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Prevalence of bacterial vaginosis among women in Delhi, India

Authors:

Abstract

Bacterial vaginosis is the most common cause of vaginal discharge among women in reproductive age. Surveillance studies on bacterial vaginosis are mostly based on specialist clinic settings. As few population-based prevalence surveys of bacterial vaginosis have been conducted, we studied the prevalence of bacterial vaginosis in the urban and rural communities in Delhi, and to associate the presence of bacterial vaginosis with demographic profile, risk factors and presence of other reproductive tract infections (RTIs)/ sexually transmitted infections (STIs). Vaginal specimens for Gram-stain evaluation of vaginal flora for diagnosis of bacterial vaginosis and culture of Trichomonas vaginalis and Candida spp, blood samples for HIV and syphilis serology, and urine for detection of Neisseria gonorrhoeae and Chlamydia trachomatis were collected from women (15-49 yr) from rural and urban areas. Information on demographic characteristics, risk factors and clinical symptoms was obtained. Bacterial vaginosis was diagnosed in 70 (32.8%) subjects. A high percentage though asymptomatic (31.2%) were found to have bacterial vaginosis. Highest prevalence was seen in urban slum (38.6%) followed by rural (28.8%) and urban middle class community (25.4%). All women with vaginal trichomoniasis were found to have bacterial vaginosis while 50 per cent of subjects having syphilis also had bacterial vaginosis.. The study showed high prevalence of bacterial vaginosis. The asymptomatic women having bacterial vaginosis are less likely to seek treatment for the morbidity and thus are more likely to acquire other STIs. Women attending various healthcare facilities should be screened and treated for bacterial vaginosis to reduce the risk of acquisition of other STIs.
Prevalence of bacterial vaginosis among women in Delhi, India
P. Bhalla, Rohit Chawla, S. Garg*, M.M. Singh*, U. Raina**, Ruchira Bhalla & Pushpa Sodhani
Departments of Microbiology, *Community Medicine, **Obstetrics & Gynaecology
Maulana Azad Medical College & associated LN Hospital, New Delhi &
Institute of Cytology & Preventive Oncology, Noida, India
Received March 3, 2005
Background & objectives: Bacterial vaginosis is the most common cause of vaginal discharge among
women in reproductive age. Surveillance studies on bacterial vaginosis are mostly based on specialist
clinic settings. As few population-based prevalence surveys of bacterial vaginosis have been
conducted, we studied the prevalence of bacterial vaginosis in the urban and rural communities in
Delhi, and to associate the presence of bacterial vaginosis with demoraphic profile, risk factors
and presence of other reproductive tract infections (RTIs)/ sexually transmitted infections (STIs).
Methods: Vaginal specimens for Gram-stain evaluation of vaginal flora for diagnosis of bacterial
vaginosis and culture of Trichomonas vaginalis and Candida spp, blood samples for HIV and syphilis
serology, and urine for detection of Neisseria gonorrhoeae and Chlamydia trachomatis were collected
from women (15-49 yr) from rural and urban areas. Information on demographic characteristics,
risk factors and clinical symptoms was obtained.
Results: Bacterial vaginosis was diagnosed in 70 (32.8%) subjects. A high percentage though
asymptomatic (31.2%) were found to have bacterial vaginosis. Highest prevalence was seen in urban
slum (38.6%) followed by rural (28.8%) and urban middle class community (25.4%). All women
with vaginal trichomoniasis were found to have bacterial vaginosis while 50 per cent of subjects
having syphilis also had bacterial vaginosis.
Interpretation & conclusion: The study showed high prevalence of bacterial vaginosis. The
asymptomatic women having bacterial vaginosis are less likely to seek treatment for the morbidity
and thus are more likely to acquire other STIs. Women attending various healthcare facilities
should be screened and treated for bacterial vaginosis to reduce the risk of acquisition of other
STIs.
Key words Bacterial vaginosis - community based study - prevalence
167
Indian J Med Res 125, February 2007, pp 167-172
Bacterial vaginosis is the most common cause
of vaginal discharge among women in reproductive
age
1
. It is characterized by an increased vaginal pH
and the replacement of vaginal lactobacilli
(particularly those that produce hydrogen peroxide)
with Gardnerella vaginalis and anaerobic Gram-
negative rods
2
. Bacterial vaginosis has been
consistently associated with preterm delivery, but
its role in upper genital tract infection (pelvic
inflammatory disease), tubal damage and infertility
is less certain
3
. Surveillance studies on bacterial
vaginosis are mostly based on specialist clinic
settings, such as genitourinary medicine clinics
4
,
gynaecology and antenatal clinics
5
, which
underestimate the true burden of disease in the
community given the high proportion of
asymptomatic cases. Very few population based
prevalence surveys of bacterial vaginosis have been
conducted. Most of these have been carried out in
rural Africa
6,7
, the findings of which may be hard to
apply in other settings.
Lactobacilli dominated vaginal ecology may be
an important defense against pathogen acquisition
as various studies have shown that women with
bacterial vaginosis are more likely than women with
normal vaginal flora to acquire infection due to
herpes simplex virus type-2
1
(HSV-2), Trichomonas
vaginalis
8
, Neisseria gonorrhoeae
8
and HIV
6,8
.
Therefore, the present study was carried out to
determine the prevalence of bacterial vaginosis in
the urban and rural communities in Delhi, India, and
to associate the presence of bacterial vaginosis with
demographic profile, risk factors and presence of
other reproductive tract infections (RTIs)/sexually
transmitted infections (STIs).
