Vaginal Discharge Syndrome Research Articles

Performance of syndromic management for the detection and treatment of genital Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis among women attending antenatal, well woman and sexual health clinics in Papua New Guinea: a cross-sectional study

ObjectivePapua New Guinea (PNG) has among the highest estimated prevalences of genital Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) of any country in the Asia-Pacific region. Diagnosis...

Etiological study of vaginal discharge syndrome in RTI clinic attendees in a tertiary care hospital

Etiological study of vaginal discharge syndrome in RTI clinic attendees in a tertiary care hospital

Pattern of Sexually Transmitted Infections at Kohalpur Teaching Hospital

Background: WHO estimated that approximately 448 million new cases of four main curable sexually transmitted infections (STIs), viz., gonorrhoea, syphilis, chlamydial infection, and trichomoniasis occur every year, nearly 80% of which in developing countries. STIs has proven role in facilitation of HIV infection and also increases susceptibility to other STIs. Most of the STIs, both ulcerative and non-ulcerative, are prevalent in Nepal and constitute one of the major health problem. Their epidemiological and clinical picture is being modified in the context of ongoing HIV/AIDS epidemic, especially during the last decade.Objectives: This study was undertaken to find out the pattern of sexually transmitted infections in Nepalgunj Medical College Teaching Hospital, Kohalpur.Method and material: This is a hospital - based descriptive study conducted in the Department of Dermatology, Venereology and Leprology of Nepalgunj Medical College Teaching Hospital, Kohalpur between August 2013 to July 2014. A total of 52 patients were included in the study and verbal consent was taken. History and clinical examinations were performed and the data were recorded and analyzed.Results: Total of 52 patients were diagnosed with Sexually Transmitted Infections, out of which 75% were male and 25% were female. The most common diagnosis was gonorrhea (34.6%) followed by condyloma accuminata (32.7%), latent syphilis (15.4%) non-gonococcal urethritis(9.6%), vaginal discharge syndrome (5.8%)and HIV (1%). Age group 21 to 30 years were the maximum sufferers.Conclusion: Gonorrhoea still comprises a major bulk of STI in Nepalgunj Medical College Hospital, Kohalpur. Majority of the patients suffering from sexually transmitted infections were in the age group 21-30 years. A trend of sexual exposure during adolescence with multiple partners and inconsistent use of condoms was observed as a common factor in its promotion despite efforts from various sectors.Journal of Nepalgunj Medical College Vol.13(1) 2015: 25-27

Usefulness and Utility of NACO Regime in the Management of Sexually Transmitted Infections: A Pilot Study.

Introduction:Treatment of sexually transmitted infections (STIs) has been made easy for field workers due to syndromic approach. The etiological agent responsible for different STI syndromes needs to be validated from time to time so as to guide the therapeutic regimen.Aims and Objectives:The aim of this study was to evaluate the etiological agent for STI syndromes and correlate the syndromic diagnosis with etiological diagnosis.Materials and Methods:The study was conducted over 9 months in all patients attending the STI and Gynaecology Outpatient Department. Syndromic diagnosis was done by STI-trained medical officer of respective clinic. Sample was collected for etiological diagnosis and subjected to relevant investigations. Data were analyzed by applying statistical methods.Results:Among 308 patients (male:female = 1:3.5), no syndromic diagnosis could be made in 11 cases (all females and had premalignant changes on Pap smear). In 68 patients (22.08%), no etiological diagnosis could be arrived at (mostly genital ulcer disease [GUD]-herpetic [H] and vaginal discharge). In cervical discharge syndrome, six patients (16.7%) showed gonococcus. In GUD-H syndrome, 37 patients (27.027%) were tested positive. In GUD-nonherpetic syndrome, three patients (33.33%) were syphilis, granuloma inguinale, and chancroid (1 each). In urethral discharge syndrome, etiology could not be found in 33 cases (45.45%). In vaginal discharge syndrome (n = 217), etiologies were overlapping as follows: trichomonas vaginalis (76.04%), bacterial vaginosis (40%), gonococcus (24%), and undiagnosed (6.5%).Conclusion:The present tool for validation of GUD-H can validate only 27% of cases. Overlap of etiologies is mostly common in vaginal discharge syndrome, wherein malignancies and premalignant conditions are overtreated with kits. Validation can be done only in two-third of cases with the available resources. However, syndromic approach provides the opportunity of treating STI without delay.

Correlating CD4 count with mucocutaneous manifestations in HIV-positive patients: A prospective study.

