27 (1) (

43/12),

1

.

2

, .
3


.
1 ,
,

,
.
4

.

. 07-6510/2
07 2012

____________________

13.09.2011

()
Trichomoniasis
()

,
, .

. , ,
,
, , ,
() .
: Trichomoniasis ( T.vaginalis), (),
,
(Prevotella sp,Ureaplasma, Mycoplasma, Gardnerella vaginalis, ),
Candidiasis ( C.Albicans).
C.Trachomatis N.gonorrhoeae .
, ,

.

. -
. ,
pH
, KOH () - 1. pH
; pH
4,5. pH ,
. : 0,9% ,
10% KOH ().
, KOH
.
.
T.vaginalis clue (
),
. KOH, .
, C.albicans T.vaginalis
, 50% nucleic
acid amplification test(NAAT) .
1

, KOH ,
.
,
, , , ,
.
()
hydrogen
peroksid (H2O2) (Lactobacillus sp.)
( ,, Prevotella sp., Mobiluncus sp., Gardnerella
vaginalis, Ureaplasma, Mycoplasma hominis ).
,
.
,
, , ,
lactobacilli.
,
. , (HIV,
Neisseria Gonorrhoeae, Chlamydia trachomatis HSV-2) ,
.
.

() ( ). -

:
, ,
clue
pH 4,5
10% KOH ( whiff test)
G.Vaginalis
.
.

.

.
HIV, Neisseria Gonorrhoeae, Chlamydia trachomatis .

Metronidazole 500 mg 7 .

Metronidazole 0,75%, (5g) , ,

5 .

Clindamycin 2%, (5g) ,

7 .

:
24 . Clindamycin
.
,
, .

. ,
.

Tinidazole 2 2g 2

Tinidazole 1g 5

Clindamycin 100mg 3

Clindamycin 300mg 7
750mg 1
7 , single dose Clindamycin ,
.
Lactobacilli
.
.

,
.
, .
. ,
.
, -
4 6 ,
.

.

,
.


Clindamycin
.
2

,
3

, ,
.

.
(
, , , ),

.
( ).
250 mg . ,
500 mg.

.
,
- .

Metronidazole 500mg , 7 .

Metronidazole 250mg , 7 .

Clindamycin 300mg 7 .
(
) .
,
.
,
,
. U.S. Preventive Services Task Force (USPSTF)
, 40%
13 22 ..
20 ..
.
(
) . ,
.

.
.
TRICHOMONIASIS
trichomoniasis T. vaginalis.
T.vaginalis , -
. :
, , - . ,
. , T.vaginalis
.

 T.vaginalis ( ,
, , , ).
, , , 60-70% ,
. ,
T.vaginalis. ,
, T.vaginalis.
, liquid-based
. , - ,
. PCR T.vaginalis
( 88 97%, 98
99%).
, ,
, . , NAAT (PCR)
T.vaginalis kaj .
T.vaginalis ( ,
).

Metronidazole 2g .

Tinidazole 3 2g .

Metronidazole 500mg 7 .

. , FDA .
90 95% , 86 100%.
. ,
, (2g) ,

, .

() .
.

2g ,
500mg 7 .

2g, 5 . ,
, T. vaginalis
.

,
5



.

,
.
.
, (
50 %).

(
, ). ,
. ,
, , ,
2g, .

.
.
12 24
. ,
3 .

T.vaginalis
.
(2g)
500mg 7 . ,
T.vaginalis .
()
Candida albicans, Candida sp.
. . , , .
. 75 % , 40 45%
. ,
, .
10 20%
.


Candida vaginitis :
, , . , ,
, .
1) ( , 10% KOH)
6

 , 2)
. Candida vaginitis pH ( 4,5),
pH . 10% KOH

.
KOH ,
. ,
Candida.
, ,
. Candida
,
10 20% Candida sp. .
.
.

( ,, 1 3
) . .
80 90% .

:
Butoconazole 4 2% 5g 3

Clotrimazole 1% 5g 7-14

Clotrimazole 2% 5g 3

Miconazole 2% 5g 7

Miconazole 4% 5g , 3

Miconazole 100mg , 7

Miconazole 200mg 3

Miconazole 1200mg , 1

Tioconazole1 6,5 % 5g

Nystatin 100,000- , 14

Butoconazole12% 5g ( )
.

Terconazole1 0,4% 5g 7

Terconazole1 0,8% 5g 3.
4

,
7


Terconazole1 80mg 3 .

:
Fluconazole 150mg , .
:
.
,
2 ,
.

.

2
.

,
. .. balanitis
glans penis .
.

,

, .
.
astemizole, , cisaprid, coumadin, cyclosporine A,
, phenytoin, , terfenadin, tacrolimus, theophyllin, trimetrexate,
rifampin warfarin.

()
,
- 5%.
,
. , non-albicans species,
Candida glabrata (
). C. glabrata non albicans Candida species
10 20% .
C. albicans.


C.albicans
. ( 7 14 100, 150 200mg.
Fluconazol 3 , , 1, 4 7)
.

(100, 150 200mg) 6
. ,
.
. , 30
50% .
. C.albicans

.

( , ,
) .
: 7 14 150mg fluconazole
, 72 .
Non-albicans
. (7-14 ) ( ) .
600mg 5,
2 . 70% .
, .


( ,
) .
(7-14 ).

.
7 .

,
9


. Candida
.
.
,
. fluconazole 200mg
C.albicans ,
.
,
.

1.

Centers for Disease Control and Prevention(CDC) . Diseases characterized by vaginal discharge.
In:Sexually transmitted diseases treatment guidelines,2010. MMWR Recomm Rep 2010 Dec
17;59(RR-12):56-63.

Guideline Developer(s)
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]
1.
2.
3.

NGC Guidelines, 13.09.2011, www.guideline.gov

4 .
2015 .

10