Material & Methods
This study was conducted under the aegis of
National AIDS Control Organization (NACO), and
Delhi State AIDS Control Society (DSACS), Delhi,
after approval by the ethics committee of Maulana
Azad Medical College, New Delhi. The
communities studied were randomly selected and
included two urban slums (Census enumeration
block: Sanjay Amar Colony, Charge No.: 19 and
Census enumeration block: Lal Bag, Charge No.:
77), one urban middle class colony (Census
enumeration block: Tilak Vihar, Charge No.: 49)
and one rural area (Block Name: Khanjawala,
Village name: Bajidpur Thakran). Initial house-to-
house survey was carried out in 100 households in
each area; these households were selected by
systematic random sampling method. The survey
was carried out during September and December
2002 and information regarding socio-
demographic profile of the household; knowledge,
attitude and practices regarding STIs; and health
seeking behaviour was collected. The number of
eligible women (15-49 yr of age) enumerated was,
143 in Sanjay Amar Colony, 137 in Lal Bag, 132
in Tilak Vihar and 125 in Bajidpur Thakran. The
minimum number of women to be studied was 50
in each area but 65 women were selected from the
eligible women enumerated in each area by
systematic random sampling. The sample size was
decided on the basis of the findings of the previous
study
9
. Camps were held in the health centres
located in these areas. During the camps
demographic, risk factor and clinical data were
collected using a structured questionnaire.
Relevant specimens (vaginal specimens, blood and
urine) were collected for laboratory diagnosis of
various RTIs/ STIs after obtaining informed
consent from all participants. Women who were
menstruating, pregnant or had received antibiotics
in the past four weeks, were excluded from the
study.
Two vaginal swabs were collected from each
women, one used for preparation of saline and KOH
wet mount and smear for Gram staining. The second
swab was used for inoculation in Kupferberg
medium (for culture of T. vaginalis) and Sabouraud
dextrose agar (SDA, for culture of Candida spp.).
This was done to minimize the number of swabs to
be collected from each women. Culture for
T. vaginalis was incubated at 37°C and wet mounts
168 INDIAN J MED RES, FEBRUARY 2007
were prepared and examined after 2,4 and 7 days of
incubation
10
. SDA was incubated at 37°C and
examined for growth after 72 h of incubation.
Diagnosis of trichomoniasis and candidiasis was
made on the basis of positivity in direct microscopy
and/or culture. First-void urine specimen was
collected for diagnosis of N. gonorrhoeae and
Chlamydia trachomatis infection using a
commercially available multiplex polymerase chain
reaction kit (Amplicor CT/NG test, Roche
Molecular Systems, Branchburg, N.J.). The urine
specimen was transported, stored and tested as per
manufacturer’s instructions. Venous blood sample
(5 ml) was collected for HIV and syphilis serology.
For syphilis serology all serum samples were
screened by VDRL test (Serologist to the
Government of India, Kolkata) and positive results
were confirmed by treponema pallidum
haemagglutination test (TPHA) (Immunotrep
TPHA, Omega Diagnostics Limited, Scotland,
U.K.). For serodiagnosis of HIV infection, serum
samples were screened by ELISA (HIVASE 1+2,
General Biologicals Corporation, Taiwan) and
positive results were confirmed by a second rapid
and simple test (Capillus HIV1/ HIV2, Trinity Biotech
PLC, Ireland). For diagnosis of bacterial vaginosis
Gram stained vaginal smear was examined under oil
immersion objective (1000x magnification) and
graded as per standardized, quantitative,
morphological classification developed by Nugent et
al
11
. Composite score was categorized into three
categories, scores 0-3 being normal, 4-6 intermediate
and 7-10 as definite bacterial vaginosis.
Statistical analysis: Data was statistically analysed
for correlation of bacterial vaginosis with
demographic profile, risk factors and presence of
other laboratory confirmed RTIs/STIs using
Chi-square test and Fisher’s exact test.
Results & Discussion
Of the total of 260 women invited to participate,
237 (91.1%) were enrolled for the study. Of these,
122 (51.4%) belonged to urban slum, while 60
(25.3%) and 55 (23.25%) subjects belonged to urban
Table I. Association between bacterial vaginosis and presence of other laboratory confirmed sexually transmitted or reproductive
tract infections
Characteristic n Vaginal flora morphology
(%) BV (%) I (%) N (%)
Trichomoniasis* Positive 6 (2.8) 6 (100) 0 (0) 0 (0)
Negative 207 (97.1) 64 (30.9) 36 (17.3) 107 (51.6)
Candidiasis Positive 36 (16.9) 9 (25) 6 (16.6) 21 (58.3)
Negative 177 (83.0) 61 (34.4) 30 (16.9) 86 (48.5)
HIV infection
Positive 2 (0.95) 0 (0) 1 (50) 1 (50)
Negative 208 (99.0) 70 (33.6) 34 (16.3) 104 (50)
Syphilis
Positive 10 (4.76) 5 (50) 1 (10) 4 (40)
Negative 200 (95.2) 65 (32.5) 34 (17) 101 (50.5)
Gonorrhea Positive 2 (0.93) 0 (0) 1 (50) 1 (50)
Negative 211 (99.0) 70 (33.1) 35 (16.5) 106 (50.2)
BV, bacterial vaginosis: score of 7-10; I, intermediate: score of 4-6; N, normal: score of 0-3;
Blood samples for serology could not
be collected from three subjects.
