Avaliação de corrimento vaginal

Melhores critérios clínicos.

Várias gotas de uma solução de KOH a 10% são adicionadas a uma amostra do corrimento vaginal. Um forte odor de peixe proveniente da mistura significa vaginose bacteriana.

Testes de pH + KOH: a precisão diagnóstica da combinação dos 2 testes, teste de pH e teste de aminas (whiff) com a adição de KOH, foi de 88% com um valor preditivo positivo de 62% em um estudo. Esses 2 critérios clínicos foram sugeridos para uso no diagnóstico de vaginose bacteriana em áreas carentes de recursos.[95]Mittal V, Jain A, Pradeep Y. Development of modified diagnostic criteria for bacterial vaginosis at peripheral health centres in developing countries. J Infect Dev Ctries. 2012 May 14;6(5):373-7. http://www.ncbi.nlm.nih.gov/pubmed/22610702?tool=bestpractice.com

As células-chave (clue cells) são células epiteliais que revestem a vagina e são cobertas por bactérias associadas à vaginose bacteriana; isso causa uma aparência granular distinta.[96]Amsel R, Totten PA, Spiegel CA, et al. Nonspecific vaginitis: diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983 Jan;74(1):14-22. http://www.ncbi.nlm.nih.gov/pubmed/6600371?tool=bestpractice.com [97]Simoes JA, Discacciati MG, Brolazo EM, et al. Clinical diagnosis of bacterial vaginosis. Int J Gynaecol Obstet. 2006 Jul;94(1):28-32. http://www.ncbi.nlm.nih.gov/pubmed/16756982?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: Fotomicrografia revelando bactérias aderentes às células epiteliais vaginais, conhecidas como células-chave (clue cells)Biblioteca de Imagens do CDC; M. Rein [Citation ends].

Considerada por alguns especialistas como o melhor exame para diagnosticar vaginose bacteriana.[9]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/toc.htm A coloração de Gram quantitativa é específica para vaginose bacteriana, mas de 20% a 30% são indeterminadas.​[81]Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae104/7619499 http://www.ncbi.nlm.nih.gov/pubmed/38442248?tool=bestpractice.com ​​​

Uma coloração de Gram pode ser avaliada pelos critérios de Nugent ou pelos critérios de Hay-Ison. Os critérios de Nugent relatam as proporções relativas dos diferentes morfotipos bacterianos. Os critérios de Hay-Ison são graduados: 0 para células epiteliais apenas; 1 para predominância de Lactobacillus; 2 para flora mista; 3 para predominância de Gardnerella e/ou Mobiluncus; e 4 para vaginite aeróbia com predominância de bactérias aeróbias. A British Association for Sexual Health and HIV recomenda o uso dos critérios de Hay-Ison em vez dos critérios de Nugent.[25]British Association for Sexual Health and HIV. UK National guideline for the management of bacterial vaginosis. 2012 [internet publication]. https://www.bashh.org/documents/4413.pdf

Testes de amplificação de ácido nucleico (NAATs, os quais incluem os ensaios de reação em cadeia da polimerase) estão disponíveis para os organismos comumente associados à vaginose bacteriana.[81]Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae104/7619499 http://www.ncbi.nlm.nih.gov/pubmed/38442248?tool=bestpractice.com ​Os NAATs são mais precisos que uma sonda de ácido nucleico, mas são caros.[82]Coleman JS, Gaydos CA. Molecular diagnosis of bacterial vaginosis: an update. J Clin Microbiol. 2018 Sep;56(9):e00342-18. https://journals.asm.org/doi/10.1128/JCM.00342-18 http://www.ncbi.nlm.nih.gov/pubmed/29769280?tool=bestpractice.com ​ Os testes tradicionais podem continuar sendo úteis para o diagnóstico dessas infecções devido ao seu custo mais baixo e à capacidade de alguns de proporcionar um diagnóstico rápido.[9]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/toc.htm [81]Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae104/7619499 http://www.ncbi.nlm.nih.gov/pubmed/38442248?tool=bestpractice.com ​[82]Coleman JS, Gaydos CA. Molecular diagnosis of bacterial vaginosis: an update. J Clin Microbiol. 2018 Sep;56(9):e00342-18. https://journals.asm.org/doi/10.1128/JCM.00342-18 http://www.ncbi.nlm.nih.gov/pubmed/29769280?tool=bestpractice.com

