Symptoms Of Vaginal Discharge Research Articles

EFFECTIVENESS OF RED BETEL (PIPER CROCATUM) EXTRACT ON LEUCORRHEA IN WOMEN OF CHILDBEARING AGE

Introduction: Reproductive health problems exist in Asia; 76% of women experience vaginal discharge. Vaginal discharge symptoms are also experienced by women of childbearing age (around 31.8%). Women of childbearing age are more at risk of fluor albus, which can be a trigger for reproductive organ infections. One of the treatments is to use betel leaves, which contain natural antiseptics and antibiotics. Objectives: This study aimed to determine the effectiveness of red betel leaf extract (Piper crocatum) against leucorrhea in women of childbearing age. Method: This research method uses a quasi-experiment design with one pre-and post-test design technique group. The research was conducted at the Independent Midwife Practice in Bandung City. The population in the study were all women of childbearing age in Bandung City. The sample consisted of women of childbearing age, according to the inclusion criteria of 36 people. The data obtained were primary data from the measurement of vaginal pH with Neco test litmus paper. The data analysis used was the Wilcoxon test to test the difference in pH scores before and after the intervention. Result: The results showed a significant difference in the use of 0.5% red betel leaf extract in women of childbearing age before and after the intervention. Conclusion: Red betel leaf extract 0.5% is effective in reducing the incidence of leucorrhea. There is a decrease in vaginal pH before and after the use of red betel leaf extract 0.5% by 1.78 (p <0.05).

Antenatal Care: A Comparative Review of Guidelines.

Antenatal care plays a crucial role in safely monitoring and ensuring the well-being of both the mother and the fetus during pregnancy, ultimately leading to the best possible perinatal outcomes. The aim of this study was to review and compare the most recently published guidelines on antenatal care. A descriptive review of guidelines from the National Institute for Health and Care Excellence, the Public Health Agency of Canada, the World Health Organization, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists regarding antenatal care was conducted. There is a consensus among the reviewed guidelines regarding the necessary appointments during the antenatal period, the proper timing for induction of labor, the number and frequency of laboratory examinations for the assessment of mother's well-being, and management strategies for common physiological problems during pregnancy, such as nausea and vomiting, heartburn, pelvic pain, leg cramps, and symptomatic vaginal discharge. In addition, special consideration should be given for mental health issues and timely referral to a specialist, reassurance of complete maternal vaccination, counseling for safe use of medical agents, and advice for cessation of substance, alcohol, and tobacco use during pregnancy. Controversy surrounds clinical evaluation during the antenatal period, particularly when it comes to the routine use of an oral glucose tolerance test and symphysis-fundal height measurement for assessing fetal growth, whereas routine cardiotocography and fetal movement counting are suggested practices only by Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Of note, recommendations on nutritional interventions and supplementation are offered only by Public Health Agency of Canada and World Health Organization, with some minor discrepancies in the optimal dosage. Antenatal care remains a critical factor in achieving positive outcomes, but there are variations depending on the socioeconomic status of each country. Therefore, the establishment of consistent international protocols for optimal antenatal care is of utmost importance. This can help provide safe guidance for healthcare providers and, consequently, improve both maternal and fetal outcomes.

Comparison Between Urine Dipstick and Microscopic Examination Urinalysis With Urine Culture to Evaluate the Sensitivity and Specificity for Each in Diagnosing Urinary Tract Infection in Qassim Region, Saudi Arabia.

Urinalysis is the most popular test for evaluating emergency room patients with possible urinary tract infections (UTIs). Due to their speed and inexpensive cost, urine dipsticks are frequently performed in the Emergency Room. Although a urine dipstick test may be less expensive and time-saving than a laboratory study, it may not be accurate. The study evaluated the sensitivity and specificity of urine dipstick and microscopic urinalysis with a urine culture. A prospective, observational study was conducted on adults who visited the Emergency Department at King Fahd Specialist Hospital in Buraydah and reported having dysuria, urine urgency, or frequency, as well as suprapubic or costovertebral angle soreness. Patients who could not give a trustworthy history, had symptoms of vaginal discharge, or had taken antibiotics within the previous 72 hours were excluded. One hundred fifty-three urine samples were collected and examined using urinalysis and dipstick. In addition, 113 (73.86%) of 153 urine samples exhibited no growth in urine culture. With a count of nine, Escherichia coli (E. coli) was the most often isolated organism among the positive cultures (5.88%). Klebsiella pneumoniae was the second most common in our sample with eight (5.23%). The urine dipstick was shown to have an overall sensitivity of 0.79, specificity of 0.39, positive productive value (PPV) of 0.30, and negative productive value (NPV) of 0.85. Urinalysis exhibited a high sensitivity of 0.95 and a poor specificity of 0.21. Our study showed that urine dipsticks may be more beneficial than urinalysis for ruling out urinary tract infections (UTIs), while urinalysis may be more helpful in verifying their presence.