*P<0.001 BV vs. I+N
BHALLA et al: PREVALENCE OF BACTERIAL VAGINOSIS 169
Table II. Correlation between bacterial vaginosis and various socio-demographic and risk factors
Characteristic n Vaginal flora morphology
BV (%) I (%) N (%)
Age (yr) 15-24 38 13 (34.2) 6 (15.7) 19 (50)
25-49 175 57 (32.5) 30 (17.1) 88 (50.2)
Income (Rs) <520 4 2 (50) 0 (0) 2 (50)
520-1299 35 15 (42.8) 7 (20) 13 (37.1)
1300-2599 130 37 (28.4) 24 (18.4) 69 (53)
2600-4159 34 13 (38.2) 4 (11.7) 17 (50)
³ 4160 10 3 (30) 1 (10) 6 (60)
Religion Hindu/Sikh 176 56 (31.8) 30 (17) 90 (51.1)
Muslim 37 14 (37.8) 6 (16.2) 17 (45.9)
Literacy Illiterate 114 38 (33.3) 23 (20.1) 53 (46.4)
Just literate 27 9 (33.3) 4 (14.8) 14 (51.8)
Primary 36 12 (33.3) 5 (13.8) 19 (52.7)
Secondary 28 10 (35.7) 2 (7.1) 16 (57.1)
Higher 5 0 (0) 2 (40) 3 (60)
secondary
Graduate 3 1 (33.3) 0 (0) 2 (66.6)
Location Urban slum 106 41 (38.6) 19 (17.9) 46 (43.3)
Urban middle 55 14 (25.4) 11 (20) 30 (54.5)
class
Rural 52 15 (28.8) 6 (11.53) 31 (59.6)
Marital status Married 203 69 (33.9) 34 (16.7) 100 (49.2)
Unmarried 10 1 (10) 2 (20) 7 (70)
History of Yes 26 9 (34.6) 4 (15.38) 13 (50)
abortion No 187 61 (32.6) 32 (17.1) 94 (50.2)
Smoking Yes 15 4 (26.6) 3 (20) 8 (53.3)
No 198 66 (33.3) 33 (16.6) 99 (50)
Past history Yes 100 36 (36) 16 (16) 48 (48)
suggestive of No 113 34 (30) 20 (17.6) 59 (52.2)
RTIs/STIs
Complaint of Yes 88 31 (35.2) 14 (15.9) 43 (48.8)
vaginal discharge No 125 39 (31.2) 22 (17.6) 64 (51.2)
Complaint of Yes 41 10 (24.3) 8 (19.5) 23 (56)
lower abdominal No 172 60 (34.8) 28 (16.2) 84 (48.8)
pain
BV, bacterial vaginosis: score of 7-10; I, intermediate: score of 4-6; N, normal: score of 0-3
170 INDIAN J MED RES, FEBRUARY 2007
middle class and rural communities, respectively.
The majority of the women in this investigation were
>30 yr of age (143, 63.3%), were married (226,
95.3%), and were not working (208, 87.7%). Most
of them were Hindus (177, 74.6%), illiterate (131,
55.2%), and non smokers (198, 93%).
Of the 237 women enrolled in the study, vaginal
swabs and urine specimens could be obtained from
213 and blood samples from 210 subjects. Prevalence
of laboratory confirmed STIs/ RTIs with 95 per cent
CI was as follows: bacterial vaginosis 32.8 per cent
(26.38, 39.22), trichomoniasis 2.8 per cent (0.54,
5.06), candidiasis 16.9 per cent (11.78, 22.02),
syphilis 4.7 per cent (1.84, 7.68), HIV infection 0.95
per cent (0, 2.27), gonorrhoea 0.93 per cent (0, 2.23)
and C. trachomatis infection 0 per cent.
Table I shows the association between bacterial
vaginosis and other laboratory confirmed STIs/ RTIs.
All women with vaginal trichomoniasis were found
to have bacterial vaginosis (P<0.001) while 50 per cent
of subjects having syphilis also had bacterial vaginosis.
Table II shows the association between socio-
demographic profile of the study population and
prevalence of bacterial vaginosis. The highest
prevalence was seen in urban slum (38.6%) followed
by rural community (28.8%) and urban middle class
community (25.4%). In a study conducted by Garg
et al
9
in ever-married women belonging to an urban
slum in Delhi, prevalence of bacterial vaginosis was
41 per cent. Higher prevalence reported in this study
could be because of more than one method used for
the diagnosis of bacterial vaginosis. In a study
conducted in married rural women in Karnataka,
India, prevalence of bacterial vaginosis using
Nugent’s criteria was reported to be 20.5 per cent
12
.
In another study from Haryana, India, bacterial
vaginosis was diagnosed in a high percentage
(48.5%) of rural women
13
. This shows that
prevalence of bacterial vaginosis varies widely
among different areas and communities within the
country. The contrasting prevalence figures may be
because of various reasons such as differences in
economic status and educational background, study
population and method used for diagnosis of
bacterial vaginosis.
In the present study we found no association
between prevalence of bacterial vaginosis with age,
as almost equal prevalence was seen in women
between 15 to 24 yr of age and those who were
>25 yr. However, other studies showed a strong
association between the presence of bacterial
vaginosis age >25 yr
4,6
. Smoking has also been
reported to be associated with bacterial vaginosis
14
.
However, no such association was found in the
present study as number of smokers was very few.
Bacterial vaginosis (score >7) was found in 32.8
per cent of women while a shift from normal flora
(score 4-6) was observed in another 16.9 per cent of
women. Sewankambo et al
6
reported bacterial
vaginosis in 50.8 per cent and intermediate flora in
31.7 per cent women. An intermediate score between
4-6 may be found among women who are either
recovering from bacterial vaginosis or who may
develop bacterial vaginosis subsequently. Such
women therefore should be followed up to confirm
the same as these alterations in vaginal microflora
may increase the risk of acquisition of other STIs
including HIV infection.
