Abstract
Genital inflammations are most frequent ailments, accounting for approximately 20% of all gynaecological diseases. Mostly these are common vulvo-vaginal infections where determining the correct diagnosis and applying a corresponding treatment does not pose any problem.
However, in clinical practice we often see that "potentially pathogenic" bacteria are detected by standard cultivation procedures for women with non-specific problems - while, in fact, they are a common aspect of the vaginal population. In these cases the positive result does not give any valuable information to the clinical practitioner, as it is impossible to distinguish colonisation from infection or, more precisely, the role the bacteria plays in the patient's symptoms.
A frequent mistake is to prescribe a systemic antibiotic treatment purely on the basis of the cultivation results - the isolated bacteria with a determined sensitivity. In most cases, the treatment does not make the patient any better, and it may even worsen the clinical symptoms; on the other hand, capturing definite pathogens, such as sexually transmitted trichomonas, chlamydia or gonococcus, requires immediate treatment not only of the patient, but of all her sexual partners as well.
Also, microscopic diagnostics has virtually disappeared from clinical practice - without assessing stained preparations or wet mount saline microscopic examination, it is impossible to carry out adequate diagnostics of defects of vaginal environment. Only in recent years, in the context of monitoring the human microbiome (including the vaginal component), we are discovering what types of bacteria inhabit the vagina, and what their role in the development of various problems is; there are bacteria commonly occurring in the vagina which we cannot isolate by common cultivation procedures.
Another problem is the diagnostics and treatment of pelvic inflammatory disease. Presently, diagnostic criteria are set so as to capture the highest possible number of infections.
When pelvic inflammatory disease is suspected, the examination should always include tests for diagnosing the presence of chlamydia and gonorrhoea. Past inflammations may often leave permanent consequences: chronic fluor, dyspareunia, infertility, extrauterine pregnancy, pelvic pain and other functional defects.
Reducing these negative consequences is where our efforts should be aimed.