Sociodemographic profile of women with abnormal vaginal flora: a prospective study

<p class="abstract"><strong>Background:</strong> The objective of the study was to evaluate the prevalence and association of abnormal vaginal flora with socio demographic profile of patients.</p><p class="abstract"><strong>Methods:</strong> The present study was undertaken in outpatient’s department of obstetrics and gynaecology, government medical college, Patiala. We studied 300 cases with symptoms and signs of vaginal infections in the reproductive age group (15-49 years). After taking detailed history, examination and collecting samples of vaginal discharge, patients were subjected to colposcopy followed by microbiological analysis of vaginal discharge. Recorded data was analysed for prevalence and sociodemographic profile of affected women.</p><p class="abstract"><strong>Results:</strong> The prevalence rate of vaginal infections was 31% among patients who had reported to us with symptoms and signs of vaginal infections. The most common micro-organism detected was <em>B. vaginosis</em> (BV) in 14%, <em>C. albicans </em>(C) in 12% and <em>T. vaginalis</em> (T) in 3.33%. It was analysed that association is more with 25-34 years age, low education level, lower socioeconomic status, unemployed and with married and multiparous group. White and watery discharge characteristic were found to be more common. Lower abdominal pain, dysuria and backache were the most prevalent co-morbidities associated with vaginal infections.</p><p class="abstract"><strong>Conclusions: </strong>We concluded that vaginal discharge is a common gynaecological complaint and vaginal infections are an important cause of vaginal discharge thus leading to significant proportion of female morbidity in sexually active age group. Education and women’s empowerment can prove powerful methods to solve this feminine issue.</p>

Colposcopic and microbiological correlation in patients with vaginal infections: a prospective study

Background: Objective of the study was to evaluate the association of abnormal vaginal flora with pathological colposcopic and microbiological findings.Methods: The present study was conducted in outpatient’s department of Obstetrics and Gynaecology, Government Medical College, Patiala. We studied 300 cases with symptoms and signs of vaginal infections in reproductive age group (15-49 years). After taking detailed history and examination, samples of vaginal discharge were collected for microbiological analysis and patients were subjected to colposcopy. Recorded data was analysed to find out any association of abnormal vaginal flora with pathological colposcopic and microbiological analysis.Results: The prevalence rate of vaginal infections was 31% among patients who reported to us with symptoms and signs of vaginal infections. The most common micro-organism detected was B. vaginosis (BV) in 14%, C. albicans (C) in 12% and T. vaginalis (T) in 3.33%. The normal colposcopic findings were observed in 81.33% and abnormal colposcopic findings were noted in 18.67% of the patients which were vaginal hyperaemia in 9%, chronic cervicitis in 5.33%, small iodine negative area in 2.33%, keratosis in 1.33% and cervical polyp in 0.67% of the patients.Conclusions: We concluded that vaginal discharge is a common gynaecological complaint and vaginal infections are an important cause of the vaginal discharge thus leading to significant proportion of female morbidity in reproductive age group. So, vaginitis and vaginal discharge highlights the importance of microbiological investigations to find out the causative organisms and the specific findings due to particular micro-organism can be correlated colposcopically and specific treatment can be provided.

Bacterial vaginosis in pregnancy and early labour using Nugent scoring and the implication on foetal outcome

Background: To compare the pattern of vaginal microflora during pregnancy with pattern in early labour using Nugent scoring and determine the effect of these changes on fetal outcome. Design: A prospective longitudinal study. Setting and Population: Pregnant women attending antenatal clinics of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between June 2017 and May 2018. Methods: Consenting pregnant women who attended antenatal clinics were recruited. Vaginal secretions were obtained for Nugent scoring during pregnancy and at presentation in labour. Main Outcome Measures: Prevalence of abnormal vaginal flora in pregnancy and early labour, birth outcome, birth weight, gestational age at delivery, APGAR scores, need for neonatal ward admission. Results: Sixty-seven (33.3%) of pregnant women had abnormal flora which was consistent with bacterial vaginosis.At the presentation of these women in labour, 14.4% of them had bacterial vaginosis thus indicating a significant reduction in abnormal vaginal flora in labour compared to the proportion of abnormal flora in antenatal period(P<0.001). There were no significant differences in the fetal outcomes of mothers with bacterial vaginosis when compared with those with normal vaginal flora (P-value >0.05). Conclusions: Persistence of abnormal vaginal microflora from pregnancy till early labour did not seem to be associated with poorer foetal outcomes when compared with women with normal vaginal microflora in labour. The possibility of persistent infection or re-infection before labour may justify the need for re-evaluation of vaginal smears in the late third trimester to allow for prompt treatment before the onset of labour. Keywords: Bacterial vaginosis, foetal outcome, Lactobacillus, pregnancy, vaginal microflora. Funding: This research work was sponsored by the Tertiary Education Trust Fund, Nigeria (TETFund) with referencenumber OOU/IBR/010.