39/125 (31.2%) women not complaining of
vaginal discharge also had bacterial vaginosis. These
asymptomatic women are less likely to seek treatment
for the morbidity and thus are more likely to acquire
other serious STIs. In view of this it is suggested
that women attending various health care facilities
including antenatal clinic, gynaecology clinic,
genitourinary medicine clinic or family planning
clinic should be screened and treated for bacterial
vaginosis to reduce the risk of acquisition of other
more serious STIs.
Acknowledgment
Authors thank Shrimati Sujatha Grover and
Seema Malhotra for technical support.
BHALLA et al: PREVALENCE OF BACTERIAL VAGINOSIS 171
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Reprint requests: Dr Rohit Chawla, 4A/ 55, First Floor, Old Rajinder Nagar, New Delhi 110060, India
e-mail: rohitchawla_75@hotmail.com
172 INDIAN J MED RES, FEBRUARY 2007
... The study of [28] mentioned that the bacterial vaginosis prevalence will increases with age, which measured in line with high prevalence detected with the age range between 21-25 years, our results was disagreement with this outcome. Furthermore, our results were in agreements with that obtained by Bhalla et al., (2007) [29] , Bitew et al., (2017) [30] , Bhakta et al., (2021) [31] , concerning that the presence of the bacterial vaginosis was not significantly associated with age. The results for education was exhibited significantly association among education level (p< 0.001), our result was in agreements with that obtained by Bahram et al., (2009)35 and Nayak et al., (2020) [34] , while it was contradicted with that obtained by Xueqiang et al., (2007) [32] and Bitew et al., (2017) [30] . ...
... The study of [28] mentioned that the bacterial vaginosis prevalence will increases with age, which measured in line with high prevalence detected with the age range between 21-25 years, our results was disagreement with this outcome. Furthermore, our results were in agreements with that obtained by Bhalla et al., (2007) [29] , Bitew et al., (2017) [30] , Bhakta et al., (2021) [31] , concerning that the presence of the bacterial vaginosis was not significantly associated with age. The results for education was exhibited significantly association among education level (p< 0.001), our result was in agreements with that obtained by Bahram et al., (2009)35 and Nayak et al., (2020) [34] , while it was contradicted with that obtained by Xueqiang et al., (2007) [32] and Bitew et al., (2017) [30] . ...
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... Vaginal infection ranges from 1-14% of all women of reproductive age throughout the world and the reported prevalence in India is 30% [6,7] . These variations may be because of differences in the study population, economic status, educational background, geographic location and method of diagnosis [8,9] . Variable prevalence rates of infectious vaginitis can be attributed to the varied etiologies studied, the detection techniques applied, patient groups involved, and the geographical locales as having been reported by studies conducted globally as well as in India [9][10][11][12][13] . ...
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... In bacterial vaginosis, vaginal discharge has typical fishy odour with minimal or no vulvar irritation. [13][14][15] While studying the patients with vaginal infections, it was found that B. vaginosis, Candida and Trichomonas were the leading cause of vaginal infections either singly or in combination ( Coexistence of bacterial vaginosis and trichomonas vaginalis is even more common, with co-infection rates of 60%-80%. 17,18 Though sample size was not so big in the present study, but several such studies has been done earlier and sociodemographic profile may vary place to place due to local factors. ...
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INTRODUCTION Though reproductive tract infections affect both men and women, women tend to suffer disproportionately more than men. The commonest symptom of reproductive tract infection among women is vaginal discharge. It is found to be very common in South Asian women. Almost every fourth woman in gynaecological outpatient department has the complaint of vaginal discharge. 1 Women are the silent sufferers of this problem. It restricts her domestic and occupational work thus resulting in social and economic problems. It not only affects her routine physical and social activities but also affect mental health and all aspects of a women's life. 2 The most common infection causing vaginal discharge is non-inflammatory bacterial vaginosis, responsible for 40% to 50% of vaginal infections, followed closely by vulvovaginal candidiasis (20% to 25%) and finally trichomoniasis, which occur less frequently (15% to 20%). 3 Abnormal vaginal discharge predisposes to significant morbidity in the form of vaginal itching, dyspareunia, emotional irritability, pelvic inflammatory disease, ABSTRACT Background: The objective of the study was to evaluate the prevalence and association of abnormal vaginal flora with socio demographic profile of patients. Methods: 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. Results: 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 microorganism detected was B. vaginosis (BV) in 14%, C. albicans (C) in 12% and T. vaginalis (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. Conclusions: 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.
... 4 An increased vaginal pH and the replacement of vaginal lactobacilli by Gardnerella vaginalis and anaerobic gram-negative rods characterizes this VD. 5 Vulvovaginal candidiasis is an extremely common infection in women of childbearing age of all strata of society, the second most common cause of vaginitis in the United States and the most common cause in Europe, and it has a high negative impact over women's comfort and well-being. 6 Some genital hygiene behaviors and/or sexual practices might represent potential mechanisms for facilitating the installation of one of these conditions. ...
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Objective: To evaluate genital hygiene among women with and without bacterial vaginosis (BV) and/or vulvovaginal candidiasis (VVC). Methods: A cross-sectional study of reproductive-aged women who underwent gynecological and laboratory tests and fulfilled a genital hygiene questionnaire. Results: This study evaluated 166 healthy controls and 141 women diagnosed with either BV (n = 72), VVC (n = 61), or both (n = 8). The use of intimate soap and moist wipes after urination was more frequent among healthy women (p = 0.042 and 0.032, respectively). Compared to controls, bactericidal soap was more used by women with BV (p = 0.05). Conclusion: Some hygiene habits were associated to BV and/or VVC. Clinical trials should address this important issue in women's health.