O swab vaginal autocoletado pode aumentar a capacidade de rastreamento ao remover barreiras ao exame.[75]Chinnock B, Yore M, Mason J, et al. Self-obtained vaginal swabs are not inferior to provider-performed endocervical sampling for emergency department diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis. Acad Emerg Med. 2021 Jun;28(6):612-20. https://onlinelibrary.wiley.com/doi/10.1111/acem.14213 http://www.ncbi.nlm.nih.gov/pubmed/33460481?tool=bestpractice.com [76]Barnes P, Vieira R, Harwood J, et al. Self-taken vaginal swabs versus clinician-taken for detection of candida and bacterial vaginosis: a case-control study in primary care. Br J Gen Pract. 2017 Dec;67(665):e824-9. https://bjgp.org/content/67/665/e824.long http://www.ncbi.nlm.nih.gov/pubmed/29158246?tool=bestpractice.com [77]Strauss RA, Eucker B, Savitz DA, et al. Diagnosis of bacterial vaginosis from self-obtained vaginal swabs. Infect Dis Obstet Gynecol. 2005 Mar;13(1):31-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1784556 http://www.ncbi.nlm.nih.gov/pubmed/16040325?tool=bestpractice.com [78]Smith K, Harrington K, Wingood G, et al. Self-obtained vaginal swabs for diagnosis of treatable sexually transmitted diseases in adolescent girls. Arch Pediatr Adolesc Med. 2001 Jun;155(6):676-9. https://jamanetwork.com/journals/jamapediatrics/fullarticle/190688 http://www.ncbi.nlm.nih.gov/pubmed/11386956?tool=bestpractice.com [79]Van Der Pol B, Williams JA, Taylor SN, et al. Detection of Trichomonas vaginalis DNA by use of self-obtained vaginal swabs with the BD ProbeTec Qx assay on the BD Viper system. J Clin Microbiol. 2014 Mar;52(3):885-9. https://journals.asm.org/doi/10.1128/JCM.02966-13?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed http://www.ncbi.nlm.nih.gov/pubmed/24391200?tool=bestpractice.com ​[80]Gaydos CA, Hsieh YH, Barnes M, et al. Trichomonas vaginalis infection in women who submit self-obtained vaginal samples after internet recruitment. Sex Transm Dis. 2011 Sep;38(9):828-32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157012 http://www.ncbi.nlm.nih.gov/pubmed/21844738?tool=bestpractice.com

Como Gardnerella vaginalis, Mycoplasma hominis, espécies de Prevotella, espécies de Porphyromonas, espécies de Bacteroides, espécies anaeróbias de Peptostreptococcus, espécies de Fusobacterium ou Atopobium vaginae.[20]Hill GB. The microbiology of bacterial vaginosis. Am J Obstet Gynecol. 1993 Aug;169(2 Pt 2):450-4. http://www.ncbi.nlm.nih.gov/pubmed/8357043?tool=bestpractice.com

Útil quando a microscopia não está disponível.

Estudado principalmente em cenários com poucos recursos; não é um método diagnóstico preferencial para o diagnóstico de vaginose bacteriana.[9]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/toc.htm ​

Altamente sensível, detectando mais infecções por T vaginalis que a microscopia em câmara úmida.[9]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/toc.htm ​Os NAATs são mais precisos que uma sonda de ácido nucleico, mas são caros.[82]Coleman JS, Gaydos CA. Molecular diagnosis of bacterial vaginosis: an update. J Clin Microbiol. 2018 Sep;56(9):e00342-18. https://journals.asm.org/doi/10.1128/JCM.00342-18 http://www.ncbi.nlm.nih.gov/pubmed/29769280?tool=bestpractice.com

Os testes tradicionais podem continuar sendo úteis para o diagnóstico dessas infecções devido ao seu custo mais baixo e à capacidade de alguns de proporcionar um diagnóstico rápido.[9]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/toc.htm [81]Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae104/7619499 http://www.ncbi.nlm.nih.gov/pubmed/38442248?tool=bestpractice.com [82]Coleman JS, Gaydos CA. Molecular diagnosis of bacterial vaginosis: an update. J Clin Microbiol. 2018 Sep;56(9):e00342-18. https://journals.asm.org/doi/10.1128/JCM.00342-18 http://www.ncbi.nlm.nih.gov/pubmed/29769280?tool=bestpractice.com