The Folkloric Practices of Dominican Women in Managing Bacterial Vaginosis

Bacterial vaginosis (BV) is characterized by changes in the vaginal flora caused by an elevated pH, resulting in symptoms of vaginal discharge, odor, and irritation. BV affects all women, including Dominican women who have specific cultural beliefs regarding vaginal health hygiene. Due to the prevalence of this condition and cultural norms that may influence how women respond to the diagnosis of BV, it is important to understand the factors that may promote the development of BV and that may influence women’s choices of treatment options. Amsel’s criteria are the most commonly used clinical approach for the diagnosis of BV. Recurrent BV is common and affects women’s lives to varying degrees. Discussion about cultural norms and hygienic practices may provide information that may decrease the recurrence of BV. Nurses can provide support and evidence-based information in a culturally sensitive manner to help Dominican women manage BV.

EFFICACY AND SAFETY OF "SACHI SAHELI" POLYHERBAL FORMULATIONS IN GYNAECOLOGICAL DISORDERS: A PROSPECTIVE, NON-RANDOMISED, OPEN-LABEL STUDY

Background and aim: Symptoms of gynaecological disorders, including dysmenorrhea, leukorrhea, and premenopausal syndrome (PMS), are a common health concern, particularly among women of reproductive age. Due to the adverse effects of conventional treatments, the use of herbal remedies to treat various gynaecological disorders has increased. This study aimed to assess the efficacy and safety of Sachi Saheli formulations in subjects suffering from dysmenorrhea, leucorrhoea, and PMS. Methods: This was a single-arm, open-label, non-randomised prospective study. Female participants were recruited based on the inclusion and exclusion criteria. Study interventions were given to all participants for 90 days. Changes in blood haemoglobin levels were assessed from the baseline to the end of the study. Subjective symptoms and the investigators' severity assessment on 27 questionnaires were evaluated at baseline and the end of the study. Safety was also assessed by measuring liver and kidney function's haematological and biochemical markers. Results: A total of 120 female subjects were enrolled. After treatment with Sachi Saheli syrup and tablets, blood haemoglobin levels increased significantly compared to baseline (p < 0.0001). All subjects showed significant improvement in anxiety, menstrual pain, depression, and vaginal discharge symptoms. A significant improvement in the severity of physical and affective symptoms across 27 parameters was also observed. There were no significant changes observed in laboratory safety parameters. None of the subjects reported any adverse events during the treatment period. Conclusions: Sachi Saheli syrup and tablet may improve the symptoms of dysmenorrhea, leukorrhea and PMS.

O-054 Live Births following Laparoscopic Caesarean Scar Niche Repair in patients with Secondary Infertility: A Self-Controlled Case Series and Literature Review.