... 8 Urban and ruler communities of India mostly have asymptomatic bacterial vaginosis (BV) and are more likely to acquire other STIs. It was also reported that genital mycoplasmas are associated with BV. 9 Univariate study showed Mycoplasma Genitalium (MG) infection to be significantly associated with cervicitis compared to that of CT, NG and TV infections. 10 However, these infections are least studied especially in Indian context. ...
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Background: Asymptomatic RTIs/STIs and Adolescent physiologies impel them towards high risk infections. Persistent infection increases risk of infertility, pregnancy-complication and neonatal infections. We assessed prevalence of seven RTIs/STIs in adolescent asymptomatic pregnant women to find significant correlation between infection and pregnancy-outcome. Method: Prospective cohort study was conducted on 279 asymptomatic pregnant women in north-India. Cervical samples were collected and tested using qPCR-Taqman probe-diagnostic. Maternal measures like premature rupture of membranes (PROM), preterm premature rupture of membranes (PPROM) etc. were assessed. Statistical analysis of prevalence of infections and significance of its association with adverse outcome was determined by applying χ² tests and univariate conditional logistic regression. Findings: The prevalence for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), Trichomonas vaginalis (TV), Mycoplasma hominis (MH), Ureaplasma urealyticum (UU), Ureaplasma parvum (UP) were found to be 8·96%, 5·38%, 7·17%, 15·41%, 5·73%, 20·79%, 41·22% respectively in asymptomatic adolescent. Most prevalent and significant co-infections were observed for CT/NG (2·15%;p-value-0·0028/OR-6.9949), CT/MG (3·25%;p-value-0·0007/OR-7·3984), CT/TV (1·43%;p-value-0·0282/OR-4·311), MG/MH (0·03%;p-value-0·0321/OR-0·0771), TV/MH (5·3%;p-value-0·0008/OR-8·2457), MH/UU (7·88%;p-value-0·0119/OR-2·6455), MH/UP (9·31%;p-value-0·0071/OR-2·6421). Among 279 subjects, 32·97% women gave birth to LBW fetus, PTB (11·82%), PROM (2·50%), PPROM (2·15%), leaking/vaginum (8·96%), NICU-stay (10·03%), infant death (1·79%). RTIs increased the risk factor. Statistically significant association was found between CT ([p-value-0·0439];OR-2·9902) and MG ([p-value-0·0284];OR-3·442) with PTB, NG with LBW <2.5Kg ([p-value-0·0052];OR-4·9017)), UU with VLBW <2kg infants delivery ([p-value-0·0262];OR-3·0207), MG (p-value-0·0184]; OR-11·7976) and TV([p-value 0·0063]; OR-19·4275) infections significantly increase the risk of PROM while MG ([p-value 0·0190]; OR-12·9230) and UU ([p-value 0·0063]; OR-14·5149) infection increase the risk for PPROM at 95% CI respectively. Interpretation: All infection except MH found to be significantly correlated with adverse pregnancy outcome. MG infection prominently increases the incidence of PTB, PROM and PPROM. More comprehensive study is warranted globally to identify determinants associated with adverse pregnancy outcome to manage reproductive health.
... "The aim of the study was to assess the prevalence of bacterial vaginosis among women in selected rural areas." There were women still suffering from the Bacterial Vaginosis some of them were affected due to use of contraception, in selected rural areas this condition shows prevalence rate according to the Delhi scenario was 28.8% [4]. ...
Article
Bacterial vaginosis is condition in which abnormal vaginal discharge can cause. Due to this sexually transmitted diseases are causing in the women. In the bacterial vaginosis there is an imbalance in the vaginal acidity the pH becomes more than 5 the bacteria becomes overgrowth and due to this bacterial infection or bacterial vaginosis leads [1]. Objective: 1: To assess the prevalence of bacterial vaginosis among women. 2: To find out the association between prevalence of bacterial vaginosis among women with socio-demographic variable. Materials and Methods: Research Approach- Quantitative research approach. Research Design: Cross sectional survey design. Setting of the Study: The study was conducted at rural hospital and primary health centre. Population: women Sampling technique: non-probability convenient sampling technique. Sample size: 115. Results: The data obtained to describe the sample characteristics including demographic variables (age of women, education, marital status, occupation, age of menarche ,menstrual history, use of contraception, types of contraception), prevalence of bacterial vaginosis women the total participant was 115 women age of 30-50 years. Hence the all findings were describes there was no association between socio demographic variables and prevalence of bacterial vaginosis is 6.1%. Conclusion In this study the finding of the study shows that overall there was n association between bacterial vaginosis and demographic variables. The prevalence of bacterial vaginosis was 6.1% in the present study which was relatively low. However it vaginosis was common among sexually active women. The test was done by pap smear test which gave exact result and interpretation of test.
