美国阴道炎患者经验性治疗的患病率和准确性

IF 1.7 4区 医学 Q3 INFECTIOUS DISEASES
Sexually transmitted diseases Pub Date : 2025-11-01 Epub Date: 2025-06-04 DOI:10.1097/OLQ.0000000000002197
Jenny Tse, Justin Chen, Liucheng Shi, Mindy M Cheng, Rebecca Lillis, Aimee M Near
{"title":"美国阴道炎患者经验性治疗的患病率和准确性","authors":"Jenny Tse, Justin Chen, Liucheng Shi, Mindy M Cheng, Rebecca Lillis, Aimee M Near","doi":"10.1097/OLQ.0000000000002197","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests low diagnostic test utilization and high empiric prescribing rates for vaginitis symptoms. This study retrospectively assessed real-world bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis (TV) treatment patterns in the United States relative to test results and their timing.</p><p><strong>Methods: </strong>Patients with vaginitis or related symptom diagnosis were identified between 2018 and 2023 in an ambulatory electronic medical record database linked to prescription and outpatient medical claims databases. Pregnant and nonpregnant subgroups were stratified by test type (nucleic acid amplification test [NAAT] panel [BV, VVC, and TV], direct probe, or traditional methods) up to first diagnosis date +2 days. Treatment claims before (empiric) and up to 7 days after (informed) the test result date were assessed.</p><p><strong>Results: </strong>There were 1465 pregnant and 13,447 nonpregnant patients meeting selection criteria; 31.7%, 26.3%, and 2.0% of pregnant and 26.6%, 16.1%, and 2.0% of nonpregnant cohorts had positive results for BV, VVC, and TV, respectively. Empiric treatment was common across treated pregnant subgroups tested with laboratory NAAT panel (55.0%), direct probe (35.5%), and traditional methods (66.7%), and nonpregnant subgroups (55.7%, 52.2%, 74.2%, respectively). Many empiric treatments were not aligned to positive test results, including coinfections (e.g., 6.5%-8.2% of pregnant and 11.7%-13.0% of nonpregnant patients who tested BV positive by NAAT panel or direct probe were empirically treated with antifungal agents for VVC).</p><p><strong>Conclusions: </strong>High empiric treatment rates and evidence of inappropriate treatment highlight the potential utility for rapid, accurate tests to diagnose common vaginal infections, to inform clinical decision making and results-guided prescribing at the point of care.</p>","PeriodicalId":21837,"journal":{"name":"Sexually transmitted diseases","volume":" ","pages":"690-698"},"PeriodicalIF":1.7000,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12520029/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prevalence and Accuracy of Empiric Treatment Among Patients With Vaginitis Symptoms in the United States.\",\"authors\":\"Jenny Tse, Justin Chen, Liucheng Shi, Mindy M Cheng, Rebecca Lillis, Aimee M Near\",\"doi\":\"10.1097/OLQ.0000000000002197\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Evidence suggests low diagnostic test utilization and high empiric prescribing rates for vaginitis symptoms. This study retrospectively assessed real-world bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis (TV) treatment patterns in the United States relative to test results and their timing.</p><p><strong>Methods: </strong>Patients with vaginitis or related symptom diagnosis were identified between 2018 and 2023 in an ambulatory electronic medical record database linked to prescription and outpatient medical claims databases. Pregnant and nonpregnant subgroups were stratified by test type (nucleic acid amplification test [NAAT] panel [BV, VVC, and TV], direct probe, or traditional methods) up to first diagnosis date +2 days. Treatment claims before (empiric) and up to 7 days after (informed) the test result date were assessed.</p><p><strong>Results: </strong>There were 1465 pregnant and 13,447 nonpregnant patients meeting selection criteria; 31.7%, 26.3%, and 2.0% of pregnant and 26.6%, 16.1%, and 2.0% of nonpregnant cohorts had positive results for BV, VVC, and TV, respectively. Empiric treatment was common across treated pregnant subgroups tested with laboratory NAAT panel (55.0%), direct probe (35.5%), and traditional methods (66.7%), and nonpregnant subgroups (55.7%, 52.2%, 74.2%, respectively). Many empiric treatments were not aligned to positive test results, including coinfections (e.g., 6.5%-8.2% of pregnant and 11.7%-13.0% of nonpregnant patients who tested BV positive by NAAT panel or direct probe were empirically treated with antifungal agents for VVC).</p><p><strong>Conclusions: </strong>High empiric treatment rates and evidence of inappropriate treatment highlight the potential utility for rapid, accurate tests to diagnose common vaginal infections, to inform clinical decision making and results-guided prescribing at the point of care.</p>\",\"PeriodicalId\":21837,\"journal\":{\"name\":\"Sexually transmitted diseases\",\"volume\":\" \",\"pages\":\"690-698\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12520029/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Sexually transmitted diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/OLQ.0000000000002197\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/4 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Sexually transmitted diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/OLQ.0000000000002197","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/4 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0