Abstract Study question Does laparoscopic repair of caesarean scar niches as a treatment for secondary infertility improve live birth rates? Summary answer In our self-controlled case series, the laparoscopic repair of caesarean section niches in patients with secondary infertility has improved pregnancy and live birth rates. What is known already A niche is an iatrogenic myometrial defect due to abnormal tissue healing at a previous caesarean section scar site. Patients with a niche present with symptoms of vaginal discharge, abnormal uterine bleeding, chronic pelvic pain, dyspareunia and secondary infertility. As a niche is secondary to caesarean sections, rising caesarean section rates will lead to an increase in the rate of niche presentation and diagnosis. Study design, size, duration A retrospective review was performed of all women undergoing a hysteroscopy assisted laparoscopic niche repair between 2016 and 2023 at Guy’s and St Thomas’ Hospital in London. The primary outcome measure was live births. A literature review was performed to interrogate the currently available evidence on live birth rate following niche repair. Ultrasound images of the niche prior to and post repair, as well as intra-operative laparoscopic and hysteroscopic images and videos, are also presented. Participants/materials, setting, methods The cases were identified from the Assisted Conception Unit database. Only women who presented with secondary infertility with a diagnosis and repair of a niche were reported. Niche diagnosis was made in patients presenting with abnormal discharge, bleeding and fluid in the uterine cavity. Any incidental myometrial defect found on transvaginal ultrasound was also a diagnostic characteristic. Main results and the role of chance There are some reports in the literature on pregnancy outcome following niche repair. A scarcity of studies reporting specifically on live birth rates following repair, suggests this case series as unique. Eleven patients underwent caesarean section niche repair by two surgeons at our unit. The mean age at repair of the patients was 36. All patients had two or more years of subfertility on presentation, with a proportion having several failed in-vitro fertilisation (IVF) cycles prior to repair. The pregnancy rate, clinical pregnancy rate and live birth rate were 73% (8/11), 64% (7/11) and 45% (5/11) respectively. One patient had an early miscarriage at age 48 following repair and has not conceived again since. One patient underwent a second repair and is awaiting further investigations. Two patients have not yet conceived following repair, one of which had sickle cell disease, age factor and endometriosis. Our findings suggest a positive correlation between surgical repair of the niche and live births. However, this could be due to a strict selection criteria in a small sample size. In the two patients that did not have live births following repair, other factors of subfertility such as age, male factor and comorbidities could also play a role. Limitations, reasons for caution The small sample size can lead to selection bias and impairs the external validity of our findings. The likelihood of random error is high. Lack of a control group prevents any comparisons. Furthermore, all repairs were performed by the two surgeons which introduces operator bias. Outcome assessors were not blinded. Wider implications of the findings Subfertility secondary to niches is likely to be a growing challenge as caesarean section rates continue to increase. Our study suggests that surgical repair may improve live birth rates. We present our findings to augment the current international data on live birth rates following niche repair. Trial registration number not applicable

Clinical Characteristics of Gynecologic Problems During Childhood in the Korean Population.

This study analyzed common gynecologic problems among Korean patients younger than ten years. We performed a retrospective analysis of medical records of patients younger than ten years who visited the Pediatric and Adolescent Gynecology Clinic at Samsung Medical Center between 1995 and 2020. Among the 6,605 patients who visited the Pediatric and Adolescent Gynecology Clinic, data from 642 patients younger than ten years were analyzed in this study. The most common chief complaint was genital anomalies, followed by increased vaginal discharge and abnormal findings on clinical examinations. The most common disease entity was agglutination of the labia minora, which was commonly discovered incidentally during routine screenings. Vulvovaginitis, the second most common disease, was identified by symptoms of vaginal discharge, pruritus, and vaginal spotting. Neoplasm, issues with vaginal bleeding, and "other causes" were additional categories of gynecologic problems. 245 patients (38.2%) were referred from primary care sources, 175 patients (27.4%) sought care directly at the clinic, 169 patients (26.3%) were referrals from the institution's pediatric department, and the remainder were referrals from other departments. This study provides information about the gynecologic problems most frequently encountered in pediatric patients. The study provides helpful insight for primary care physicians into the proper management and timing of referrals for these gynecologic problems of pediatric patients.

An enigmatic tale of the missed and migrated tail

We, report a case of missing and migrated intrauterine device presenting as vague abdominal pain. The patient had symptoms of vaginal discharge and menstrual disturbances as polymenorrhagia and leukorrhea. She was evaluated for a suspected malignancy of the ovaries. During evaluation on pelvic CT scan, the missing and migrated Intrauterine Contraceptive Device (IUCD) was located in the small bowel and tumor markers were normal. We treated her with antibiotics for presumptive diagnosis of pelvic inflammatory disease and then posted her for the evaluation of the missing IUCD and the tubo-ovarian masses by endoscopy. The missed IUCD was seen embedded in the terminal ileum with intraperitoneal adhesions and the tubo-ovarian masses. The IUCD was removed endoscopically enterotomy of ileum which was sutured. The patient recovered well and was discharged on the 6th post-operative day.