Background:Mucocutaneous findings may be the presenting symptoms in HIV-afflicted individuals. A multitude of mucocutaneous diseases also occurs during the course of the ailment, with some conditions being classed as disease defining. They include infectious diseases and noninfective inflammatory and neoplastic dermatoses. With progressive fall in CD4 count, there is a change in the types of mucocutaneous lesions encountered.Aim:This study aims to statistically correlate the CD4 counts with the mucocutaneous manifestations in 100 HIV-positive patients.Materials and Methods:A total of 100 cases of HIV-positive patients with skin and mucous membrane manifestations were selected serially. A complete history was taken, clinical examination was done, and the CD4 count was noted. Patients were divided into four groups (Groups I, II, III, IV) with different ranges of CD4 values, namely, <50, 50–200, 201–500, >500, respectively.Results:The distribution of study population in CD4 ranges showed that majority (47%) of the study population had CD4 count between 201 and 500, and 29% of the study group had CD4 count between 50 and 200 cells. Almost 21% of the patients had the count > 500 cells and 3% had cell count < 50. Majority of the infectious and non-infectious dermatoses were common in the CD4 count between 201–500 (Group III) and 50–200 (Group II). In the study groups, 52 cases (52%) were on antiretroviral therapy (ART), and the remaining 48 cases (48%) were not on ART at the time of diagnosis of mucocutaneous manifestations. Out of 48 ART-naïve cases, 23 patients were screened and newly diagnosed at the outpatient department (OPD) based on the mucocutaneous manifestations. Most of the patients with multiple mucocutaneous conditions were in the CD4 count <200, whereas single manifestation was seen predominantly in CD4 count >200.Conclusion:Statistically significant association with the CD4 count was seen in herpes zoster ophthalmicus, genital wart, genital herpes, vaginal discharge syndrome, scabies, pyoderma, dermatophytosis, Hansen's disease, herpetic gingivostomatitis, seborrhoeic dermatitis, lichen planus, and drug reactions. These dermatoses may indicate the worsening of immune status and the need for regular monitoring with periodical CD4 counting. Occurrence of dermatoses such as photosensitive eczema, drug reaction, lichen planus, Type I lepra reaction, and herpes zoster ophthalmicus in patients on ART may be due to IRIS. To avoid the more frequent occurrence of infectious dermatoses and to reduce the development of IRIS with ART, all HIV-positive cases may be started on ART at higher CD4 count. Screening for HIV infection is suggested whenever the following conditions are seen: persistent oral candidiasis, atypical manifestations of zoster, herpes zoster ophthalmicus, herpetic gingivostomatitis and MC in adults, exaggerated IBA, and extensive seborrhoeic dermatitis.

Utility of Laboratory Diagnosis for Confirmation of the Syndromic Case Management in Married Indian Women with Vaginal Discharge

WHO and NACO recommend treatment of STIs/RTIs on the basis syndromic case management (SCM), even without laboratory confirmation, which may lead to over-treatment. Thus, this study was conducted to evaluate the utility of laboratory diagnosis for confirmation of patients with vaginal discharge diagnosed on the basis of SCM. 234 married women in reproductive age group, diagnosed as having vaginal discharge syndrome were included. Normal saline wet-mount slide preparations were made for detection of motile trichomonads. Gram stained smear were prepared and scored as per classification developed by Nugent. The presence of pseudohyphae and/or budding yeast cells was considered diagnostic of candidal infection. VDRL, TPHA and HIV testing were also done as per protocol. The median age of the study population was 34 years. Most common cause was bacterial vaginosis (positive= 21.4%, 95% CI= 16.6-27.1%; intermediate score= 17.5%, 95% CI= 13.2-22.9%), followed by candidiasis (13.7%, 95% CI= 98-18.7%) and trichomoniasis (0.4%, 95% CI= 0-2.6%). No etiological diagnosis for vaginal discharge could be established in approximately half of the women. Only two women were HIV positive; one was reactive by VDRL and TPHA tests. Our study highlights the possible lacunae in SCM. Large number of patients may be over-treated if only syndromic management is followed, with financial, medical and social implications. Thus we recommend, the treatment maybe initiated on the basis of SCM, but it is essential that laboratory diagnosis is sought for and the treatment modified accordingly.

Efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome.