O swab vaginal autocoletado pode aumentar a capacidade de rastreamento ao remover barreiras ao exame.[75]Chinnock B, Yore M, Mason J, et al. Self-obtained vaginal swabs are not inferior to provider-performed endocervical sampling for emergency department diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis. Acad Emerg Med. 2021 Jun;28(6):612-20. https://onlinelibrary.wiley.com/doi/10.1111/acem.14213 http://www.ncbi.nlm.nih.gov/pubmed/33460481?tool=bestpractice.com [76]Barnes P, Vieira R, Harwood J, et al. Self-taken vaginal swabs versus clinician-taken for detection of candida and bacterial vaginosis: a case-control study in primary care. Br J Gen Pract. 2017 Dec;67(665):e824-9. https://bjgp.org/content/67/665/e824.long http://www.ncbi.nlm.nih.gov/pubmed/29158246?tool=bestpractice.com [77]Strauss RA, Eucker B, Savitz DA, et al. Diagnosis of bacterial vaginosis from self-obtained vaginal swabs. Infect Dis Obstet Gynecol. 2005 Mar;13(1):31-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1784556 http://www.ncbi.nlm.nih.gov/pubmed/16040325?tool=bestpractice.com [78]Smith K, Harrington K, Wingood G, et al. Self-obtained vaginal swabs for diagnosis of treatable sexually transmitted diseases in adolescent girls. Arch Pediatr Adolesc Med. 2001 Jun;155(6):676-9. https://jamanetwork.com/journals/jamapediatrics/fullarticle/190688 http://www.ncbi.nlm.nih.gov/pubmed/11386956?tool=bestpractice.com [79]Van Der Pol B, Williams JA, Taylor SN, et al. Detection of Trichomonas vaginalis DNA by use of self-obtained vaginal swabs with the BD ProbeTec Qx assay on the BD Viper system. J Clin Microbiol. 2014 Mar;52(3):885-9. https://journals.asm.org/doi/10.1128/JCM.02966-13?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed http://www.ncbi.nlm.nih.gov/pubmed/24391200?tool=bestpractice.com [80]Gaydos CA, Hsieh YH, Barnes M, et al. Trichomonas vaginalis infection in women who submit self-obtained vaginal samples after internet recruitment. Sex Transm Dis. 2011 Sep;38(9):828-32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157012 http://www.ncbi.nlm.nih.gov/pubmed/21844738?tool=bestpractice.com

Teste laboratorial remoto para a detecção qualitativa de antígenos contra Trichomonas vaginalis a partir de um swab vaginal. Uma alternativa à cultura ou aos testes moleculares.

Sensibilidade de 80% a 94% e especificidade >95% foram relatadas para um ensaio de fluxo lateral (imunocromatográfico) (OSOM), dependendo do comparador.[37]Sherrard J, Pitt R, Hobbs KR, et al. British Association for Sexual Health and HIV (BASHH) United Kingdom national guideline on the management of Trichomonas vaginalis 2021. Int J STD AIDS. 2022 Jul;33(8):740-50. http://www.ncbi.nlm.nih.gov/pubmed/35701863?tool=bestpractice.com

A amostra deve ser misturada com soro fisiológico.[Figure caption and citation for the preceding image starts]: Micrografia de contraste de fases em câmara úmida de corrimento vaginal revelando a presença do protozoário Trichomonas vaginalisBiblioteca de Imagens do CDC [Citation ends].[Figure caption and citation for the preceding image starts]: Vaginite por tricomonas com corrimento purulento abundante emanando do óstio cervicalBiblioteca de Imagens do CDC [Citation ends].

Sensibilidade de 44% a 68%.[9]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/toc.htm

Deverá ser considerada se o pH for >4.5, na presença de leucócitos polimorfonucleares elevados e ausência de tricomonas móveis na microscopia em câmara úmida, ou se a microscopia não estiver disponível.

Negativa em 50% das pacientes com candidíase confirmada. A câmara úmida muitas vezes não é capaz de identificar espécies diferentes da Candida albicans.[48]Eckert LO, Hawes SE, Stevens CE, et al. Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm. Obstet Gynecol. 1998 Nov;92(5):757-65. http://www.ncbi.nlm.nih.gov/pubmed/9794664?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: Esfregaço vaginal identificando Candida albicans por meio da técnica de câmara úmidaBiblioteca de Imagens do CDC; Dr. Stuart Brown [Citation ends].[Figure caption and citation for the preceding image starts]: Esfregaço vaginal identificando Candida albicans por meio da técnica de coloração de GramBiblioteca de Imagens do CDC; Dr. Stuart Brown [Citation ends].

O hidróxido de potássio (KOH) melhora a visualização.[9]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/toc.htm

Deve ser obtida para confirmar o diagnóstico em pacientes com sinais e sintomas clínicos típicos, mas pH normal e microscopia negativa. Também deve ser obtida para pacientes com sintomas recorrentes.

Os meios de cultura incluem Ágar Sabouraud, meio de Nickerson e Microstick-candida.

Testes de amplificação de ácidos nucleicos (NAATs, os quais incluem os ensaios de reação em cadeia da polimerase) estão disponíveis para a detecção de cândida.

ONAATs são mais precisos que uma sonda de ácido nucleico, mas são caros.[82]Coleman JS, Gaydos CA. Molecular diagnosis of bacterial vaginosis: an update. J Clin Microbiol. 2018 Sep;56(9):e00342-18. https://journals.asm.org/doi/10.1128/JCM.00342-18 http://www.ncbi.nlm.nih.gov/pubmed/29769280?tool=bestpractice.com ​ Os testes tradicionais podem continuar sendo úteis para o diagnóstico dessas infecções devido ao seu custo mais baixo e à capacidade de alguns de proporcionar um diagnóstico rápido.[9]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/toc.htm [81]Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae104/7619499 http://www.ncbi.nlm.nih.gov/pubmed/38442248?tool=bestpractice.com ​[82]Coleman JS, Gaydos CA. Molecular diagnosis of bacterial vaginosis: an update. J Clin Microbiol. 2018 Sep;56(9):e00342-18. https://journals.asm.org/doi/10.1128/JCM.00342-18 http://www.ncbi.nlm.nih.gov/pubmed/29769280?tool=bestpractice.com