MICROBIOLOGICAL PROFILE IN WOMEN WITH SYMPTOMATIC VAGINAL DISCHARGE

The study's main goals are to determine the prevalence of symptomatic vaginal discharge in different age groups and the microbiological makeup of women who report with symptomatic vaginal discharge. The study was conducted in 200 cases. A detailed clinical history and examination of all cases were done. A speculum examination done to visualize cervix and vagina , swabs were collected from the posterior fornix of vagina and sent for microbiological examination. Following tests were done a) Gram staining and Nugent scoring system used, based on the morphology of the bacteria, score >/= to 7 is considered positive for bacterial vaginosis, b) Wet mount preparation done to look for motility of Trichomonas, c) KOH preparation, d) Swabs are inoculated in Blood agar, Mac Conkey's agar and Sabouraud's dextrose agar. Maximum patients had associated symptoms as foul smell (27%),followed by itching(26%) ,others like abdominal pain(11.5%),burning micturition(6%) , heavy menstrual bleeding(4.5%) and low backache(2.5%). Majority had homogeneous discharge(44.5%), followed by mucopurulent(19.5%),curdy white(18%) and yellowish (18%). Incidence of bacterial vaginosis is maximum(42.5%), followed by vaginal candidiasis (21.5%),other non specific (17%) and Trichomonas(8%). In around 11% of cases no cause was identified.

Utilization of the Microbiological Profile of Symptomatic Vaginal Discharge in Rural Reproductive-Age Women

Women frequently report an irregular vaginal discharge, which can be caused by vaginal pathogens such as bacterial vaginosis, candidiasis, and trichomoniasis. The research objective was to ascertain the microbiological composition of symptomatic vaginal discharge in rural areas and the use of this information for treating genital tract infections. The current research was carried out over the course of a year, from Jan 2022 to June 2022, among sexually active females of reproductive age between 18 and 40 years, who visited the Obstetrics and Gynecology Department at the Hayatabad Medical Complex, Peshawar. Out of 120 women who had symptomatic vaginal secretions, 62 patients (51.67%) were in the 18–28 age range, followed by 39 patients (32.5%) in the 29–39 age range, and 19 patients (15.83%) in the 40–45 age range. Chlamydia trachomatis and Candida were discovered in 21 and 26 women, respectively, accounting for 17.5% and 21.67% of infections, but bacterial vaginosis infections were common in women (n=59), representing approximately 49.16% of scenarios. The majority of the patients (n=62; 51.67% and n=29; 24.16%) exhibited homogeneous and mucopurulent discharge respectively. Low socioeconomic class, premature sexual activity, and recognized genetic factors for unusual vaginal secretions, are one of the important risk factors that cause mortality in women in the form of lack of self, reduced work time, more hospital visits, and miscarriage. To assess the potential health benefits, thorough economic studies must be conducted after these experiments. It can assist doctors in implementing the proper antimicrobial therapy to treat these illnesses, avoid long-term complications, as well as avoid overdiagnosis and the emergence of antibiotic resistance.

Bacterial vaginosis pattern and antibiotic susceptibility testing in female patients using high vaginal swabs

Abstract. Al-Kraety IAA, Al-Muhanna SG, Banoon SR, Ghasemian A. 2022. Bacterial vaginosis pattern and antibiotic susceptibility testing in female patients using high vaginal swabs. Biodiversitas 23: 2838-2844. Bacterial species found in the vaginal environment encompass a wide variety of species. A common cause of vaginal discharge in women is bacterial vaginosis BV (BV). Various Gram-positive and Gram-negative rod shaped bacteria, including E. coli, Klebsiella spp., Enterococcus spp., Enterobacter spp., Raoultella ornithinolytica, and Staphylococcus spp. contribute significantly to bacterial vaginosis. In this study, vaginal swabs (VS) were obtained from 50 individuals with symptoms of vaginal discharge. The swabs were inoculated on blood, Mannitol, and MacConkey agar culture media. Biochemical tests were performed after an overnight incubation period to determine growth and colonial morphology. In addition to VITEK® 2 compact system and PCR technique by using a 16s RNA gene where all bacteria isolates were positive for this gene. Antibiotic sensitivity was investigated through compact VITEK® 2 and sensitivity cards (AST-P580), (AST-N222), and (AST-GN76). The bacterial isolates including 20 (43.4%) of E. coli, 8 (17.3%) of Klebsiella spp. and 8 (17.3%) of Staphylococcus spp. were investigated in present study. Additionally, 4 (8.6%) isolates of Enterobacter spp., 3 (6.5%) of E. faecalis, and 3 (6.5%) of R. ornithinolytica. The E. coli, Staphylococcus spp., Enterobacter spp., E. faecalis and R. ornithinolytica isolates were found resistant to several antibiotics and considered multi-resistance (MDR).