In spite of a few shortcomings such as over diagnosis and over treatment, syndromic management is a recommended practice in India for sexually transmitted infections (STIs). This study tries to find out the efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome. The objective of the study is to find out the effectiveness of syndromic management in terms of symptomatic improvement among females with vaginal discharge syndrome. A longitudinal study was conducted in Gynecology Department of Tertiary Care Hospital including 180 symptomatic females having vaginal discharge syndrome. Demographic profile, presenting complaints, menstrual history, obstetric history, partner history, and contraceptive history were noted. This was followed by clinical examination and specimen collection for laboratory tests and blood tests to find out type of STI including viral STI such as human immunodeficiency virus (HIV), herpes simplex virus (HSV), and hepatitis B surface antigen (HBsAg). Treatment was given according to syndromic management on the same day. All the participants were asked to come for follow-up after 15 days and their improvement in symptoms was noted as complete improvement, some improvement or no improvement on a five point scale. 63.9% cases showed complete improvement, while 36.1% showed some improvement. None of the patients was without any improvement. Vaginal discharge syndrome was most common between 20 and 30 years (43.4%), and 67.8% of symptomatic females with vaginal discharge syndrome belonged to the lower socioeconomic group. HSV infection was the most common (15%) associated viral infection with vaginal discharge syndrome, while hepatitis B infection was the least common (0.5%). HIV was reactive in 2.8% cases only. Syndromic management was found to be effective in relieving symptoms in most of the cases of vaginal discharge syndrome.

Efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome

Background:In spite of a few shortcomings such as over diagnosis and over treatment, syndromic management is a recommended practice in India for sexually transmitted infections (STIs). This study tries to find out the efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome.Objective:The objective of the study is to find out the effectiveness of syndromic management in terms of symptomatic improvement among females with vaginal discharge syndrome.Materials and Methods:A longitudinal study was conducted in Gynecology Department of Tertiary Care Hospital including 180 symptomatic females having vaginal discharge syndrome. Demographic profile, presenting complaints, menstrual history, obstetric history, partner history, and contraceptive history were noted. This was followed by clinical examination and specimen collection for laboratory tests and blood tests to find out type of STI including viral STI such as human immunodeficiency virus (HIV), herpes simplex virus (HSV), and hepatitis B surface antigen (HBsAg). Treatment was given according to syndromic management on the same day. All the participants were asked to come for follow-up after 15 days and their improvement in symptoms was noted as complete improvement, some improvement or no improvement on a five point scale.Results:63.9% cases showed complete improvement, while 36.1% showed some improvement. None of the patients was without any improvement. Vaginal discharge syndrome was most common between 20 and 30 years (43.4%), and 67.8% of symptomatic females with vaginal discharge syndrome belonged to the lower socioeconomic group. HSV infection was the most common (15%) associated viral infection with vaginal discharge syndrome, while hepatitis B infection was the least common (0.5%). HIV was reactive in 2.8% cases only.Conclusion:Syndromic management was found to be effective in relieving symptoms in most of the cases of vaginal discharge syndrome.

Quality of Sexually Transmitted Infection Case Management Services in Gauteng Province, South Africa: An Evaluation of Health Providers' Knowledge, Attitudes, and Practices.

The sexually transmitted infection (STI) clinical encounter is an opportunity to identify current and prevent new HIV and STI infections. We examined knowledge, attitudes, and practices regarding STIs and HIV among public and private providers in a large province in South Africa with a high disease burden. From November 2008 to March 2009, 611 doctors and nurses from 120 public and 52 private clinics serving patients with STIs in Gauteng Province completed an anonymous, self-administered survey. Responses were compared by clinic location, provider type, and level of training. Most respondents were nurses (91%) and female (89%), were from public clinics (91%), and had received formal STI training (67%). Most (88%) correctly identified all of the common STI syndromes (i.e., genital ulcer syndrome, urethral discharge syndrome, and vaginal discharge syndrome). However, almost none correctly identified the most common etiologies for all 3 of these syndromes (0.8%), or the recommended first or alternative treatment regimens for all syndromes (0.8%). Very few (6%) providers correctly answered the 14 basic STI knowledge questions. Providers reporting formal STI training were more likely to identify correctly all 3 STI syndromes (P = 0.034) as well as answer correctly all 14 general STI knowledge questions (P = 0.016) compared with those not reporting STI training. In addition, several providers reported negative attitudes about patients with STI that may have affected their ability to practice optimal STI management. Sexually transmitted infection general knowledge was suboptimal, particularly among providers without STI training. Provider training and brief refresher courses on specific aspects of diagnosis and management may benefit HIV/STI clinical care and prevention in Gauteng Province.

Three methods of delivering clinic-based training on syndromic management of sexually transmitted diseases in South Africa: a pilot study

IntroductionThe South African National Department of Health sought to improve syndromic management of sexually transmitted infections (STIs). Continuing medical education on STIs was delivered at primary healthcare (PHC) clinics using...

