Abstract
BackgroundIn Yemen, the underlying causes of infectious vaginitis have been neglected. Therefore, this study aimed to determine the prevalence and risk factors associated with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonal vaginitis (TV) among non-pregnant reproductive-aged women.MethodsA cross-sectional study was conducted among 347 non-pregnant reproductive-aged women seeking primary healthcare in Sana’a city, Yemen. Data about sociodemographic characteristics, lifestyle-related behaviors, routine hygienic practices, menstrual care and history and type of contraceptive intake were collected using a structured questionnaire. Vaginal discharge samples were collected and examined for discharge characteristics and pH by a gynecologist. Then, samples were examined for BV, VVC and TV. Data were analyzed using suitable statistical tests.ResultsVaginal infections were prevalent among 37.6% of reproductive-aged women, where BV was the most prevalent (27.2%). VVC was significantly higher among symptomatic women and significantly associated with itching (P = 0.005). Using bivariate analysis, the age of < 25 years (odds ratio [OR] = 1.9, 95% confidence interval [CI]: 1.16–3.10; P = 0.010) and using intrauterine contraceptive devices (IUCDs) (OR = 1.8, 95% CI: 1.09–2.89; P = 0.020) were significantly associated with BV, while history of miscarriage was significantly associated with a lower risk of BV (OR = 0.5, 95% CI: 0.31–0.85, P = 0.009). However, polygyny was significantly associated with VVC (OR = 3.4, 95% CI: 1.33–8.66; P = 0.007). Multivariable analysis confirmed that age of < 25 years and using IUCD were the independent predictors of BV, while history of miscarriage was an independent protective factor against BV. On the other hand, marriage to a polygamous husband was the independent predictor of VVC.ConclusionsMore than a third of non-pregnant reproductive-aged women seeking PHC in Sana’a have single or mixed infections with BV, VVC or TV. BV is the most frequent cause of vaginitis and is significantly associated with the age of < 25 years and using IUCDs, while VVC is significantly higher among women with polygamous husbands. Health education of polygamous husbands and their wives, regular monitoring of BV among IUCD users and screening women for vaginitis before treatment are recommended.
Highlights
In Yemen, the underlying causes of infectious vaginitis have been neglected
bacterial vaginosis (BV) is the most frequent cause of vaginitis and is significantly associated with the age of < 25 years and using Intrauterine contraceptive device (IUCD), while vulvovaginal candidiasis (VVC) is significantly higher among women with polygamous husbands
Mixed infection with BV and VVC was observed among 2.6% of women, while mixed infection with trichomonal vaginitis (TV) and VVC was observed among 0.3% of women
Summary
In Yemen, the underlying causes of infectious vaginitis have been neglected. This study aimed to determine the prevalence and risk factors associated with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonal vaginitis (TV) among non-pregnant reproductive-aged women. Inflammation of the vagina, or vaginitis, is caused by various infectious and non-infectious factors [1]. The most common causes of infectious vaginitis are bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonal vaginitis (TV) [2]. The healthy vaginal tract of reproductive-aged women is colonized by normal microbiota dominated by lactobacilli, which protect against pathogenic bacterial species when present in sufficient numbers [3]. Depletion of lactobacilli distorts the balance of the vaginal microbiota and leads to an increase in anaerobic organisms, contributing to BV [4, 5]. The prevalence of BV ranges from 8 to 51%, depending on geographical location, socioeconomic status and ethnicity [10]
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