THE EFFECTIVENESS OF THE DECOCTION OF RED BETEL LEAVES (PIPER CROCANTUM) AGAINST THE REDUCED SYMPTOMS OF FLUOR ALBUS IN ADOLESCENT GIRLS

Background: Fluor albus is excessive fluid from vagina that is not menstruation. To reduce the symptoms of fluor albus, non-pharmacological treatment from the decoction water of red betel leaves (Piper crocantum) was used in the present study. These red betel leaves (Piper crocantum) contain alkaloids that the green betel leaves do not have, and the alkaloids play a role as an antimicrobial agent. Besides, the red betel leaves have antiseptic power that is twice higher than the green betel leaves. The red betel leaves (Piper crocantum) also contain carvakrol which is anti-fungal and disinfectant, and it that can be used as an antiseptic medicine to maintain oral cavity health, cure fluor albus disease, and alleviate bad odor. Purpose: The present study aims to discover the effectiveness of the decoction of red betel leaves in reducing the fluor albus symptoms. Method: This study uses quasi-experimental research design with one group undertaking pre- and post-tests. It involved 20 adolescent girls of Al-Adzkia Sentul Boarding School in which the sample was taken using purposive sampling techniques. Further, a closed ended questionnaire is used to collect data, then analyzed using paired t-test. Result: The results showed a meaningful difference before being given treatment for 13.40. After treatment the value became 8.27 with a p-value < of α (0.005). Conclusion: The results this study indicated a decrease in symptoms of vaginal discharge after the use of red betel leaf decoction and recommended it to be used as a form of non-pharmacological therapy or traditional medicine in reducing fluor albus symptoms in adolescent girls.

Clinical Characteristics of Vaginitis and Effectiveness of Fenticonazole - An Observational Study from India

Objective: To characterise vaginitis among menstrual and menopausal women and to determine the effectiveness of Fenticonazole for the treatment of vaginitis. Methods: A retrospective study was conducted on 86 women attending the gynecology clinic. The patients underwent screening for symptoms of vaginitis. The clinical and demographic characteristics were compared between menstrual and menopausal women. Results: Based on the clinical examination, it was identified that 80 (93.02%) patients had symptoms of vaginal discharge (white discharge) and 51 (59.30%) of patients had a vaginal fungal infection. Mean age was 34.73 (10.13) years, and 52.04 (14.38) years and mean BMI 26.74 (3.31) and 29.32 (3.22) were significantly different among menstrual women and menopausal women respectively. Also, inflammatory smear and vaginitis both were found to be higher among menstrual women. It was identified that Fenticonazole was effective in the treatment of vaginitis. Conclusion: In this observational study, vaginitis was identified in 51 (59.30%) patients, and Fenticonazole was found to be effective in treating vaginitis. Keywords: Vaginitis, Vulvovaginal candidiasis, Fenticonazole, Menopausal

Some Clinical and Inflammatory Aspects of Trichomonas vaginalis Infection among Women with Pelvic Inflammatory Diseases

