Complaints Of Abnormal Vaginal Discharge Research Articles

Phenotypic characterization and antifungal susceptibility profile of Candida isolates from women with vulvovaginal candidiasis at a community health center linked to a teaching institution in the Sub-Himalayan region of North India.

Vulvovaginal candidiasis (VVC) is considered a common gynecological problem among females of reproductive age group. 70-75% of women report having had candidal vulvovaginitis at some point in their lifetimes and 40-50% suffer recurrent candidal vulvovaginitis. This study aims to identify the Candida species involved in VVC and to determine their antifungal susceptibility pattern. The present study was a cross-sectional study conducted on 257 females (18-55 yr) with complaints of abnormal vaginal discharge. For detection of Candida, the swab samples were subjected to Gram stain, 10% KOH mount, and culture on Sabouraud dextrose agar (SDA). Candida species identification was done by subculturing Candida isolates onto CHROMagar, corn meal agar (Himedia), and further confirmation was done by MALDI-TOF MS. Antifungal testing was done using the disk diffusion method. A total of 257 females with complaints of abnormal discharge were enrolled in this study. Out of 257, C. albicans 37 (58.7%) and 26 (41.3%) isolates were identified as non-albicans Candida. Out of 63 positive cases, a maximum number of study subject belongs to the age group 26-35 years (50.8%). Along with vaginal discharge, itching (65.37%) is the most common complaint. VVC was found to be most predominant in patients with prolonged antibiotic therapy (38.1%), and in pregnant females (15.9%). Understanding the emerging fungal pathogens and their drug susceptibility patterns is essential for the effective management of infections. Drug resistance can lead to treatment failure and highlights the need for alternative treatment options or strategies.

DETECTION OF ABNORMAL CERVICAL CYTOLOGY BY LBC (LIQUID BASED CYTOLOGY)

Introduction: Cancer cervix is the fourth most common cancer among women globally. It is responsible for 7.7% of all female cancer death.It takes around 15-20 years in normal immunity patients and 5-10 years in immune-compromised patients to convert precancerous lesions of the cervix into cancer cervix. Cervical cytology plays a very important role in the early diagnosis and management of these precancerous lesions to improve prognosis.quite low Pap smear sensitivity, in the range of 50%, but as low as 20%10 has been reported by some recent meta-analysis studies. LBC was introduced in the mid-1990s as an alternative technique to process cervical smear samples for cytological evaluation.11Studies of the accuracy of liquid-based preparations reports sensitivity of 61-66% and specicity of 82- 91%. A retrospective study was done at a private clinic and pathology lab in Di Materials And Methods: strict Shivpuri (MP) from 1st October 2020to 30th November 2022 on 760 patients. Inclusion criteria:-Patients in the age group of 21-65 years with complaints of abnormal vaginal discharge, intermenstrual bleeding, ostmenopausal bleeding, post-coital bleeding, dyspareunia, foul-smelling discharge, backache, and Lower abdominal pain were included in this study. Sample was taken with Broom, and Cyto-brush from the transformation zone and endocervix and placed in liquid xative buffered methanol solution and send to the pathology lab. Results Most of the patient 42% were between 31-40 years of age group. The majority 48.42% of them were educated up to High school. Most of them 84.07%were from rural back ground, multiparous 86.05%, and married 99.73%. 25% ofwomen visited OPD with complaints of abnormal vaginal discharge followed by menstrual abnormalities in 20.79%, other complaints were, Pain abdomen 16.97%, Vulval itching12.11%, Low back pain 3.95%, Dyspareunia 3.03% and others 5.13%. (Loss of weight and appetite, STD/genital warts) .9.08% women came for routine checkup. The most common nding on per speculum examination was Cervical ectopy in 33.95% .Normal cervix was found in 26.05%. Other ndings on Per-speculum examination were, Hypertrophied cervix, Inammation, Cervical Polyp, UV Prolapse/ cystocele, Cervical Ulcer ,Cervix ushed with the vagina and Cervical growth in. 20%, 9.08%, 4.34% 4.61% 3.03% 0.13% and 0.13% respectively. Out of 760 cases, 61.05% of patients were reported as negative for intraepithelial lesion (NILM). The most common non-neoplastic cytological nding was an inammatory smear in 25.00% of cases. Various Infections were found in 6.18% of cases, and epithelial cell abnormalities were found in 3.42% of cases. The most common abnormalities were ASC-US 0.92% and ASC-H 0.92%, followed by LSIL 0.53%, HSIL 0.66%, AGUS 0.26%, and SCC 0.13%. Bacterial vaginosis 2.37% was the most common infective organism found in cytology followed by Candida albicans 1.97%, Trichomonas vaginalis 1.71%, and Herpes simplex virus 0.13%. The cytology-based screening program is still the mainstay in the earl Conclusion y diagnosis of cancer cervix. To improve diagnostic accuracy as sensitivity and specicity in the eld of cervical cytology, Liquid-based cytology (LBC) is preferred. Its advantages over conventional Pap smears include proper visualization of cellular features due to a reduction in air-drying artifacts and reduced number of unsatisfactory smears. The residual specimens from the LBC technique can be used to detect human papillomavirus DNA through immune-cytochemistry if needed. thus, LBC is recommended as a cervical cytology screening tool to achieve the WHO elimination strategy.

