【求助】美国CDC性病预防治疗指南的两个版本为何不同？ [病例帖]

以下是美国CDC性病预防治疗指南三个版本中确诊尿道炎的段落（2002年，2006年，2010年）等版本。因为2006年版本与2002年，2010年版本在某些描述上不一样，所以百思不得其解，所以特向各位老师求助，

不同之处我已经用红色标注，

2002版本

Confirmed Urethritis

Clinicians should document that urethritis is present. Urethritis can be documented on the basis of any of the following signs.

• Mucopurulent or purulent discharge.
• Gram stain of urethral secretions demonstrating >5 WBCs per oil immersion field. The Gram stain is the preferred rapid diagnostic test for evaluating urethritis. It is highly sensitive and specific for documenting both urethritis and the presence or absence of gonococcal infection. Gonococcal infection is established by documenting the presence of WBCs containing intracellular Gram-negative diplococci.
• Positive leukocyte esterase test on first-void urine or microscopic examination of first-void urine demonstrating >10 WBCs per high power field.

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2006年版本。

Confirmed Urethritis
Clinicians should document that urethritis is present. Urethritis
can be documented on the basis of any of the following
signs or laboratory tests:
·Mucopurulent or purulent discharge.

·Gram stain of urethral secretions demonstrating >5 WBC
per oil immersion field. The Gram stain is the preferred
rapid diagnostic test for evaluating urethritis. It is highly
sensitive and specific for documenting both urethritis and
the presence or absence of gonococcal infection. Gonococcal
infection is established by documenting the presence
of WBC containing GNID, or
·Positive leukocyte esterase test on first-void urine or microscopic
examination of first-void urine sediment demonstrating
>10 WBC per high power field.

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2010年版本

Confirmed Urethritis
Clinicians should attempt to obtain objective evidence of urethral inflammation. However, if clinic-based diagnostic tools (e.g., Gram-stain microscopy) are not available, patients should be treated with drug regimens effective against both gonorrhea and chlamydia.
Urethritis can be documented on the basis of any of the following signs or laboratory tests:
·Mucopurulent or purulent discharge on examination.
·Gram stain of urethral secretions demonstrating .5 WBC per oil immersion field. The Gram stain is the preferred rapid diagnostic test for evaluating urethritis and is highly sensitive and specific for documenting both urethritis and the presence or absence of gonococcal infection. Gonococcal infection is established by documenting the presence of WBC containing GNID.

·Positive leukocyte esterase test on first-void urine or microscopic examination of first-void urine sediment demonstrating .10 WBC per high-power field.
If none of these criteria are present, testing for N. gonorrhoeae and C. trachomatis using NAATs might identify additional infections (248). If the results demonstrate infection with either of these pathogens, the appropriate treatment should be given and sex partners referred for evaluation and treatment. If none of these criteria are present, empiric treatment of symptomatic males is recommended only for men at high risk for infection who are unlikely to return for a follow-up evaluation. Such patients should be treated with drug regimens effective against gonorrhea and chlamydia. Partners of patients treated empirically should be evaluated and treated, if indicated.

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以下是中文版本，对应英文版本红色部分也已经用红色标注。

2002年版本。

确诊尿道炎 临床医生应明确患者是否存在尿道炎。尿道炎的诊断可以基于以下任何一项体征或任何一项实验室检查结果：

·黏液脓性或脓性分泌物 ；

·每个油镜视野下尿道分泌物革兰染色显示≥5个白细胞。革兰染色是一种理想的用于评估尿道炎快速诊断方法。其高敏感性和高特异性可以诊断淋球菌性尿道炎和非淋菌性尿道炎。淋球菌的感染诊断基于尿道分泌物白细胞内包含革兰阴性双球菌。（此出没有2006年版本的“，或”）

·首段尿白细胞脂酶阳性或首段尿尿沉渣显微镜下每高倍镜视野显示≥0个白细胞。

如果患者未出现以上体征或实验室检查结果中的任何一项，那么针对尿道炎的治疗将不急于展开，此时需要对患者进行淋球菌及沙眼衣原体的检测，如果检查结果阴性，需要对患者严密的观察和随访。如果检查结果显示患者感染了淋球菌或沙眼衣原体其中的任何一种，这时应当给予患者适当的治疗并要求患者通知其性伴而进行评估与治疗。

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2006年版本。

Confirmed Urethritis
Clinicians should document that urethritis is present. Urethritis
can be documented on the basis of any of the following
signs or laboratory tests:
·Mucopurulent or purulent discharge.

·Gram stain of urethral secretions demonstrating >5 WBC
per oil immersion field. The Gram stain is the preferred
rapid diagnostic test for evaluating urethritis. It is highly
sensitive and specific for documenting both urethritis and
the presence or absence of gonococcal infection. Gonococcal
infection is established by documenting the presence
of WBC containing GNID, or此处是否存在语法错误？或者存在理论错误，不过理论错误的可能性应该为零。
·Positive leukocyte esterase test on first-void urine or microscopic
examination of first-void urine sediment demonstrating
>10 WBC per high power field.

=====================================

2010年版本：

2002年版本。

确诊尿道炎 临床医生应明确患者是否存在尿道炎。尿道炎的诊断可以基于以下任何一项体征或任何一项实验室检查结果：

·黏液脓性或脓性分泌物 ；

·每个油镜视野下尿道分泌物革兰染色显示≥5个白细胞。革兰染色是一种理想的用于评估尿道炎快速诊断方法。其高敏感性和高特异性可以诊断淋球菌性尿道炎和非淋菌性尿道炎。淋球菌的感染诊断基于尿道分泌物白细胞内包含革兰阴性双球菌。（此出没有2006年版本的“，或”）

·首段尿白细胞脂酶阳性或首段尿尿沉渣显微镜下每高倍镜视野显示≥0个白细胞。

如果患者未出现以上体征或实验室检查结果中的任何一项，那么针对尿道炎的治疗将不急于展开，此时需要对患者进行淋球菌及沙眼衣原体的检测，如果检查结果阴性，需要对患者严密的观察和随访。如果检查结果显示患者感染了淋球菌或沙眼衣原体其中的任何一种，这时应当给予患者适当的治疗并要求患者通知其性伴而进行评估与治疗。

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2002年与2010年版本描述基本一样，我查看过美国CDC网站2006年美国CDC性病预防治疗指南，与现在网络上的版本及我国叶顺章等出版的《性病诊断治疗学》的内容一致。所以不存在翻译，复制等此类问题的错误。