O swab vaginal autocoletado pode aumentar a capacidade de rastreamento ao remover barreiras ao exame.[75]Chinnock B, Yore M, Mason J, et al. Self-obtained vaginal swabs are not inferior to provider-performed endocervical sampling for emergency department diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis. Acad Emerg Med. 2021 Jun;28(6):612-20. https://onlinelibrary.wiley.com/doi/10.1111/acem.14213 http://www.ncbi.nlm.nih.gov/pubmed/33460481?tool=bestpractice.com [76]Barnes P, Vieira R, Harwood J, et al. Self-taken vaginal swabs versus clinician-taken for detection of candida and bacterial vaginosis: a case-control study in primary care. Br J Gen Pract. 2017 Dec;67(665):e824-9. https://bjgp.org/content/67/665/e824.long http://www.ncbi.nlm.nih.gov/pubmed/29158246?tool=bestpractice.com [77]Strauss RA, Eucker B, Savitz DA, et al. Diagnosis of bacterial vaginosis from self-obtained vaginal swabs. Infect Dis Obstet Gynecol. 2005 Mar;13(1):31-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1784556 http://www.ncbi.nlm.nih.gov/pubmed/16040325?tool=bestpractice.com [78]Smith K, Harrington K, Wingood G, et al. Self-obtained vaginal swabs for diagnosis of treatable sexually transmitted diseases in adolescent girls. Arch Pediatr Adolesc Med. 2001 Jun;155(6):676-9. https://jamanetwork.com/journals/jamapediatrics/fullarticle/190688 http://www.ncbi.nlm.nih.gov/pubmed/11386956?tool=bestpractice.com [79]Van Der Pol B, Williams JA, Taylor SN, et al. Detection of Trichomonas vaginalis DNA by use of self-obtained vaginal swabs with the BD ProbeTec Qx assay on the BD Viper system. J Clin Microbiol. 2014 Mar;52(3):885-9. https://journals.asm.org/doi/10.1128/JCM.02966-13?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed http://www.ncbi.nlm.nih.gov/pubmed/24391200?tool=bestpractice.com ​[80]Gaydos CA, Hsieh YH, Barnes M, et al. Trichomonas vaginalis infection in women who submit self-obtained vaginal samples after internet recruitment. Sex Transm Dis. 2011 Sep;38(9):828-32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157012 http://www.ncbi.nlm.nih.gov/pubmed/21844738?tool=bestpractice.com

Testes de amplificação de ácidos nucleicos (NAATs, os quais incluem ensaios de reação em cadeia da polimerase) estão disponíveis para a detecção de clamídia.

ONAATs são mais precisos que uma sonda de ácido nucleico, mas são caros.[82]Coleman JS, Gaydos CA. Molecular diagnosis of bacterial vaginosis: an update. J Clin Microbiol. 2018 Sep;56(9):e00342-18. https://journals.asm.org/doi/10.1128/JCM.00342-18 http://www.ncbi.nlm.nih.gov/pubmed/29769280?tool=bestpractice.com ​ Os testes tradicionais podem continuar sendo úteis para o diagnóstico dessas infecções devido ao seu custo mais baixo e à capacidade de alguns de proporcionar um diagnóstico rápido.[9]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/toc.htm [81]Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae104/7619499 http://www.ncbi.nlm.nih.gov/pubmed/38442248?tool=bestpractice.com ​[82]Coleman JS, Gaydos CA. Molecular diagnosis of bacterial vaginosis: an update. J Clin Microbiol. 2018 Sep;56(9):e00342-18. https://journals.asm.org/doi/10.1128/JCM.00342-18 http://www.ncbi.nlm.nih.gov/pubmed/29769280?tool=bestpractice.com

Os NAATs para Chlamydia trachomatis podem usar amostras coletadas do colo uterino, vagina ou urina ou swabs vaginais.