摘要

背景:有证据表明,阴道炎症状的诊断测试使用率低,经验处方率高。本研究回顾性评估了美国真实世界细菌性阴道病(BV)、外阴阴道念珠菌病(VVC)和滴虫病(TV)的治疗模式与测试结果及其时间的关系。方法:在2018-2023年期间,在与处方和门诊医疗索赔数据库相关的门诊EMR数据库中识别出阴道炎或相关症状诊断的患者。根据检测类型(核酸扩增试验[NAAT]面板[BV, VVC, TV],直接探针或传统方法)将妊娠和非妊娠亚组分层至首次诊断日+2天。评估测试结果日期前(经验性)和测试结果日期后7天内的治疗要求。结果:符合入选标准的孕妇1465例,非孕妇13447例;31.7%、26.3%和2.0%的孕妇和26.6%、16.1%和2.0%的非孕妇分别有BV、VVC和TV阳性结果。经验性治疗在实验室NAAT面板检测的孕妇亚组(55.0%)、直接探查(35.5%)和传统方法检测的孕妇亚组(66.7%)和非孕妇亚组(分别为55.7%、52.2%和74.2%)中普遍存在。许多经验性治疗与阳性检测结果不一致,包括合并感染(例如,通过NAAT面板或直接探测检测bv阳性的孕妇中有6.5-8.2%和11.7-13.0%的非妊娠患者接受了VVC抗真菌药物的经验性治疗)。结论:高经验治疗率和不适当治疗的证据突出了快速、准确的检测方法诊断常见阴道感染的潜在效用,为临床决策提供信息,并在护理点以结果为导向开处方。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prevalence and Accuracy of Empiric Treatment Among Patients With Vaginitis Symptoms in the United States.

Background: Evidence suggests low diagnostic test utilization and high empiric prescribing rates for vaginitis symptoms. This study retrospectively assessed real-world bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis (TV) treatment patterns in the United States relative to test results and their timing.

Methods: Patients with vaginitis or related symptom diagnosis were identified between 2018 and 2023 in an ambulatory electronic medical record database linked to prescription and outpatient medical claims databases. Pregnant and nonpregnant subgroups were stratified by test type (nucleic acid amplification test [NAAT] panel [BV, VVC, and TV], direct probe, or traditional methods) up to first diagnosis date +2 days. Treatment claims before (empiric) and up to 7 days after (informed) the test result date were assessed.

Results: There were 1465 pregnant and 13,447 nonpregnant patients meeting selection criteria; 31.7%, 26.3%, and 2.0% of pregnant and 26.6%, 16.1%, and 2.0% of nonpregnant cohorts had positive results for BV, VVC, and TV, respectively. Empiric treatment was common across treated pregnant subgroups tested with laboratory NAAT panel (55.0%), direct probe (35.5%), and traditional methods (66.7%), and nonpregnant subgroups (55.7%, 52.2%, 74.2%, respectively). Many empiric treatments were not aligned to positive test results, including coinfections (e.g., 6.5%-8.2% of pregnant and 11.7%-13.0% of nonpregnant patients who tested BV positive by NAAT panel or direct probe were empirically treated with antifungal agents for VVC).

Conclusions: High empiric treatment rates and evidence of inappropriate treatment highlight the potential utility for rapid, accurate tests to diagnose common vaginal infections, to inform clinical decision making and results-guided prescribing at the point of care.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Sexually transmitted diseases
Sexually transmitted diseases 医学-传染病学
CiteScore
4.00
自引率
16.10%
发文量
289
审稿时长
3-8 weeks
期刊介绍: ​Sexually Transmitted Diseases, the official journal of the American Sexually Transmitted Diseases Association​, publishes peer-reviewed, original articles on clinical, laboratory, immunologic, epidemiologic, behavioral, public health, and historical topics pertaining to sexually transmitted diseases and related fields. Reports from the CDC and NIH provide up-to-the-minute information. A highly respected editorial board is composed of prominent scientists who are leaders in this rapidly changing field. Included in each issue are studies and developments from around the world.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信