Infection with Trichomonas vaginalis and its relation to some diseases have lately had much attention. The objective of this study was to assess the infection rate of T. vaginalis and its relation to pelvic inflammatory diseases, infertility, and vaginosis. The study also assessed some demographic, clinical, and immunological parameters in women infected with T. vaginalis. The study included 160 non-pregnant married women who attended some private clinics and public hospitals in Baghdad from October 2020 to February 2021. All participants had symptoms of vaginal discharge only or vaginal discharge with lower abdominal pain. The participants were divided into an infertility group (n = 61) and fertility group (n = 99). The participants were also divided into Pelvic Inflammatory Disease (PID) group (n=41) and non-PID group (n=119). All participants underwent vaginal examination. Vaginal swabs were taken from all participants for T. vaginalis, bacteria, yeast, clue cell, pH, and vaginal leukocyte examinations. Sera were also taken to measure both IL-1α and IL-8 using sandwich ELISA technique to compare them with apparently healthy control subjects who had no vaginal discharge. The study revealed that the total infection rate of T. vaginalis was 14.37%. The results showed no significant relations between T. vaginalis positive status and each of age, infertility, vaginosis, contraceptive use, and high BMI. While a significant relation (P=0.03) was noticed between T. vaginalis positive status and PID. Women with PID exhibited a higher infection rate with T. vaginalis (24.39%) versus non PID women (10.92%). High clue cells number was not significantly related to T. vaginalis positive status, only if both PID and vaginosis were considered in the statistical analysis. In addition, high leukocytes count was not related to T. vaginalis positive status. While abnormal vaginal pH was significantly (P=0.01) related to T. vaginalis positive status. Finally, the levels of both IL-1α and IL-8 were noticed to be declined in women who had T. vaginalis infection, although they were not declined significantly. This study gives an insight about some clinical aspects of T. vaginalis infection among PID women. T. vaginalis is highly predictable in women with PID. Consequently, attention and more investigation would be needed on this topic in Iraq.

Distress Due to Nonpathological Vaginal Discharge: A New Face of Dhat Syndrome in Females

Female Dhat syndrome (FDS) is not yet an established clinical entity, but nonpathological vaginal discharge has been discussed in the scientific literature for quite a long time. Various studies have reported the existence of the phenomenon of nonpathological vaginal discharge. All the existing literature on Dhat syndrome was reviewed. Studies have reported that nonpathological vaginal discharge has a high prevalence among the rural and urban populations of Indian women (around 30%). The symptom of vaginal discharge has been an area of concern for a sizable proportion of women in the community, and anxiety related to this has been a frequent reason to seek medical attention. The ideas associated with vaginal discharge are similar to Dhat syndrome in males. The variations of associated symptomatology, course of illness, and somatization of the complaint make it challenging to diagnose and treat. The diagnostic criterion needs careful evaluation; management needs an appropriate multidisciplinary approach by various health team members, including psychological interventions and adjunct pharmacotherapy in effectively managing the FDS. Dhat syndrome in females has similar phenomenology to that in males. Unfortunately, this is under-researched and hence, underdiagnosed.

A study on microbiological profile in women with symptomatic vaginal discharge

Background and Objective: Abnormal vaginal discharge is characterized by change of colour, consistency, volume, or odour, and may be associated with symptoms such as itch, soreness, dysuria, pelvic pain, or intermenstrual or post-coital bleeding. Main objective of the study is to know the incidence of symptomatic vaginal discharge in various age groups and to know the microbiological profile in women presenting with symptomatic vaginal discharge. Methods: The study was conducted in the department of OBG, EPIONE Hera Hospitals over a period of 20 months Aug 2018- Apr 2020 among women complaining of vaginal discharge of various degrees who fulfilling the inclusion and exclusion criteria were included in the study. A detailed clinical history and examination of all cases were done, a speculum was inserted into the vagina, to visualize cervix and vagina, any pathology in the cervix and vagina noted, swabs were collected from the posterior fornix of vagina and sent for microbiological examination. Following tests were done a) Gram staining and Nugent scoring system used, based on the morphology of the bacteria, score 0 to 7 is considered positive for bacterial vaginosis, b) Wet mount preparation done to look for motility of Trichomonas, c) KOH preparation, d) Swabs are inoculated in Blood agar, Mac Conkey’s agar and Sabouraud’s dextrose agar. Results: Out of 260 cases, majority of the patients 145 (55.76%) were in the age group of 19-28 years, followed by 91 (35%) cases in the age group 29-38 years, 21 (8.07%) cases in age Group 39-48 and 3 (1.15%) were below 19 years. Maximum 128 (49.23%) were illiterate, followed by 82 (31.53%) were with primary schooling educational status. Most of the women 160 (61.53%) were in the lower socioeconomic status followed by 62 (23.84%) upper lower class. Majority patients 161 (61.92%) had associated combined symptoms of foul smell and itching, others like only vaginal discharge 51 (19.61%) abdominal pain 18 (6.92%), burning micturition 13 (5%), heavy menstrual bleeding (3.46%) and lower backache 8 (3.07%) were noted. Large part 98 (37.69%) showed mucopurculent discharge, followed by 89 (34.23%) yellowish and fothy discharge, curdy white 46 (17.69%) and homogenous discharge 27 (10.38%). Prevalence of bacterial vaginosis is maximum 122 (46.92%), followed by Trichomonas vaginalis 99 (38.07%), vaginal candidiasis 18 (6.92%), other nonspecific 9 (3.46%). In around 10 (3.84%) of cases no cause was identified. Conclusion: White discharge is one of the major women public health problem, principle morbidity to the women in terms of loss of self-esteem, reduction in work time, increased hospital visits and their expenses and also vulnerable to pelvic inflammatory diseases, infertility, endometriosis, cuff cellulitis, urethral syndrome, spontaneous abortions, preterm labor etc. So, it is very important for microbiological diagnosis of abnormal vaginal discharge especially, when a patient is having recurrence or not responding to standard therapy. Increase of educational status in urban and rural areas is considered one of the greatest way to reduce the genital health problems.