O swab vaginal autocoletado pode aumentar a capacidade de rastreamento ao remover barreiras ao exame.[75]Chinnock B, Yore M, Mason J, et al. Self-obtained vaginal swabs are not inferior to provider-performed endocervical sampling for emergency department diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis. Acad Emerg Med. 2021 Jun;28(6):612-20. https://onlinelibrary.wiley.com/doi/10.1111/acem.14213 http://www.ncbi.nlm.nih.gov/pubmed/33460481?tool=bestpractice.com [76]Barnes P, Vieira R, Harwood J, et al. Self-taken vaginal swabs versus clinician-taken for detection of candida and bacterial vaginosis: a case-control study in primary care. Br J Gen Pract. 2017 Dec;67(665):e824-9. https://bjgp.org/content/67/665/e824.long http://www.ncbi.nlm.nih.gov/pubmed/29158246?tool=bestpractice.com [77]Strauss RA, Eucker B, Savitz DA, et al. Diagnosis of bacterial vaginosis from self-obtained vaginal swabs. Infect Dis Obstet Gynecol. 2005 Mar;13(1):31-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1784556 http://www.ncbi.nlm.nih.gov/pubmed/16040325?tool=bestpractice.com [78]Smith K, Harrington K, Wingood G, et al. Self-obtained vaginal swabs for diagnosis of treatable sexually transmitted diseases in adolescent girls. Arch Pediatr Adolesc Med. 2001 Jun;155(6):676-9. https://jamanetwork.com/journals/jamapediatrics/fullarticle/190688 http://www.ncbi.nlm.nih.gov/pubmed/11386956?tool=bestpractice.com [79]Van Der Pol B, Williams JA, Taylor SN, et al. Detection of Trichomonas vaginalis DNA by use of self-obtained vaginal swabs with the BD ProbeTec Qx assay on the BD Viper system. J Clin Microbiol. 2014 Mar;52(3):885-9. https://journals.asm.org/doi/10.1128/JCM.02966-13?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed http://www.ncbi.nlm.nih.gov/pubmed/24391200?tool=bestpractice.com ​[80]Gaydos CA, Hsieh YH, Barnes M, et al. Trichomonas vaginalis infection in women who submit self-obtained vaginal samples after internet recruitment. Sex Transm Dis. 2011 Sep;38(9):828-32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157012 http://www.ncbi.nlm.nih.gov/pubmed/21844738?tool=bestpractice.com

Sensibilidade de 75% a 95%; excelente especificidade quando coletadas do colo uterino. Opção ao exame de amostras do primeiro jato de urina, cuja sensibilidade é levemente menor. Úteis nas pacientes assintomáticas.​[98]Centers for Disease Control and Prevention. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae - 2014. MMWR Recomm Rep. 2014;63(RR-02):1-19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047970 http://www.ncbi.nlm.nih.gov/pubmed/24622331?tool=bestpractice.com [99]Geisler WM, Chow JM, Schachter J, et al. Pelvic examination findings and Chlamydia trachomatis infection in asymptomatic young women screened with a nucleic acid amplification test. Sex Transm Dis. 2007 Jun;34(6):335-8. http://www.ncbi.nlm.nih.gov/pubmed/17028510?tool=bestpractice.com

Exame caro; pode ser reservado a pesquisas ou casos de estupro/abuso infantil.[98]Centers for Disease Control and Prevention. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae - 2014. MMWR Recomm Rep. 2014;63(RR-02):1-19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047970 http://www.ncbi.nlm.nih.gov/pubmed/24622331?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: Micrografia de monocamadas de célula McCoy revelando corpos de inclusão intracelular de Chlamydia trachomatis; com aumento de 50xCDC; Dr. E. Arum, Dr. N. Jacobs [Citation ends].

Sonda invasiva usando swab cervical ou uretral.

Testes de amplificação de ácidos nucleicos (NAATs, os quais incluem ensaios de reação em cadeia da polimerase) estão disponíveis para a detecção de gonorreia.

ONAATs são mais precisos que uma sonda de ácido nucleico, mas são caros.[82]Coleman JS, Gaydos CA. Molecular diagnosis of bacterial vaginosis: an update. J Clin Microbiol. 2018 Sep;56(9):e00342-18. https://journals.asm.org/doi/10.1128/JCM.00342-18 http://www.ncbi.nlm.nih.gov/pubmed/29769280?tool=bestpractice.com ​ Os testes tradicionais podem continuar sendo úteis para o diagnóstico dessas infecções devido ao seu custo mais baixo e à capacidade de alguns de proporcionar um diagnóstico rápido.[9]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/toc.htm [81]Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae104/7619499 http://www.ncbi.nlm.nih.gov/pubmed/38442248?tool=bestpractice.com ​[82]Coleman JS, Gaydos CA. Molecular diagnosis of bacterial vaginosis: an update. J Clin Microbiol. 2018 Sep;56(9):e00342-18. https://journals.asm.org/doi/10.1128/JCM.00342-18 http://www.ncbi.nlm.nih.gov/pubmed/29769280?tool=bestpractice.com

Mais sensíveis que a cultura.[81]Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae104/7619499 http://www.ncbi.nlm.nih.gov/pubmed/38442248?tool=bestpractice.com [98]Centers for Disease Control and Prevention. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae - 2014. MMWR Recomm Rep. 2014;63(RR-02):1-19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047970 http://www.ncbi.nlm.nih.gov/pubmed/24622331?tool=bestpractice.com ​​​

Os NAATs para Neisseria gonorrhoeae podem usar amostras coletadas por swab endocervical, swab vaginal ou urina.

