful diagnosis and treatment, avoiding unnecessary antimicrobial use and costs. For BV detection, molecular testing may seem attractive, but Nugent scoring still remains the low-cost gold standard. We recommend incorporating the above in the appropriate guidelines.
中文翻译:
外阴阴道炎和阴道分泌物的细菌因子:荷兰一项为期 10 年的回顾性研究
外阴阴道炎是全科医生实践中的常见问题。原因是细菌性阴道病 (BV)、念珠菌感染和性传播感染 (STI)。只有当经验性治疗失败时,才会送入阴道拭子进行培养和 BV 检测。然而,如果没有必要的培养,细菌病原体可能无法诊断。最近市场上出现了许多分子 BV 检测,它们的价格和目标都大不相同。然而,多年来,Nugent 评分一直是 BV 检测的黄金标准。我们回顾性分析了 10 年外阴阴道拭子的微生物学结果,重点关注报告较少的细菌病原体,并评估了 BV 诊断的特征。分析了 2010 年至 2020 年期间从超过 11,000 名有外阴阴道炎相关症状但 STI 检测结果为阴性的 GP 患者发送的外阴阴道拭子。至少 6 个月后的首次培养和重复培养包括在四个年龄组中:念珠菌属和 BV 最常见,绝经前妇女的患病率最高。5.6% 的培养物中分离出流感嗜血杆菌、β-溶血性链球菌、肺炎链球菌和金黄色葡萄球菌,其中儿童和绝经后妇女的比例最高。如果外阴阴道炎的经验性治疗失败,应进行细菌培养,检测所有潜在的病原微生物,以获得更高的诊断和治疗成功率,避免不必要的抗生素使用和费用。对于 BV 检测,分子检测似乎很有吸引力,但 Nugent 评分仍然是低成本的黄金标准。我们建议将上述内容纳入适当的指南。