Article
Background- Sexually transmitted infections (STI's) are foremost community well being problems midst the women specially in developing countries. Vaginosis is conjoint gynaecological disorder stated in 5-51 % of women reliant upon demographics & whether or not they are suggestive of symptoms.1 Bacterial vaginosis is presently measured as the furthermost predominant vaginal infection. 50% of the total statistics of BV infections are symptomless. It is related with low birth weight & avoidable preterm birth. The study included 800 Methods- patients attending ANC & STI clinic who were screened for Bacterial vaginosis, candida, Gonorrhoea, Trichomonas vaginalis, HIV, Hepatitis b, Herpes simplex virus –II, Syphilis, Chlamydia by appropriate serological and bacteriological identication methods. In this study vaginal Results- trichomoniasis showed highly signicant association with bacterial vaginosis. In present study candidiasis OR=0.19 (95% CI) 0.19(0.14-0.28)( p= 0.000 ) showed highly signicant association with bacterial vaginosis. Similarly HIV (OR=5.79 (95% CI) (1.09-57.35) p=0.0138 and Syphilis OR=3.66 (95% CI) (1.16-13.57) p = 0.0108 also signicantly associated with bacterial vaginosis. A diagnosis of Chlamydia, Gonorrhoea and HSV-2 showed no signicant association with BV (all p>0.05). Screening for BV could reduce HIV Conclusions- -1 transmision. Additionally, BV is associated with STIs including HIV, so further investigation is needed to apprehend the potential role of screening and treatment of BV in STIs /HIV prevention programs.
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: Vaginitis is the most common health problem among women of reproductive age group, which is associated with gynaecological and obstetrical complications and also increases the transmission of HIV and other sexually transmitted diseases. : This study aimed at estimating the various etiological agents causing vaginitis, different laboratory methods for its diagnosis, isolation of different species and antibiotic susceptibility pattern of aerobic bacterial isolates. : In present study, 104 clinically suspected cases of vaginitis attending gynaecology OPD was included after obtaining informed consent and various data were collected using via questionnaire. Three high vaginal swabs collected from each patient and subjected to PH, Whiff test, Microscopic examination (Grams staining, KOH mount, Acridine orange staining (AO), Saline wet mount) Culture and Biochemical reactions following standard protocols. Aerobic isolates were subjected to antibiotic susceptibility testing as per CLSI guidelines. : Out of 104 Clinically suspected cases most common type of vaginitis were Bacterial vaginosis (BV)51.9% followed by Candidiasis 41.3%, Trichomoniasis 3.9%. Most common species isolated in vulvovaginal Candidiasis is 32.5%. Majority of Gram positive organisms were susceptible to Linezolid and Gram negative organisms to Azithromycin. : Bacterial vaginosis, Candidiasis and Trichomoniasis are common problem in women of reproductive age, therefore screening of vaginal infection in women of reproductive age should be implemented. Culture and sensitivity should be mandatory and treatment should be based on invitro susceptibility testing. So that misuse of antibiotics will be avoided.
Article
INTRODUCTION: Leukorrhoea develops due to physiological and pathological conditions among women of reproductive age.Due to its presentation, determining the source and cause of discharge is crucial, therefore, differential diagnosis and microbiological prole would aid in its management. AIM: To identify etiological agents and estimate their proportions in leucorrhoea among women of reproductive age for better treatment of genital tract infection. MATERIALS AND METHODS: The study was conducted at the OBG Department of a tertiary medical hospital from January 2018 to December 2018. Vaginal swabs were collected sterilely from 152 patients complaining of abnormal vaginal discharge or any other associated ailment. Samples were processed for culture as per standard recommendations. Bacterial vaginosis(BV)was diagnosed by clinical composite criteria (Amsel's criteria) and Gram stain (Nugent's score). RESULTS: Among the 152 patients, infectious etiology was observed in 65.8%, normal ora in 28.9% & no growth in 5.3% in culture media. BV (44%) had higher prevalence followed by Candidiasis (26%) and Trichomoniasis (2%). Amsel's criteria identied 28.9% of BV compared to Nugent's criteria (25%).A considerable increase in non-albicans Candida species (53.8%) was observed compared to Candia albicans(46.2%). Other organisms isolated included, Acinetobacter spp. (3.6%), Pseudomonas spp. (14.3%), E. coli (39.3%), Klebsiella pneumoniae (10.7%), MSSA (10.7%), Enterococcus spp. (21.4%). CONCLUSION:Bacterial vaginosis was the prominent cause of infection in leukorrhoea among the women of reproductive age. Timely diagnosis and appropriate management avert serious complications and risks of ectopic pregnancy, infertility, chronic pelvic pain, and abdominal discomfort.
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The purpose of the study was to examine intercenter variability in the interpretation of Gram-stained vaginal smears from pregnant women. The intercenter reliability of individual morphotypes identified on the vaginal smear was evaluated by comparing them with those obtained at a standard center. A new scoring system that uses the most reliable morphotypes from the vaginal smear was proposed for diagnosing bacterial vaginosis. This scoring system was compared with the Spiegel criteria for diagnosing bacterial vaginosis. The scoring system (0 to 10) was described as a weighted combination of the following morphotypes: lactobacilli, Gardnerella vaginalis or bacteroides (small gram-variable rods or gram-negative rods), and curved gram-variable rods. By using the Spearman rank correlation to determine intercenter variability, gram-positive cocci had poor agreement (0.23); lactobacilli (0.65), G. vaginalis (0.69), and bacteroides (0.57) had moderate agreement; and small (0.74) and curved (0.85) gram-variable rods had good agreement. The reliability of the 0 to 10 scoring system was maximized by not using gram-positive cocci, combining G. vaginalis and bacteroides morphotypes, and weighting more heavily curved gram-variable rods. For comparison with the Spiegel criteria, a score of 7 or higher was considered indicative of bacterial vaginosis. The standardized score had improved intercenter reliability (r = 0.82) compared with the Spiegel criteria (r = 0.61). The standardized score also facilitates future research concerning bacterial vaginosis because it provides gradations of the disturbance of vaginal flora which may be associated with different levels of risk for pregnancy complications.