A Comparative study of the etiology of symptomatic vaginal discharge based on WHO syndromic diagnosis and microbiological diagnosis

Introduction: Vaginal discharge is the most common complaint with which women of reproductive age group present to the gynecological outpatient. WHO syndromic approach algorithm helps in identifying the etiology based on the gross appearance of discharge but it often fails to detect the etiology correctly. Addition of simple microbiological tests helps to diagnose the etiology accurately. Objective: To compare the diagnosis of symptomatic vaginal discharge based on WHO syndromic algorithm and microbiological tests. Materials and Methods: 100 Women in the age group of 18 to 45 years with symptomatic vaginal discharge attending the gynecological OPD of Apollo Institute of Medical Science and Research, Hyderabad were examined in the outpatient and a clinical diagnosis made using WHO syndromic algorithm for vaginal discharge. Under aseptic precautions, vaginal discharge was collected and subjected to simple lab tests such as Gram’s stain and direct microscopy (wet mount). The lab results were compared with the clinical diagnosis. Results: Among 100 women, bacterial vaginoses was the most common diagnosis. In 55% of patients etiological agent could be identified by lab investigations. By WHO syndromic approach, bacterial vaginosis was over diagnosed (70 vs. 44 cases confirmed by lab) and candidiasis was slightly under diagnosed (8 vs. 10 cases by lab). The sensitivity of WHO syndromic approach in diagnosing bacterial vaginosis is 100% while specificity is only 53%. The difference in diagnosis rate of candidiasis clinical versus microbiological diagnosis was marginal (10% vs. 11%). Trichomoniasis was accurately diagnosed by WHO syndromic approach. Conclusions: WHO syndromic algorithm for vaginal discharge over diagnoses bacterial vaginosis but has a high sensitivity and specificity in diagnosing candidiasis and trichomoniasis. Simple microbiological test such as Gram stain and wetmount will increase the accuracy in diagnosis thereby preventing overtreatment. Keywords:

Testing the regulatory framework in South Africa \u2013 a single-blind randomized pilot trial of commercial probiotic supplementation to standard therapy in women with bacterial vaginosis

BackgroundBacterial vaginosis (BV) increases HIV risk and adverse reproductive outcomes. Standard-of-care (SOC) for BV are antibiotics; however, cure rates are low. Probiotics for vaginal health may be useful in improving cure and recurrence although the regulatory framework governing probiotics and the conduct of randomized clinical trials to evaluate these has not been established in South Africa. We performed an exploratory single-blind trial evaluating a commercial oral-vaginal-combination probiotic as adjunct to SOC for BV treatment.MethodsWomen with symptomatic vaginal discharge were screened for BV and common sexually transmitted infections (STIs). BV+ (Nugent 7–10) but STI- women were randomized to vaginal metronidazole alone (n = 12) or to metronidazole followed by a commercial oral/vaginal probiotic (n = 18). The primary qualitative outcome was to test the regulatory landscape for conducting randomized probiotic trials in South Africa; and acceptability of vaginal application by women. BV cure at 1 month (Nugent≤3) was the primary quantitative endpoint. Secondary quantitative endpoints were BV recurrence, symptoms, vaginal microbiota and genital cytokine changes over 5 months post-treatment.ResultsThe South African Health Products Regulatory Authority (SAHPRA) reviewed and approved this trial. As probiotics continue to be regulated as health supplements in South Africa, SAHPRA required a notification application for this trial. Acceptability and adherence to the oral and vaginal application of the probiotic were high, although women reported a preference for oral capsules. 44.8% of women cleared BV one-month post-treatment, and no significant differences in BV cure (RR = 0.52, 95% CI = 0.24–1.16), recurrence, vaginal pH, symptoms, microbiota or vaginal IL-1α concentrations were found between SOC and intervention groups in this pilot study with an over-the-counter product.ConclusionNavigation of the SAHPRA registration process for evaluating a commercial probiotic in a randomised trial laid the foundation for planned larger trials of improved probiotic products for vaginal health in South Africa. Although adherence to the vaginally delivered probiotic was high, women preferred oral application and we recommend that improvements in the content and method of application for future probiotics for vaginal health should be considered.Trial registrationThis trial was registered on 17 October 2017 with the South African National Clinical Trial Register (http://www.sanctr.gov.za/; BV-trial1; DOH-27-1117-5579).