The Association between Abnormal Vaginal Flora and Cytological Evidence of HPV with Prematurity in High-Risk Pregnant Women

<p><strong>Objective:</strong> To evaluate the association between abnormal vaginal flora and cytological evidence of HPV with prematurity in high-risk pregnant women. <br /><strong></strong></p><p><strong>Study design:</strong> A prospective cohort study was designed with high-risk pregnant women who delivered singletons between 20-42 gestational weeks between January to November 2018. Vaginal specimens were collected to obtain material from the upper lateral vaginal vault and cervix for direct microscopic examination of vaginal contents and preparation of Gram-stained and pap smear slides. Potential determinants of infection were assessed using the chi-square test. Poisson regression was used to determine the prevalence ratio and 95% confidence interval of the association between the vaginal flora and cytology with prematurity and a p &lt;0.05 was considered as statistical significance. <br /><strong></strong></p><p><strong>Results:</strong> A total of 68 pap smear and high vaginal swab samples were collected from high-risk pregnant women with a mean age of 30.3 years. There were 26 (38.2%) cases of abnormal vaginal flora and 6 (8.8%) of HPV-induced cytological abnormalities. The preterm delivery rate was comparable between women with normal and abnormal vaginal flora (11.9% vs. 11.5%, prevalence ratio 1.0 [95% confidence interval: 0.8-1.2], aPR 1.0 [95% confidence interval: 0.8-1.2]) and between women with and without abnormal cytology (16.7% vs. 11.3%, prevalence ratio 0.9 [95% confidence interval: 0.6-1.4], aPR 0.9 [95% confidence interval: 0.6-1.4]). <br /><strong></strong></p><p><strong>Conclusions:</strong> We determined no association between abnormal cytology or altered vaginal flora in high-risk pregnancy in terms of overall preterm birth rate.</p>

Detection of protozoal Trichomonas vaginalis and abnormal vaginal flora in high vaginal smear

Background: Vagina is the fibro muscular membrane sheath communicating with the uterine cavity and to the exterior at the vulva. Infection of female genital tract results from vaginal flora, extraneous agents and sexually transmitted diseases. The objective of the study was: a) high vaginal smear screening to find out incidence of abnormal vaginal flora of micro-organisms, b) prevalence of protozoal Trichomonas vaginalis.Methods: Rural women from in and around Ammapettai in the age group of 20-50 years attending Gynaecology OPD of SSSMC&RI for vaginal discharge and itching vulva. Exclusion criteria were age less than 20 and above 50 and pruritis vulva due to other causes the study size comprised of 50 women. After getting Institutional ethical committee’s approval and written informed consent from the patients, detailed history regarding type of discharge, odour, itching, and associated bleeding was taken. Per speculum and per vaginal examination done. High vaginal smear for aerobic bacterial profile and Trichomonas infection were taken and transported to microbiology laboratory for staining and culture. Wet mount microscopic examination of Trichomonas vaginalis and Candidiasis with saline and KOH mount done.Results: Out of 100 smears 9 were normal vaginal flora organisms, aerobic pathogens 43%, Trichomonas vaginalis (TV) 30%, and Candida albicans 5% mixed infections on 7 smears. E. coli was seen in 23 samples, Klebsiella in 14, Pseudomonas aeroginosa 4, Staphylococcus in 6 samples. Gram negative organisms were 100% sensitive to imipenem, amikacin and gentamycin and 100% resistant to cefazolin, 80% to ceftazidime, 74% to cefotaxime. Gram positive staphylococcus 50% were resistant to gentamycin, ampicillin.Conclusions: This study reflects on our responsibility to create awareness among women regarding abnormal vaginal discharge through proper health education routine screening targeted treatment to envisage healthy quality life.