Подход к лечению бактериального вагиноза с применением комплекса бактериофагов

Introduction. A variety of treatment regimens for bacterial vaginosis (BV) pose to the clinician the question of choosing appropriate therapy for this disease. Aim. Improving the results of combination treatment of reproductive-age women with bacterial vaginosis by topical application of polyvalent bacteriophages. Materials and methods. A prospective study involving 120 female patients from 18 to 45 years old with complaints of abnormal vaginal discharge, diagnosis of BV confirmed by the Amsel criteria was performed. The patients were divided into 4 groups of 30 people, depending on the treatment regimen for BV: group 1 – metronidazole (gel) intravaginally + preparation Phagogyn (gel), polyvalent bacteriophage (PVB) for topical application; group 2 – clindamycin (cream) intravaginally + Phagogyn for topical application; group 3 – chlorhexidine gluconate (vaginal tablets) + Phagogyn for topical application; group 4 – Elzhina (ornidazole 500 mg, neomycin 65 000 U, prednisolone 3 mg, econazole 100 mg) + Phagogyn for topical application. Results. 10–14 days after the treatment, the effectiveness of metronidazole for vaginal application in combination with Phagogyn according to the Amsel criteria was 60.00%, clindamycin intravaginally in combination with Phagogyn – 73.33%, chlorhexidine gluconate intravaginally with Phagogyn – 43.33%, Elzhina + Phagogyn – 96.67%. Conclusion. The combination of Elzhina with Phagogyn is feasible for use in clinical practice to achieve better results in the treatment of BV, since this combination turned out to be the most effective.

Etiological Surveillance of Vaginal Discharge Syndrome in South Africa: 2019 to 2020.

The syndromic management of vaginal discharge syndrome (VDS) is challenging because of the prevalence of mixed infection with sexually transmitted infection (STI) pathogens and non-STI causes, such as bacterial vaginosis and candidiasis (CA). We aimed to determine the relative prevalence of VDS etiologies in women presenting to sentinel primary health care clinics in South Africa. Secondary objectives were to ascertain the predictive value of speculum findings for the presence of STI pathogens and the proportion of women presenting with clinical features of CA who had identifiable yeast on vaginal smear microscopy. Consecutive, consenting women with complaints of abnormal vaginal discharge were enrolled between January 1, 2019, and December 31, 2020. Genital discharge swab and blood specimens were collected and transported to a central STI reference laboratory in Johannesburg. A total of 364 women were enrolled at 3 sentinel sites. Bacterial vaginosis was the most common cause of VDS (163 of 361 [45.2%]; 95% confidence interval [CI], 40.1%-50.3%); however, a significant proportion had STI coinfection (71 of 163 [43.6%]; 95% CI, 35.8%-51.5%). The predominant STI etiology was Chlamydia trachomatis (73 [20.2%]; 95% CI, 16.4%-24.7%). An abnormal speculum finding had poor predictive value for STIs, and Gram stain microscopy showed yeast in only 37.2% of vaginal smears from women with CA symptoms. Bacterial vaginosis is the predominant cause of VDS in South Africa; however, STI coinfection is common. Clinical findings are poorly predictive of STI etiologies or candidiasis; therefore, a rapid and accurate STI point-of-care test would be useful in optimizing VDS management.

