阴道感染及阴道炎谢美全科医师.pptVIP

谢医师简介 American board-certified family physician practicing medicine in Beijing for the last 7 years at BJU. I had 7 years experience before that in the U.S. and New Zealand in private practice. I am married with 2 sons.? I have wanted to be a family physician since I was 4 years old. 美国家庭科执照医师，近7年在BJU工作 曾在美国和新西兰从事私人医生职业7年 我已经结婚并有2个儿子，我从4岁起就想成为一名家庭医生了 Vaginal Infections and Vaginitis阴道感染及阴道炎 Dr. Marie Shieh 谢美虹 医师 Family Physician 全科医师 Vaginal and Genital Infectionsand Irritations Bacterial vaginosis 细菌性阴道病 Candida Vaginitis 念珠菌性阴道炎 Trichomonas vaginitis 滴虫阴道炎 Atrophic Vaginitis 萎缩性/老年性阴道炎 Streptococcal Vaginitis 链球菌阴道炎 Desquamative Inflammatory Vaginitis 炎性脱屑性阴道炎 Noninfectious Vaginitis 非感染性阴道炎 Cervicitis 宫颈炎 General Approach一般接诊步骤 Symptoms 症狀 Pruritis, irritation, burning, odor, dysuria 搔痒 刺激感 烧灼感 臭味 排尿困難 Sexual history 性交史– new partner 新性伴侶？ Abdominal pain (PID) 腹痛 (盆腔炎) Hygeine: pantyliners 卫生: 护垫 Medications药物: antibiotics/contraceptives/antifungals 抗生素 避孕药 抗真菌药 Timing with menses 与月经时间的关系 Candida is often premenstrual 念珠菌感染通常在经期前发生 Trichomonas is often during or right after menses 滴虫感染通常在经期当中或之后 Vaginal symptoms 症状 Vaginal discharge 白带增多 Pruritis or itching 瘙痒 Soreness 疼痛 Burning 烧灼感 Odor 臭味 Dyspareunia – pain with intercourse 性交痛 Bleeding 出血 Dysuria – pain with urination 尿痛 General Approach一般接诊步骤 Physical Exam 查体 Vulva 外阴– erythema, edema, fissure formation suggest cadida, trichomoniasis or dermatitis 红肿龟裂，提示：念珠菌，滴虫，皮炎 Vulvar discharge 阴门分泌物 – unreliable 并不可靠 Greenish yellow 黄绿色 – trichomonas 滴虫 Cottage-cheese 豆腐渣样 – candida 念珠菌 Fishy smelling/grey 鱼腥味/灰色 – bacterial vaginosis 细菌性阴道病 Cervical inflammation vs ectropion 宫颈炎症 vs 宫颈外翻 Abdominal or cervical motion tenderness 宫颈举痛 Cervical ectropion vs cervicitis宫颈外翻 vs 宫颈炎 Diagnostic studies Vaginal pH 阴道酸碱度 – apply to vaginal sidewall 置于阴道侧壁 pH5 bacterial vaginosis or trichomonas pH值大于5细菌性阴道病或滴虫感染 pH4-5 candida pH值在4-5念珠菌感染 Microscopy within 10-20 minutes of collection 10~20分钟内镜检分泌物标本 Saline: c