Clinicopathological correlation of infective vaginal discharges in non pregnant sexually active women of reproductive age group in a tertiary care centre of Western UP

Aruna Verma, Abhilasha Gupta, Swati Goel, Amit Garg

Abstract


Background: The aim was to study the etiology of infective vaginal discharges prevalent in our area and to study its association with PID.

Methods: A total of 500 patients were recruited for study attending Gynae OPD and presenting with vaginal discharge. After detailed history taking and physical examination three sterile vaginal swabs were taken from the posterior fornix and sent for culture of Candida and Trichomonas on Saborauds Dextrose Agar and Kufperberg media respectively and one was used for smear for gram’s staining to diagnose Bacterial vaginosis by Nugent’s scoring.

Results: In this study, prevalence of BV, Candida and Trichomonas vaginalis was found to be 146 (29.2%), 106 (21.2%) and 15(3%) respectively out of 24 cases had mixed infections while no organism was found in 257 cases (51.4%). Candida infection was found to be significantly associated with presence of other complaints such as itching, burning micturition, dyspareunia etc (p<0.001), curdy white discharge (p<0.001), thick consistency (p<0.001), presence of vulvitis (p<0.001) and pH 3.5-4.0 (p<0.0.001). Bacterial vaginosis was found to be significantly associated with underweights (p<0.004), cases with >1 abortions(p=0.015), presence of urogenital complaints (p<0.001), yellow/green (p<0.001) and purulent discharge (p=0.013), presence of malodour (p<0.001), thick consistency (p<0.001), moderate (p<0.001) and profuse (p=0.004) amount of discharge, vulvitis (p=0.001), cervical congestion (p=0.004), features of PID (p<0.001) and pH (4.6-5.0 & >5) (p<0.001). Trichomonas infection was found to be significantly associated with age group 31-35 (p=0.019), yellow/green vaginal discharge (p<0.001), presence of malodour (p=0.016), thick consistency of discharge (p=0.040), vulvitis (p<0.001) and pH>5 (p=0.004).

Conclusions: Bacterial vaginosis and candidiasis are the most common causes of infective vaginal discharges in our community than trichomoniasis.


Keywords


Vaginal discharge, Trichomonas vaginalis, Vaginosis, Candidiasis

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References


Livengood, C. H. Bacterial vaginosis: an overview for 2009. Reviews in Obstetrics & Gynecology, New York, v. 2, no. 1, p. 28-37, Dec. 2009.

Nugent, R. P.; Krohn, M. A.; Hillier, S. L. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. Journal of Clinical Microbiology, Washington, D. C., v. 29, no. 2, p. 297-301, Feb. 1991.

Spiegel, C. A.; Amsel, R.; Holmes, K. K. Diagnosis of bacterial vaginosis by direct gram stain of vaginal fluid. Journal of Clinical Microbiology, Washington, D. C., v. 18, no. 1, p. 170-177, July 1983.

Sobel JD, Faro S, Force RW, Foxman B, Ledger WJ, Nyirjesy PR, Reed BD. Summers PR (1998). Vulvovaginal candidiasis: Epidemiologic, diagnostic and therapeutic considerations. Am. J. Obstet. Gynaecol. 179(2): 203-211.

Bhalla P, Rohit C, Garg S, Singh M, Raina U, Bhalla R, et al. Prevalence of bacterial vaginosis among women in Delhi India. Indian J Med Res. 2007; 167-172

Jenifer E, Allsworth JE, Peipert JF. Prevalence of bacterial vaginosis: 2001-2004 National health and nutrition examination survey data. Obstetric Gynecology. 2007; 1:114-120.

Jindal N, Gill P, Aggarwal A. An epidemiological study of vulvovaginal candidiasis in women of childbearing age. Indian Journal of Medical Microbiology. 2007; 25:175-176.

Fernández-Limia O, Villar C, Fariñas T, Betancourt A, DE Armas E, Faura R, et al. Prevalence of trichomoniasis, bacterial vaginosis and candidiasis in women attending a sexual transmitted infections and gynaecologic clinic using an immunologic latex agglutination test. The Internet Journal of Gynecology and Obstetrics. 2007; 6 Number 2.

Hobbs M, Lapple D, Lawing L, Schwebke J, Cohen M, Swygard H, et al. Methods for detection of trichomonas vaginalis in the male partners of infected women: implications for control of trichomoniasis. Clin Microbiol 2006; 44:994-999.

Fang X, Zhou Y, Yang Y, Diao Y, Li H. Prevalence and risk factors of trichomoniasis, bacterial vaginosis, and candidiasis for married women of child-bearing age in rural Shandong. Jpn J Infect Dis. 2007; 60:257-261.

Sihavong A, Phouthavane T, Lundborg C, Sayabounthavong K, Syhakhang L, Wahlstrom R. Reproductive tract infections among women attending a gynecology outpatient department in Vientiane, Lao PDR. Sex Transm Dis. 2007; 34:791-795.

Oliveira F, Pfleger V, Lang K, Heukelbach J, Miralles I, Fraga F, et al. Sexually transmitted infections, bacterial vaginosis, and candidiasis in women of reproductive age in rural Northeast Brazil: a Population-based study. Mem Inst Oswaldo Cruz 2007; 102:751-756.