不像念珠菌感染 細菌性陰道炎可能是性傳染病


  July 29, 2005 - 根據一項發表於7月號婦科與產科學期刊上比較婦女的行為試驗顯示,不像念珠菌感染,細菌性陰道炎可能是一種性傳染疾病。
  
  澳洲維多利亞墨爾本Alfred醫院Catriona Susan Bradshaw醫師與其同事表示,細菌性陰道炎與荷爾蒙因素及性行為習慣有關;然而,其成因未明,而且細菌性陰道炎是否是一種性傳染疾病目前仍有爭議。為了研究細菌性陰道炎是否與特定性行為習慣、或是與性傳染疾病有共同的特色,我們比較了感染細菌性陰道炎、或是念珠菌婦女之間的行為。
  
  2003年7月到2004年8月之間,在墨爾本性健康中心,342位有異常陰道分泌物或是異味的婦女參與這項試驗,並且完成了一份有關地區性、行為性、與使用避孕措施習慣的問卷。
  
  342位婦女中,157位被診斷為細菌性陰道炎、51位透過顯微鏡被診斷為念珠菌感染、另外95位已黴菌培養診斷為念珠菌感染;細菌性陰道炎,而不是念珠菌感染,與高性行為風險,包括新性伴侶、或是在過去一年中有多重性伴侶、一生中的性伴侶數目、低教育程度、曾經懷孕、以及吸菸有關(P<.05)。
  
  而念珠菌的感染與肛交、口交以及使用灌洗器有關;細菌性陰道炎的發生與使用口服避孕藥物成負相關,且在月經週期的前17天的感染機率較高;然而,念珠菌感染傾向於發生在月經週期的黃體期。
  
  試驗限制包括了這是項觀察性試驗、少部份女同性戀及性工作者參與這項試驗、可能有未發現的干擾因素、很難將這些病例與控制組區分、而且控制組感染性傳染疾病的風險可能比一般群眾高;細菌性陰道炎與性傳染疾病有關的行為之間的關連,相對於念珠菌感染,暗示了這可能是一種性傳染疾病;最終,只有前瞻性與性伴侶試驗、以及找出造成細菌性陰道炎的特定因子,才能建立細菌性陰道炎是否是透過性行為傳染的。

Bacterial Vaginosis, Unlike Ca

By Laurie Barclay, MD
Medscape Medical News

July 29, 2005 — Unlike candidiasis, bacterial vaginosis may be a sexually transmitted disease, according to the results of a study comparing behaviors in women reported in the July issue of Obstetrics & Gynecology.

"Bacterial vaginosis has been associated with hormonal factors and sexual practices; however, the cause is unclear, and the notion that bacterial vaginosis is a sexually transmitted infection is still debated," write Catriona Susan Bradshaw, MD, FAChSHM, from the Alfred Hospital in Melbourne, Victoria, Australia, and colleagues. "To investigate whether bacterial vaginosis is associated with specific sexual practices or instead has features in common with a sexually transmitted infection, we compared behavioral associations in women with bacterial vaginosis to women with vaginal candidiasis."

At Melbourne Sexual Health Centre between July 2003 and August 2004, 342 women with symptoms of abnormal vaginal discharge or odor were enrolled in the study and completed a questionnaire concerning demographics and behavioral and contraceptive practices.

Of the 342 women, 157 were diagnosed as having bacterial vaginosis, 51 had candidiasis by microscopy, and 95 had candidiasis by culture. Bacterial vaginosis, but not candidiasis, was associated with indicators of high-risk sexual behavior including a new sexual partner and greater number of male partners in the last year, greater number of lifetime sexual partners, less than 13 years of education, past history of pregnancy, and smoking (P < .05).

Candidiasis was associated with practices such as receptive anal and oral sex and douching. Bacterial vaginosis was negatively associated with oral contraceptive use, and there was a trend toward occurrence in the first 17 days of the menstrual cycle. However, candidiasis tended to occur in the luteal phase of the menstrual cycle.

Study limitations include observational design, low number of lesbians and sex workers participating in the study, possible unmeasured confounding, difficulty in clearly separating cases from controls, and control group likely to have been at higher risk of sexually transmitted infections than average for the general community. "The association between bacterial vaginosis and practices that are associated with sexually transmitted infections, in contrast to those observed with candidiasis, suggests a possible sexually transmitted cause," the authors write. "Ultimately, only prospective and partner studies and identification of the specific causative factor responsible for bacterial vaginosis, will be able to establish whether bacterial vaginosis is sexually transmitted."

Dr. Bradshaw holds a National Medical and Research Council Research Scholarship.

Obstet Gynecol. 2005;106:105-114

Reviewed by Gary D. Vogin, MD

    
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