O swab vaginal autocoletado pode aumentar a capacidade de rastreamento ao remover barreiras ao exame.[75]Chinnock B, Yore M, Mason J, et al. Self-obtained vaginal swabs are not inferior to provider-performed endocervical sampling for emergency department diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis. Acad Emerg Med. 2021 Jun;28(6):612-20. https://onlinelibrary.wiley.com/doi/10.1111/acem.14213 http://www.ncbi.nlm.nih.gov/pubmed/33460481?tool=bestpractice.com [76]Barnes P, Vieira R, Harwood J, et al. Self-taken vaginal swabs versus clinician-taken for detection of candida and bacterial vaginosis: a case-control study in primary care. Br J Gen Pract. 2017 Dec;67(665):e824-9. https://bjgp.org/content/67/665/e824.long http://www.ncbi.nlm.nih.gov/pubmed/29158246?tool=bestpractice.com [77]Strauss RA, Eucker B, Savitz DA, et al. Diagnosis of bacterial vaginosis from self-obtained vaginal swabs. Infect Dis Obstet Gynecol. 2005 Mar;13(1):31-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1784556 http://www.ncbi.nlm.nih.gov/pubmed/16040325?tool=bestpractice.com [78]Smith K, Harrington K, Wingood G, et al. Self-obtained vaginal swabs for diagnosis of treatable sexually transmitted diseases in adolescent girls. Arch Pediatr Adolesc Med. 2001 Jun;155(6):676-9. https://jamanetwork.com/journals/jamapediatrics/fullarticle/190688 http://www.ncbi.nlm.nih.gov/pubmed/11386956?tool=bestpractice.com [79]Van Der Pol B, Williams JA, Taylor SN, et al. Detection of Trichomonas vaginalis DNA by use of self-obtained vaginal swabs with the BD ProbeTec Qx assay on the BD Viper system. J Clin Microbiol. 2014 Mar;52(3):885-9. https://journals.asm.org/doi/10.1128/JCM.02966-13?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed http://www.ncbi.nlm.nih.gov/pubmed/24391200?tool=bestpractice.com ​[80]Gaydos CA, Hsieh YH, Barnes M, et al. Trichomonas vaginalis infection in women who submit self-obtained vaginal samples after internet recruitment. Sex Transm Dis. 2011 Sep;38(9):828-32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157012 http://www.ncbi.nlm.nih.gov/pubmed/21844738?tool=bestpractice.com

Identifica uma sequência específica de ácido nucleico de N gonorrhoeae. A precisão é igual à da cultura. O armazenamento e o transporte são mais convenientes comparados aos da cultura.

Menos sensível que o NAAT. Resultados disponibilizados em 48 horas. A cultura permite examinar as sensibilidades e devem ser realizadas nos casos de falha do tratamento.[98]Centers for Disease Control and Prevention. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae - 2014. MMWR Recomm Rep. 2014;63(RR-02):1-19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047970 http://www.ncbi.nlm.nih.gov/pubmed/24622331?tool=bestpractice.com

Detecta antígenos gonocócicos de swabs cervicais e amostras de urina. Sensibilidade de 92%, especificidade de 97%, mas valor preditivo positivo de apenas 55%.

Testes de amplificação de ácidos nucleicos (NAATs, os quais incluem ensaios de reação em cadeia da polimerase) estão disponíveis para a detecção de micoplasma.

Os testes tradicionais podem continuar sendo úteis para o diagnóstico dessas infecções devido ao seu custo mais baixo e à capacidade de alguns de proporcionar um diagnóstico rápido.[9]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/toc.htm [81]Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae104/7619499 http://www.ncbi.nlm.nih.gov/pubmed/38442248?tool=bestpractice.com ​[82]Coleman JS, Gaydos CA. Molecular diagnosis of bacterial vaginosis: an update. J Clin Microbiol. 2018 Sep;56(9):e00342-18. https://journals.asm.org/doi/10.1128/JCM.00342-18 http://www.ncbi.nlm.nih.gov/pubmed/29769280?tool=bestpractice.com

Todos os exames positivos para Mycoplasma genitalium devem ser acompanhados por testes de resistência a macrolídeos, quando disponíveis.[9]Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication]. https://www.cdc.gov/std/treatment-guidelines/toc.htm [51]Jensen JS, Cusini M, Gomberg M, et al. 2021 European guideline on the management of Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2022 May;36(5):641-50. http://www.ncbi.nlm.nih.gov/pubmed/35182080?tool=bestpractice.com

NAATs para M genitalium podem usar amostras coletadas do colo uterino, vagina ou urina.