Obezite ve Bakteriyel Vajinoz İlişkisinin Mikrobiyolojik Yöntemler ve Antropometrik Ölçümler Kullanılarak Araştırılması

Objective: Nugent scoring is accepted as the gold standard for diagnosis of bacterial vaginosis. Recently, it was reported that there could be a relationship between obesity and bacterial vaginosis. In this study, we aimed to investigate the relationship between bacterial vaginosis and obesity using Nugent score and body mass index (BMI). Method: A total of 106 fertile and sexually active patients in the childbearing age admitted to gynecology outpatient department of a state hospital in our city with symptoms of vaginal discharge and itching between May 1 and November 1, 2019 were included. Pregnant women, patients with bleeding, patients with a history of cancer, contraceptives/antibiotic/vaginal drug use within the previous three weeks, chronic disease and sexual intercourse within the last two days were excluded from the study. Anthropometric measurements and calculations of BMI were performed by the dietitian. Vaginal smears were obtained by a gynecologist and Nugent scoring was performed after Gram-staining. Results: According to Nugent score, patients were classified as having bacterial vaginosis, intermediate and normal flora. Using BMI, patients were classified as obese (36.8%), overweight (34.9%), and normal (28.3%). Nugent scoring method revealed that 33 (31.1%) of 106 patients had intermediate flora, 45 (42.5%) had bacterial vaginosis and 28 (26.4%) had normal flora. No significant relationship was found between BMI and bacterial vaginosis. Conclusion: We found no significant relationship between body mass index and bacterial vaginosis. Limited number of studies investigating the relationship between bacterial vaginosis and body mass index have contradictory results. Therefore, our study may help to close the gap on this issue.

A hospital-based study on the prevalence of trichomoniasis and evaluation of accuracy of various diagnostic techniques.

Background:The sexually transmitted infections (STIs) caused by Trichomonas vaginalis have been associated with adverse pregnancy outcomes and increased risk of HIV transmission. Trichomoniasis remains underreported despite being easy to diagnose and treat. Moreover, availability of battery of diagnostic tools causes dilemma on the most appropriate techniques to be used.Aims and Objectives:The purpose of this study was to determine the prevalence of T. vaginalis and its diagnostic accuracy employing various diagnostic techniques in women presenting with vaginal discharge in gynecological outpatient department (GOPD) of our tertiary care hospital.Materials and Methods:Five vaginal swabs were collected from 204 patients with symptomatic vaginal discharge attending GOPD. Wet mount microscopy, Giemsa and acridine orange staining, culture in Kupferberg media and InPouch™ TV culture system, and polymerase chain reaction (PCR) were performed and compared.Results:The prevalence of T. vaginalis was 1.96% in the present study. Wet mount microscopy, staining method, and culture detected 1.96% of cases, whereas PCR detected 2.45% of cases.Conclusion:The prevalence of T. vaginalis was <3% among symptomatic vaginal discharge patients from GOPD. Although PCR had a higher detection rate, there was no significant difference in sensitivity and specificity between other diagnostic methods (direct wet mount, Giemsa/acridine orange staining, and InPouch™ TV culture system). Hence, the availability in a particular setting would determine the methods of choice to be used for the diagnosis of T. vaginalis.