Сравнение эффективности распространенных схем лечения бактериального вагиноза

Introduction. Bacterial vaginosis (BV), being one of the most common diseases of the female genital organs, is still of interest to a practitioner. In modern conditions, requiring a short time to make a diagnosis and start treatment, it is often necessary to prescribe treatment empirically. Given the variety of regimens for the treatment of BV, it is advisable to identify the most effective for empirical therapy. Aim. To determine the most effective treatment regimen for BV among those common in the Russian Federation. Materials and methods. The study involved 120 women aged 18 to 45 years who met the inclusion criteria: applying to the antenatal clinic with complaints of abnormal vaginal discharge, the presence of BV, confirmed by the Amsel criteria at the initial admission. The follow-up was carried out during 4 consecutive visits. At the first visit, a clinical investigation was carried out: sampling for bacterioscopic and bacteriological studies, pH-metry of the posterior vaginal vault secretion, the amine whiff test, sampling for the Femoflor 16 real-time polymerase chain reaction (RT-PCR). At the second visit, all women were divided into 4 representative groups depending on the treatment regimen (group 1: metronidazole (gel) + Lactogynal (vaginal capsules); group 2: clindamycin (cream) + Lactogynal; group 3: chlorhexidine gluconate (vaginal tablets) + Lactogynal; group 4: Elzhina (vaginal tablets) + Lactogynal). At the third visit, on the 7th day of treatment, the intermediate efficacy of the studied regimens was evaluated, and side effects were identified. The fourth visit was scheduled 10–14 days after the end of treatment, during which the final result of treatment and treatment complications were assessed. Results. There were no significant differences in the studied groups in terms of the presence of complaints of vaginal abnormal discharge, the results of bacterioscopic examination, a positive amine whiff test, and the pH level (p > 0.05). In using the Femoflor-16 RT-PCR, normal state of vaginal biocenosis was determined in 26.67% of patients of each group (p = 1.0), moderate anaerobic dysbiosis – in 33.33% (p = 1.0), severe anaerobic dysbiosis – from 33.33% (in group 4) to 40% (in groups 1–3) (p > 0.05). The most effective was the treatment regimen with the use of Elzhina, its effectiveness was 80%. Also, according to the results of the Femoflor RT-PCR, the drug Elzhina showed the highest efficacy– 96.67%. Conclusion. The most effective was the treatment regimen with the use of a combined drug with antibacterial, antiprotozoal, antifungal and anti-inflammatory action for topical administration – Elzhina. This drug is highly effective and can be recommended as an empirical treatment for BV.

The vaginal microbiota in the course of bacterial vaginosis treatment

Bacterial vaginosis (BV) is perceived as a condition of disrupted vaginal microbiota, but remains of unknown aetiology. In this study, vaginal microbiota composition was determined in twenty-one women with BV, before and after treatment with metronidazole or clindamycin. Microbiota composition varied greatly between women and defining a (un)healthy vaginal microbiota state remains elusive, challenging BV diagnosis and treatment. While relative abundance of Lactobacillus increased after antibiotic treatment in two-third of women, its abundance was not associated with treatment outcome. Instead, remaining complaints of abnormal vaginal discharge were more common after metronidazole treatment and associated with increased relative abundance of Ureaplasma.

Identification of various Candida species isolated from patients with vulvovaginal candidiasis attending a tertiary care hospital in North India

Background: Vulvovaginal Candidiasis (VVC) is a condition diagnosed in a large proportion of women presenting with complaints of abnormal vaginal discharge. The risk of VVC is high in women with diabetes mellitus, pregnancy, using oral contraceptives or broad-spectrum antibiotics and those having Human Immunodeficiency Virus infection.Objective of the present study was to identify the various species of Candida isolated from patients with Vulvovaginal Candidiasis.Methods: A cross-sectional study was done from January to June 2018. A total of 69 clinically suspected VVC cases were included in the study whose high vaginal swabs were collected and subjected to direct microscopy and cultured on Sabouraud Dextrose Agar (SDA). Creamy white pigmented colonies on SDA were confirmed as Candida by doing Gram’s staining. Speciation of positive cultures was confirmed by conventional methods like Corn Meal agar culture, Germ tube test (GTT), Candida CHROM Agar Medium (CAM), sugar assimilation and fermentation test.Results: Out of 69 clinically suspected VVC cases included in the study, only 14 cultures were positive for Candida species. All the 14 isolates were found to be Non-albicans Candida (NAC). Most common species isolated were Candida glabrata 7(50%), followed by Candida tropicalis 3(21.4%), Candida lusitaniae 3(21.4%), and Candida parapsilosis 1 (7.1%).Conclusions: Candida albicans was known to be the most common causative agent of VVC as it was isolated in 90% cases. However, this study showed that all isolates from VVC were Non-albicans Candida. Therefore, species identification should be done in all microbiology laboratories for accurate diagnosis of VVC.