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To find out whether women with bacterial vaginosis detected early in pregnancy are at increased risk of preterm delivery. Prospective description cohort study. Antenatal clinic in a district general hospital. 783 women examined during their first antenatal clinic visit and screened for recognised risk factors for preterm delivery and the presence of bacterial vaginosis or intermediate abnormal flora detected by examination of a vaginal smear stained by Gram's method. Gestational age at delivery classified as late miscarriage (16-24 weeks' gestation), preterm delivery (24-37 weeks' gestation), term delivery (> or = 37 weeks' gestation). Multiple logistic analysis showed that there was an increased incidence of preterm delivery in women with a previous preterm delivery (9/24; odds ratio 25; 95% confidence interval 9 to 70; P < 0.001) and bacterial vaginosis (9/115; 2.8; 1.1 to 7.4; P = 0.04). A further logistic analysis of data from women recruited before 16 weeks' gestation showed that preterm deliveries or late miscarriages occurred more often in women with bacterial vaginosis (12/77; 5.5; 2.3 to 13.3; P < 0.001). Late miscarriage and preterm delivery are associated with the presence of bacterial vaginosis in early pregnancy. This is independent of recognised risk factors such as previous preterm delivery.
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BackgroundIn-vitro research has suggested that bacterial vaginosis may increase the survival of HIV-1 in the genital tract. Therefore, we investigated the association of HIV-1 infection with vaginal flora abnormalities, including bacterial vaginosis and depletion of lactobacilli, after adjustment for sexual activity and the presence of other sexually transmitted diseases (STDs).MethodsDuring the initial survey round of our community-based trial of STD control for HIV-1 prevention in rural Rakai District, southwestern Uganda, we selected 4718 women aged 15–59 years. They provided interview information, blood for HIV-1 and syphilis serology, urine for detection of Chlamydia trachomatis and Neisseria gonorrhoeae, and two self-administered vaginal swabs for culture of Trichomonas vaginalis and gram-stain detection of vaginal flora, classified by standardised, quantitative, morphological scoring. Scores 0–3 were normal vaginal flora (predominant lactobacilli). Higher scores suggested replacement of lactobacilli by gram-negative, anaerobic microorganisms (4–6 intermediate; 7–8 and 9–10 moderate and severe bacterial vaginosis).FindingsHIV-1 frequency was 14·2% among women with normal vaginal flora and 26·7% among those with severe bacterial vaginosis (p<0·0001). We found an association between bacterial vaginosis and increased HIV-1 infection among younger women, but not among women older than 40 years; the association could not be explained by differences in sexual activity or concurrent infection with other STDs. The frequency of bacterial vaginosis was similar among HIV-1-infected women with symptoms (55·0%) and without symptoms (55·7%). The adjusted odds ratio of HIV-1 infection associated with any vaginal flora abnormality (scores 4–10) was 1·52 (95% Cl 1·22–1·90), for moderate bacterial vagniosis (scores 7–8) it was 1·50 (1·18–1·89), and for severe bacterial vaginosis (scores 9–10) it was 2·08 (1·48–2·94).InterpretationThis cross-sectional study cannot show whether disturbed vaginal flora increases susceptibility to HIV-1 infection. Nevertheless, the increased frequency of HIV-1 associated with abnormal flora among younger women, for whom HIV-1 acquisition is likely to be recent, but not among older women, in whom HIV-1 is likely to have been acquired earlier, suggests that loss of lactobacilli or presence of bacterial vaginosis may increase susceptibility to HIV-1 acquisition. If this inference is correct, control of bacterial vaginosis could reduce HIV-1 transmission.
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In an epidemiological survey of 2128 women attending a sexually transmitted diseases clinic for the first time and 200 attending two primary health clinics, 26% and 27% respectively were found to have bacterial vaginosis. The prevalence increased significantly with age, being diagnosed in 22.8% (326/1431) of women aged 14-24 years, and in 33.3% (232/697) of those aged greater than or equal to 25 years. Bacterial vaginosis was associated with gonorrhoea and with chlamydial infection, but was negatively associated with genital papillomavirus infection and yeast infection. Women using barrier contraceptives had a significantly lower prevalence of bacterial vaginosis than those using an intrauterine device or no contraceptive. Women less than or equal to 24 years old using oral contraceptives had a significantly lower prevalence of bacterial vaginosis than those not using contraceptives. Patients without gonorrhoea or chlamydial infection but with vaginal or urethral inflammatory signs had a significantly higher prevalence of bacterial vaginosis than those without inflammatory signs. These findings may have implications regarding complications associated with lower genital tract infections and may strengthen the hypothesis that bacterial vaginosis is a risk factor for pelvic inflammatory disease.
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Four methods for the detection of Trichomonas vaginalis in vaginal secretions from 88 symptomatic patients were compared: wet-mount examination, Kupferberg liquid medium, Hirsch charcoal agar, and the Papanicolaou smear. Hirsch diphasic slants and Kupferberg medium did not significantly differ in sensitivity from direct examination of wet mounts. The Papanicolaou smear identification of trichomonads was found to be the least sensitive method evaluated.