O swab vaginal autocoletado pode aumentar a capacidade de rastreamento ao remover barreiras ao exame.​[75]Chinnock B, Yore M, Mason J, et al. Self-obtained vaginal swabs are not inferior to provider-performed endocervical sampling for emergency department diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis. Acad Emerg Med. 2021 Jun;28(6):612-20. https://onlinelibrary.wiley.com/doi/10.1111/acem.14213 http://www.ncbi.nlm.nih.gov/pubmed/33460481?tool=bestpractice.com [76]Barnes P, Vieira R, Harwood J, et al. Self-taken vaginal swabs versus clinician-taken for detection of candida and bacterial vaginosis: a case-control study in primary care. Br J Gen Pract. 2017 Dec;67(665):e824-9. https://bjgp.org/content/67/665/e824.long http://www.ncbi.nlm.nih.gov/pubmed/29158246?tool=bestpractice.com [77]Strauss RA, Eucker B, Savitz DA, et al. Diagnosis of bacterial vaginosis from self-obtained vaginal swabs. Infect Dis Obstet Gynecol. 2005 Mar;13(1):31-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1784556 http://www.ncbi.nlm.nih.gov/pubmed/16040325?tool=bestpractice.com [78]Smith K, Harrington K, Wingood G, et al. Self-obtained vaginal swabs for diagnosis of treatable sexually transmitted diseases in adolescent girls. Arch Pediatr Adolesc Med. 2001 Jun;155(6):676-9. https://jamanetwork.com/journals/jamapediatrics/fullarticle/190688 http://www.ncbi.nlm.nih.gov/pubmed/11386956?tool=bestpractice.com [79]Van Der Pol B, Williams JA, Taylor SN, et al. Detection of Trichomonas vaginalis DNA by use of self-obtained vaginal swabs with the BD ProbeTec Qx assay on the BD Viper system. J Clin Microbiol. 2014 Mar;52(3):885-9. https://journals.asm.org/doi/10.1128/JCM.02966-13?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed http://www.ncbi.nlm.nih.gov/pubmed/24391200?tool=bestpractice.com ​[80]Gaydos CA, Hsieh YH, Barnes M, et al. Trichomonas vaginalis infection in women who submit self-obtained vaginal samples after internet recruitment. Sex Transm Dis. 2011 Sep;38(9):828-32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157012 http://www.ncbi.nlm.nih.gov/pubmed/21844738?tool=bestpractice.com

Melhora dos sintomas após a descontinuação de irritantes.

Testes de amplificação de ácidos nucleicos (NAATs, os quais incluem ensaios de reação em cadeia da polimerase) estão disponíveis para a detecção do vírus do herpes simples.

Os NAATs são os testes confirmatórios mais sensíveis para HSV. Os amplicons devem ser tipificados para determinar se o HSV-1 ou o HSV-2 é o responsável pela infecção.[100]Centers for Disease Control and Prevention. Genital herpes. Sexually transmitted infections treatment guidelines, 2021. Sep 2022 ​[internet publication]. https://www.cdc.gov/std/treatment-guidelines/herpes.htm ​

Amostras para reação em cadeia da polimerase podem ser coletadas das lesões por HSV.

Considerada se o NAAT não estiver disponível. Caso a cultura viral seja o único teste disponível, os isolados da cultura devem ser tipificados para determinar se o HSV-1 ou o HSV-2 é responsável pela infecção.[100]Centers for Disease Control and Prevention. Genital herpes. Sexually transmitted infections treatment guidelines, 2021. Sep 2022 ​[internet publication]. https://www.cdc.gov/std/treatment-guidelines/herpes.htm ​

Pode aumentar a transmissão do HIV; portanto, os riscos e benefícios devem ser avaliados.

A ausência de achados não deve descartar corpos estranhos.

A ausência de achados não deve descartar corpos estranhos.

A ausência de achados não deve descartar corpos estranhos.

Exame confirmatório, se necessário.

Exame confirmatório, se necessário.

Pode ser realizada para excluir a causa da infecção.

O swab vaginal autocoletado pode aumentar a capacidade de rastreamento ao remover barreiras ao exame.[75]Chinnock B, Yore M, Mason J, et al. Self-obtained vaginal swabs are not inferior to provider-performed endocervical sampling for emergency department diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis. Acad Emerg Med. 2021 Jun;28(6):612-20. https://onlinelibrary.wiley.com/doi/10.1111/acem.14213 http://www.ncbi.nlm.nih.gov/pubmed/33460481?tool=bestpractice.com [76]Barnes P, Vieira R, Harwood J, et al. Self-taken vaginal swabs versus clinician-taken for detection of candida and bacterial vaginosis: a case-control study in primary care. Br J Gen Pract. 2017 Dec;67(665):e824-9. https://bjgp.org/content/67/665/e824.long http://www.ncbi.nlm.nih.gov/pubmed/29158246?tool=bestpractice.com [77]Strauss RA, Eucker B, Savitz DA, et al. Diagnosis of bacterial vaginosis from self-obtained vaginal swabs. Infect Dis Obstet Gynecol. 2005 Mar;13(1):31-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1784556 http://www.ncbi.nlm.nih.gov/pubmed/16040325?tool=bestpractice.com [78]Smith K, Harrington K, Wingood G, et al. Self-obtained vaginal swabs for diagnosis of treatable sexually transmitted diseases in adolescent girls. Arch Pediatr Adolesc Med. 2001 Jun;155(6):676-9. https://jamanetwork.com/journals/jamapediatrics/fullarticle/190688 http://www.ncbi.nlm.nih.gov/pubmed/11386956?tool=bestpractice.com [79]Van Der Pol B, Williams JA, Taylor SN, et al. Detection of Trichomonas vaginalis DNA by use of self-obtained vaginal swabs with the BD ProbeTec Qx assay on the BD Viper system. J Clin Microbiol. 2014 Mar;52(3):885-9. https://journals.asm.org/doi/10.1128/JCM.02966-13?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed http://www.ncbi.nlm.nih.gov/pubmed/24391200?tool=bestpractice.com [80]Gaydos CA, Hsieh YH, Barnes M, et al. Trichomonas vaginalis infection in women who submit self-obtained vaginal samples after internet recruitment. Sex Transm Dis. 2011 Sep;38(9):828-32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157012 http://www.ncbi.nlm.nih.gov/pubmed/21844738?tool=bestpractice.com