A comparative interventional study on the efficacy of single and multiple dose combination drug regimen of leucorrhea among women in reproductive age group

Background: Reproductive tract infections (RTIs) in women are becoming major public health problem not only in India but also over the world. Syndromic approach is advocated by World Health Organization (WHO) to manage common RTIs using clinical flow charts based on identifying a syndrome that cause the symptoms reported by patients. The most commonly reported among the women with RTIs is abnormal vaginal discharge or Leucorrhea. Single dose regimen is not preventing the recurrence of infections. A second course of treatment is required followed by standard single dose regimen for achieving better cure rate in chronic vaginal discharge. Objective of the study was to compare the efficacy of single dose drug combination regimen with multiple dose regimens in the treatment of leucorrhoea. Methods: Quasi-experimental study was done in Urban field service area, RMMCH – Chidambaram among Married women in the reproductive age group (15-49 years) with complaints of abnormal vaginal discharge for ≥15 days coupled with any one of the symptoms suggestive of RTI. The study subjects were categorized into two groups – one with single dose regimen and the other with multiple dose regimen. Follow up was done on day 7, 15 and after 6 months of therapy. Results: A total of 113 subjects were recruited with 57 participants in single dose group and 56 in multiple dose groups. The subjects who received single dose had a better cure rate as compared to multiple dose group on day 7(87.7% & 85.7%), day 15 (94.7% & 89.3%) and after six months (84.2% & 76.8%) assessment respectively. Recurrence rate was found to be equal in both the groups. Our study indicates that variables such as age of the study subjects and type of flow had significant association with the outcome. Conclusions: Single-dose therapy is as effective as multiple- dose in the management of vaginal discharge based solely on symptoms. The multiple drug regimens can be given if the symptoms persist after single drug regimen as the chances of developing complications due to chronic vaginal discharge are high.

A multiplex real-time PCR assay for routine diagnosis of bacterial vaginosis.

A semi-quantitative multiplex PCR assay for the diagnosis of bacterial vaginosis (BV) was evaluated in a prospective study in a population of Dutch women with complaints of abnormal vaginal discharge. The PCR targets Gardnerella vaginalis, Atopobium vaginae, Megasphaera phylotype 1, Lactobacillus crispatus and Lactobacillus iners. Together with a short questionnaire, a vaginal swab for PCR and vaginal smear for microscopy were taken by their general practitioner or gynaecologist. Data from 151 women (median age 32) were available. Nugent Score (NS) was used to classify the samples and 83 samples were classified as normal (NS 0–3), 13 as intermediate (NS 4–6), and 55 as bacterial vaginosis (NS 7–10). In women with a NS of 7–10, PCR detected Gardnerella vaginalis, Atopobium vaginae and Megasphaera phylotype 1 in respectively, 96 %, 87 % and 60 %, whereas in women with a NS of 1–3 these species were detected in 27 %, 6 % and 2 % (P <0.001). A ratio of Lactobacillus crispatus over Lactobacillus iners of <1 (as calculated from the quantification cycle value (Cq)) was present in women with a NS of 7–10 in 66 % versus 33 % in women with a NS of 1–3 (P <0.001). The BV-PCR displayed a sensitivity of 92 % and specificity of 96 % with a positive predictive value of 94 % and a negative predictive value of 95 %. The Lactobacillus-index improved the correct classification of samples where only one of the other bacterial species was detected. Compared to the Nugent Score this multiplex qPCR offers a convenient tool for performing observer independent diagnosis of BV.

Prevalence of bacterial vaginosis in pregnant women in Maiduguri, North-Eastern Nigeria

This study determined the prevalence and socio-demographic characteristics of bacterial vaginosis (BV) among pregnant women with abnormal vaginal discharge. Descriptive cross-sectional study. University of Maiduguri Teaching Hospital. Vaginal swab samples and data on epidemiological risk factors were collected from 400 consecutive pregnant women with complaints of abnormal vaginal discharge. The data was analyzed using the SPSS 16.0 statistical software. Association between variables was compared by using the Chi-square (χ2 ) and Fisher's exact tests while P < 0.05 was considered significant at 95.0% confidence level. The prevalence of BV among pregnant women with abnormal vaginal discharge was 17.3%. Age 20-24 years, multigravidity, lack of western education and unemployment were associated with increased prevalence of BV. Yellowish, watery vaginal discharge (P = 0.001) was associated with BV. Dysuria, dyspareunia and lower abdominal tenderness were associated with BV (P = 0.001). Fifty three (77%) of patients had BV during the second trimester compared to 6 (9%) who had it in the 1 st trimester of pregnancy (P = 0.012). The high prevalence of BV in this study may necessitate adequate screening of pregnant women with abnormal vaginal discharge in order to give appropriate treatment and avoid complications associated with it.