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Bacterial vaginosis is characterized microbiologically by replacement of the Lactobacillus-predominant vaginal flora by Gardnerella vaginalis, Bacteroides species, Mobiluncus species, and genital mycoplasmas. A standardized, laboratory-based diagnostic test for bacterial vaginosis is desirable in those instances in which a microscope is unavailable in the clinic or when the evaluator of the wet mount examination is inexperienced at recognizing clue cells. Vaginal cultures have excellent sensitivity for the diagnosis of bacterial vaginosis, but because the predictive value of a positive G. vaginalis culture is less than 50%, cultures are not recommended. Vaginal Gram smears are objective and reproducible, have 62% to 100% sensitivity, and have a positive predictive value of 76% to 100%. Diagnosis of bacterial vaginosis with use of Papanicolaou-stained smears has been reported, but standardized criteria have not been widely adopted. A rapid, office-based oligonucleotide probe test for high concentrations of G. vaginalis has been developed and may be useful when direct microscopy is unavailable or confidence in microscopic examination is low. Laboratory tests that detect microbial products unique to the vaginal fluid of women with bacterial vaginosis include detection of amines (putrescine, cadaverine, and trimethylamine), measurement of the relative levels of succinate and lactate in the vaginal fluid by gas chromatography, detection of proline aminopeptidase by colorimetric assay, or detection of sialidases in the vaginal fluid. Although these tests are not yet applicable to routine use, these research tests could be adapted for wider use in office laboratories. Vaginal Gram stains are more useful than culture for laboratory confirmation of bacterial vaginosis.
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A prospective cohort study was conducted to examine the relationship between vaginal colonization with lactobacilli, bacterial vaginosis (BV), and acquisition of human immunodeficiency virus type 1 (HIV-1) and sexually transmitted diseases in a population of sex workers in Mombasa, Kenya. In total, 657 HIV-1—seronegative women were enrolled and followed at monthly intervals. At baseline, only 26% of women were colonized with Lactobacillus species. During follow-up, absence of vaginal lactobacilli on culture was associated with an increased risk of acquiring HIV-1 infection (hazard ratio [HR], 2.0; 95% confidence interval [CI], 1.2–3.5) and gonorrhea (HR, 1.7; 95% CI, 1.1–2.6), after controlling for other identified risk factors in separate multivariate models. Presence of abnormal vaginal flora on Gram's stain was associated with increased risk of both HIV-1 acquisition (HR, 1.9; 95% CI, 1.1–3.1) and Trichomonas infection (HR, 1.8; 95% CI, 1.3–2.4). Treatment of BV and promotion of vaginal colonization with lactobacilli should be evaluated as potential interventions to reduce a woman's risk of acquiring HIV-1, gonorrhea, and trichomoniasis.
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A community based study was carried out to estimate the load of reproductive tract infections (RTIs) among ever married rural women aged 15-44 years and utilisation of a mobile village based treatment facility by them, during 1997. Complete household survey was done in 10 randomly selected villages of Mahindergarh district in Haryana, India. A total of 2325 women were interviewed by auxiliary nurse midwives and were invited for medical examination in a health camp set-up in their village. Sixty-one percent (1415/2325) women reported symptoms of RTIs. Only 35% (812/2325) had their per-speculum examination done. Out of those examined, 32% (263/812) had vaginitis, 21% (175/812) had cervicits, and 19% (156/812) had pelvic inflammatory disease. Vaginal smear of those having discharge revealed that 48% (231/476) had bacterial vaginosis, 0.8% (4/476) had fungal infection 9% (44/496) had trichomonal infection and none was found to be having gonococcal infection. Tests for chlamydial infection could not be performed as the cost was not affordable. Eighty-nine percent of women who reported symptoms of RTIs had not consulted anyone for their problem prior to our village based camp. Only 42% symptomatic and 24% asymptomatics availed the services even in the village based camps. Study revealed high load of reproductive tract infections and low utilisation of treatment facility. In-depth studies are required to understand for high RTI morbidity load and low treatment seeking rate so as to design an appropriate RTI control programme.
Article
Data on the epidemiology of reproductive-organ morbidity are needed to guide effective interventions, to set health-care priorities, and to target future research. This study aimed to find out the prevalence of reproductive-organ disease in a sample of rural Gambian women. A questionnaire on reproductive health was administered by fieldworkers to women aged 15-54 years living in a rural area under demographic surveillance. A female gynaecologist questioned and examined the women (including speculum and bimanual pelvic examinations). Vaginal swabs were taken to test for Trichomonas vaginalis, Candida albicans, and bacterial vaginosis, cervical smears for cytology, cervical swabs for Chlamydia trachomatis PCR and Neisseria gonorrhoeae culture, and venous blood for haemoglobin, HIV, herpes simplex virus 2, and syphilis serology. 1348 (72.0%) of 1871 eligible women took part. Reproductive-organ symptoms were more likely to be reported to the gynaecologist (52.7% of women) than to the fieldworker (26.5%). Menstrual problems, abnormal vaginal discharge, and vaginal itching were the most commonly reported symptoms. A minority of women said they had sought health care for their symptoms. The frequencies of reproductive-organ morbidity were high: menstrual dysfunction 34.1% (95% CI 29.6-39.1), infertility 9.8% (8.2-11.6), reproductive-tract infections 47.3% (43.7-51.0), pelvic tenderness 9.8% ((7.0-13.5), cervical dysplasia 6.7% (5.2-8.4), masses 15.9% (12.5-20.1), and childbirth-related damage to pelvic structures 46.1% (40.1-52.3). 948 (70.3%) women had at least one reproductive-organ disorder. For these rural women, whose lives depend heavily on their reproductive function, reproductive-organ disease is a large burden. In inadequately resourced rural areas, with poor education, heavy agricultural and domestic labour, and limited access to quality health care, many women are not able to attain and maintain reproductive health and wellbeing.