Existem critérios diagnósticos para a doença de Behçet.[101]Criteria for diagnosis of Behçet's disease. International Study Group for Behçet's Disease. Lancet. 1990 May 5;335(8697):1078-80. https://www.thelancet.com/journals/lancet/article/PII0140-6736(90)92643-V/fulltext http://www.ncbi.nlm.nih.gov/pubmed/1970380?tool=bestpractice.com [102]International Team for the Revision of the International Criteria for Behçet's Disease (ITR-ICBD). The International Criteria for Behçet's Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol. 2014 Mar;28(3):338-47. http://www.ncbi.nlm.nih.gov/pubmed/23441863?tool=bestpractice.com

Suporte para diagnóstico quando a confirmação é necessária.

Indistinguível da vaginite atrófica grave com infecção bacteriana secundária.

Suporte para diagnóstico quando a confirmação é necessária.

Frequentemente confundida com SGM.

Em abril de 2019, a Food and Drug Administration (FDA) dos EUA proibiu a venda e a distribuição de telas cirúrgicas destinadas ao reparo transvaginal do prolapso do compartimento anterior (cistocele).[60]US Food and Drug Administration. Urogynecologic surgical mesh implants. Aug 2021 [internet publication]. https://www.fda.gov/medical-devices/implants-and-prosthetics/urogynecologic-surgical-mesh-implants Em outubro de 2022, a FDA publicou uma declaração afirmando que esses dispositivos não têm um perfil de risco-benefício favorável.[61]US Food and Drug Administration. FDA's activities: urogynecologic surgical mesh. Oct 2022 [internet publication]. https://www.fda.gov/medical-devices/urogynecologic-surgical-mesh-implants/fdas-activities-urogynecologic-surgical-mesh ​ O uso de malha/adesivo cirúrgico para o prolapso uroginecológico, onde a malha é inserida através da parede vaginal, é atualmente restrito no Reino Unido, enquanto se realiza uma revisão independente. Em julho de 2018, o NHS England informou que o uso de malhas cirúrgicas inseridas por via vaginal para prolapso dos órgãos pélvicos devem ser adiados se for clinicamente seguro fazê-lo.[62]NHS Improvement and NHS England. Vaginal mesh: high vigilance restriction period. Provider Bulletin. 11 Jul 2018 [internet publication]. https://bsug.org.uk/budcms/includes/kcfinder/upload/files/47560_embargoed-to-00-01-10-july-2018-mesh-letter-to-acute-ceos-and-mds.pdf [63]NHS Improvement and NHS England. Extension of pause on the use of vaginal mesh. 29 Mar 2019 [internet publication]. http://www.scottishmeshsurvivors.com/pdf/MESH_letter_-_Extension_of_pause_on_the_use_of_vaginal_mesh_29_March_2019.pdf [64]Medicines and Healthcare products Regulatory Agency. Pause on the use of vaginally inserted surgical mesh for stress urinary incontinence. Jul 2018 [internet publication]. https://www.gov.uk/government/news/pause-on-the-use-of-vaginally-inserted-surgical-mesh-for-stress-urinary-incontinence [65]NHS Resolution​. Vaginal mesh: what is a vaginal mesh implant? Oct 2022 [internet publication]. https://resolution.nhs.uk/vaginal-mesh/#toc-item-2 ​​​​​

Necessário para o diagnóstico definitivo.

Também pode estar elevado em outros diagnósticos não malignos (endometriose, miomas).

[Figure caption and citation for the preceding image starts]: Ovo de Enterobius vermicularis (oxiúros humanos)Biblioteca de Imagens do CDC [Citation ends].

Essas infecções indicam contato sexual.

Essas infecções indicam contato sexual.

Sugere contato sexual.

Sugere contato sexual.

A possibilidade de abuso infantil deve ser avaliada, e as autoridades competentes devem ser devidamente comunicadas para garantir a segurança da criança.