Adjuncts to case assessment of vaginal discharge syndrome in pregnant women

Objective To investigate the aetiology of abnormal vaginal discharge, using a non-culture based method, among pregnant women presenting at the University of Calabar Teaching Hospital, Calabar, Nigeria. Methods Two hundred consecutive antenatal patients, aged 18 to 38 years, with complaints of abnormal vaginal discharge between 1st April and 31st July 2004 were investigated clinically for the characteristics of the vaginal discharge. High vaginal swabs taken from the vaginal fornices were examined using a non-culture based method to determine the possible aetiology of the discharge. The possibility of integrating non-culture based laboratory methods in the syndromic case management of abnormal vaginal discharge in an antenatal clinic setting is discussed. Results The commonest form of abnormal discharge was curdy white in 66% of cases. Ten (5%) women had malodourous vaginal discharged, 92% had vulval itching; and superficial dyspareunia was seen in 29% of cases. Microscopic studies of vaginal discharge revealed the following findings: lactobacilli (96%), polymorphs (96%), 'clue' cells (4%); positive Whiff test (5%), and pH > 4.5 (7%). The clinical and laboratory assessment of each patient lasted between 35 and 45 minutes. The procedures used were acceptable to 78% of women. Conclusion The use of non-culture based laboratory methods in the initial assessment of abnormal vaginal discharge can be a useful adjunct in the syndromic case management of abnormal vaginal discharge in pregnant women.

The psychological and social contexts of complaints of abnormal vaginal discharge: A study of illness narratives in India

Objective Epidemiological studies have reported strong associations between psychosocial adversity and complaints of abnormal vaginal discharge (AVD) in South Asia. We aimed to explore the mechanism of these associations through qualitative research. Method We carried out serial in-depth interviews with 42 married women with the complaint of AVD who were purposively selected from a sample of 2494 women recruited into a population-based cohort study in Goa, India. The interviews elicited illness narratives of their complaint, focusing on causal attributions and help-seeking behaviors. Results Women explicitly link their personal experiences of social adversity and stress (such as marital problems and heavy workloads) with their complaints of AVD. The complaint of tiredness, a core feature of depressive and somatoform disorders, and complaint of “tension” were commonly associated with AVD through bidirectional causal interpretations. Reproductive events, particularly related to the menstrual cycle and contraception, comprise another set of causal attributions. Many women hold multiple causal attributions. Most women sought health care, both biomedical and traditional, and their narratives indicate reinforcement of their causal attributions by health care providers. However, treatments were often discontinued or changed due to lack of symptomatic relief, side effects, or costs. Conclusions Reproductive health policy and practice must explicitly acknowledge and integrate research findings on psychosocial associations of AVD to promote a holistic and evidence-based approach for this common complaint in women in South Asia.

Common genital complaints in women: the contribution of psychosocial and infectious factors in a population-based cohort study in Goa, India

The genital complaint of abnormal vaginal discharge is common in South Asia. We describe the risk factors for the incidence of the complaint in women of reproductive age. Method Population-based cohort study in Goa, India. Out of 3000 randomly selected women, 2494 women participated. The outcome was an incident case of the complaint of abnormal vaginal discharge at 6 months (T1) and 12 months (T2) review. In total 71 (3.6%, 95% CI 2.8-4.5%) of the 2000 eligible women reviewed at T1 reported the complaint; and 80 (4.0%, CI 3.2-5.0%) of the 1999 women who did not complain of abnormal vaginal discharge at T1 reported it at T2. Multivariate logistic regression analysis identified the following factors as associated with the complaint: younger age (OR 0.26, CI 0.1-0.5 for women aged 40-49 years compared with women aged 18-24 years); illiteracy (OR 1.48, CI 0.9-2.4); religion (Muslim women OR 3.15, CI 1.7-6.0 compared with Hindu women); women's concerns regarding their spouse's extramarital relationships (OR 3.46, CI 1.2-10.0); current BV infection (OR 1.87, CI 1.2-2.9); somatoform complaints (OR 3.30, CI 1.7-6.5 for the highest somatoform score quartile compared with the lowest); and depression and anxiety (OR 1.55, CI 0.9-2.6 for the highest mental health score quartile compared with the lowest). Reproductive and sexual health programmes must strengthen the capacity of practitioners to assess and treat bacterial vaginosis and psychosocial problems in women with complaints of abnormal vaginal discharge.