Study On The Clinical Diagnosis Of Bacterial Vaginosis, Its Mixed Infections And Its Relationship With Mycoplasma

Bacterial vaginosis is one of the most common vaginal infections in women ofreproductive age,the infection rate of 15% to 50%,cure rates of 80～90% atlweek,but recurrence rates of 15～C30% within 3 months.BV easily causes a variety ofobstetric and gynecologic complications,and has a serious impact on women'sreproductive health.The study on the clinical diagnosis and pathogenesis of BV isparticularly important.This study will explore diagnosis and the clinical features of BV and its mixedinfection,and explore mycoplasma (Ureaplasma urealyticum,Mycoplasmagenitalium) whether to participate in the pathogenesis of BV.SectionⅠ.The diagnosis of bacterial vaginosisObjective:To evaluate the sensitivity and specificity of each indicator in the Amselmethod;the Nugent method as the gold standard,to evaluate sensitivity and specificity of theAmsel,BVBlue,and BVsualn on BV;the Nugent method as gold standard method,toevaluate whether BVBlue,BVBlue+pH,BVBlue+amine test,and BVBlue+clue cells willimprove the diagnostic sensitivity and specificity.Methods:100 cases who were diagnosed with BV were randomly selected fromJuly 2008 to December 2008 in gynecologic outpatient clinic in the General Hospitalof Tianjin Medical University General.At the same time 100 non-vaginitis womenwere selected as control group.Result:The most reliable indicator of Amsel was the presence of clue cells,with a highsensitivity and specificity,followed by amine test.The kappa coefficient of the four detectionmethods(the Nugent method,the Amsel method,BVBlue,and BVSualn) was more than0.7.The Nugent method as the gold standard,the sensitivity and specificity of three detectionmethods respectively,Amsel:96%,99%,0.975;BVBlue:87%,99%,0.929;BV-speed blue:81%,98%,0.894.The Nugent method as the gold standard,the combination of BVBlue and any indicator of the Amsel respectively,BVBlue+pH:71%,100%,0.854;BVBlue+amine test:73%,100%,0.864;BVBlue+clue cells:83%,100%,0.914.The results suggest that BVBlue andBVSulan are both objective diagnostic methods on BV besides Amsel and Nugent.SectionⅡ.Clinical features of bacterial vaginosis mixed infectionsObjective:To explore clinical features of BV and its mixed infection,and providehelp for the clinical diagnosis of BV and its mixed infection.Methods:516 outpatients with vaginitis symptoms from April 2008 to December2008 in general gynecology in the General Hospital of Tianjin Medical Universitywere investigated randomly.Their infective ratio of bacterial vaginosis(BV),vulvovaginal eandidiasis(VVC),trichomonal vaginitis(TV),and aerobic vaginitis(AV)were analyzed by vaginal secretion examination.Result:BV was found in 61.63% of the women studied and was the commonestinfection diagnosed.BV mixed vaginal infections were diagnosed in 29.56%.VVC,TV,and AV infections were easily mixed with BV infection.Common symptoms inpatients with BV were foul smell,followed by leucorrhea increase,and generally notaccompanied by changes in leucorrhea character,genital itching and other symptoms.Vaginal pH value was usually more than 4.5.Vaginal cleanliness was mainlyⅠ°～Ⅱ°.symptoms and signs of BV mixed infections was atypical.Vaginal pH valuewas usuallymore than 4.5.Vaginal cleanliness was mainlyⅢ°～Ⅳ°.The resultssuggest that BV mixed infections were the most common vaginal infections,and weshould detect several common vaginal infections in the diagnosis of reproductive tractinfections.SectionⅢ.Study on the correlation between Mycoplasma infection andbacterial vaginosis Objective:Real-time PCR method quantitatively detect Uu and Mg DNA inpatients with BV and healthy controls,and at the same time quantitatively detect UuParvum biovar and Uu Urealyticum biovar.To determine whether Uu,Mg involved inthe pathogenesis of BV,and provide help to clinical diagnosis and treatment of BV.Methods:44 patients were diagnosed as BV by Nugent method,and at the sametime 88 cases as healthy control group.To extract vaginal secretions bacterial genomeDNA,real-time PCR methods was used to detect Uu,Mg DNA of vaginal secretions.Result:Uu was present in (65.9%) of 44 women with BV compared with (50.0%)of 88 women without BV(p=0.083);T960 was detected in (22.7%) of 44 women incomparison with (9.1%) of 88 women without BV(p=0.031).Mg was detected in 2(4.5%)of 44 with BV in comparison with 4(4.5%)of 88 women without BV(p=1.000).The study results suggest that T960 may be associated with the pathogenesis of BV.Conclusions1.Amsel,Nugent,BVBlue and BVSulan are diagnostic methods on BV.In additionto the Amsel and the Nugent,BVBlue and BVSulan are both Sensitive andSpecific on BV.2.Bacterial vaginosis is the most common vaginal infections,and easily mixed withother pathogens,especially with VVC,AV or TV.In the diagnosis of BV,to payattention to whether BV was mixed with other vaginal infections;and in thediagnosis of other vaginal infections,to pay attention to whether other vaginalinfections was mixed with BV.3.There was no correlation between Uu and BV,as well as Uu parvo biovar,but UuT960 biovar was associated with BV.People infected with Uu parvo biovar maybe normal carriers.Uu T960 biovar may lead to infection by itself or cooperatedwith other pathogeny.There was no correlation between Mg and BV.