细菌性阴道病合并下生殖道人乳头瘤病毒感染的全科诊断思路

Diagnosis of a Case of Bacterial Vaginosis and HPV Infection of the Lower Genital Tract in General Practice

细菌性阴道病(BV)合并下生殖道人乳头瘤病毒(HPV)感染是常见的妇科疾病,高危型HPV(HR-HPV)感染会导致外阴、阴道、宫颈鳞状上皮内瘤变(SIL)及宫颈癌的发生。目前,我国的宫颈癌筛查仍面临覆盖率不高、筛查诊治不规范、缺乏随访等问题,且随着分级诊疗步伐的不断迈进,HPV疫苗接种、社区宫颈癌筛查有望成为宫颈癌一级预防和二级预防的有效措施。全科医生对阴道感染等社区常见妇科疾病的接诊率和处理率亦有不断攀升的趋势,这对全科医生的岗位胜任力提出了新的要求。本文报道了全科医生在社区接诊的1例BV合并下生殖道HPV感染病例的诊治经过,并结合相关指南与文献进行分析,以期拓宽全科医生的全科思维,提高全科医生对妇科常见病诊治的岗位胜任力。

HPV infection of the lower genital tract is commonly found in bacterial vaginosis(BV)patients.High-risk HPV infection contributes to the squamous intraepithelial lesions of the vulva,vagina and cervix,even cervical cancer.Currently in China,the prevalence of cervical cancer screening is unsatisfied,and there is a lack of standardized procedures for screening,diagnosis and treatment of cervical cancer and follow-ups for such patients.However,with the development of hierarchical medical system,HPV vaccination and community-based cervical cancer screening are expected to become the primary and secondary preventive measures for cervical cancer.As the cases of vaginal infection and other common gynecological diseases encountered and managed by general practitioners(GPs)are increasing,GPs need to improve their professional competence.We analyzed a case of BV and HPV infection of the lower genital tract diagnosed and treated by the general practitioner based on the review of the related guidelines and literature,in order to improve GPs'understanding and management of such kind of disease.