O10.3 Low effectiveness of syndromic diseases management in women infected withchlamydia trachomatis,trichomonas vaginalisandneisseria gonorrhoeaeleads in delhi india

Introduction Besides a range of effective diagnostic tests and treatments, the extent of Sexually transmitted diseases (STDs) epidemic remains challenging. STDs are associated with enormous physical, psychological and economical consequences on the population of developing countries. World Health Organization emphasises on the syndromic approach, especially in areas having inadequate laboratory and transport facilities. Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and Neisseria gonorrhoeae (NG) are the most common STIs worldwide. They present similar clinical spectra in both women and men and are the leading cause of acquired infertility in women. Methods In this prospective study (from June 2012 to Feb 2015), the accuracy and performance of syndromic treatment given at Safdarjung hospital, as per NACO-NACP III Syndromic diagnosis of STI/RTI and treatment guidelines (Provision of directly observed therapy for single-dose regimes) were validated by comparing the diagnosis carried out by PCR based assay. Results Out of 6000 visited patients, 820 female patients (14%) had vaginal discharge syndrome and given treatment as per NACO guidelines; using Kit-I, Grey Kit (UD, ARD, Cervivitis), Kit-II, Green Kit (Vaginitis) and Kit-VI, Yellow Kit (LAP). Out of 824, 634 (77%) patients were enrolled in this study. Based on syndromic management 20%, 0.5%, 46%, pateints were infected with CT, NG, TV respectively. Co-infections were common: 7%, 11%, 1%, 12%, with CT+TV, CT+NG, NG+TV, CT+NG+TV respectively. However, with Specific PCR assays, out of 634, 110 (17%) were positive and 524 (83%) patient were negative and/or positive for other STDs. Out of 110 patients, 7%, 5%, 2%, were CT, NG, TV infected while 1%, 2%, 1%, were co-infected with CT+TV, CT+NG, CT+NG+TV respectively. Conclusion Our results provide evidence that, symptom based disease management leads to inaccurate diagnosis and over treatment of patients resulting in huge economic wastage and may also contribute towards the development of drug-resistance.

Prevalence and Associated Factors of Sexually Transmitted Infections Based on the Syndromic Approach among HIV Patients in ART Clinic; Ayder Referral Hospital, Northern Ethiopia

Background: Sexually transmitted Infections represent a large burden of disease worldwide with an annual incidence of about 333 million cases. In Ethiopia, studies on Sexually Transmitted Infections (STIs) among HIV patients are very few; therefore, conducting research on STIs in general and among HIV patients in particular is an important input to design policy and strategy aimed at preventing and controlling the infections. Objective: To determine the prevalence and associated factors of sexually transmitted infections among HIV patients in ART clinic; Ayder referral hospital, Tigray, Ethiopia. Methods: Institution based cross sectional study design was conducted among 353 HIV patients in Ayder hospital, ART clinic from July to September 2014. A systematic random sampling technique was used to identify study subjects. Data were collected using structured questionnaire and entered into and analyzed using SPSS 20 for windows. Descriptive analyses were used to estimate the prevalence of STIs and selected characteristics of patients. The effects of predictors on having STIs were analyzed using logistic regression and their effects were depicted using OR adjusted for confounding. P-value less than 0.05 were considered as statistical significant for all tests. Result;: Among total respondents; 150 (42.5%) were male and 203 (57.5%) female HIV patients .The prevalence of sexually transmitted infections based on the syndromic approach was 8.5% with specific prevalence of (4.6%) urethral discharge syndrome,(2.8%) genital ulcer syndrome, none of them scrotal swelling syndrome, (2.5%) lower abdominal pain syndrome,(0.3%)inguinal bubo and (5.5%) had vaginal discharge syndrome. 8 patients (26.7%) had recurrent disease and 28 patients (93.3%) treated without their partners. After multivariable logistic regression analysis, age (AOR=11.3 (95%CI: 1.1-116.5), marital status (AOR=0.031 (95%CI: 0.001-0.93) and having new sexual partner within the last three months (AOR=152.7 (95%CI: 3.7-6274) were significantly associated with STI syndromes p-value<0.05. Conclusion and recommendations: The prevalence of sexually transmitted infections based on the syndromic approach among HIV patients was 8.5% and the factors associated with STIs among HIV patients were: age, marital status and having new sexual partner within the last three months. Moreover, further studies to explore the predictor variables are highly recommended.

Prevalence and risk factors for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis infection in pregnant women in Papua New Guinea

ObjectiveTo determine the prevalence of, and risk factors associated with, Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis infection in pregnant women in Madang, Papua New Guinea (PNG).MethodsA cross-sectional survey was...

Validation of vaginal discharge syndrome among pregnant women attending obstetrics clinic, in the tertiary hospital of Western India

Introduction:Sexually transmitted infections (STIs) are major public health problem. The laboratory tests for diagnosing STI are often unavailable or too expensive. Therefore, World Health Organization has recommended a syndromic approach for diagnosis and management of STI/reproductive tract infections (RTIs). Very few studies so far had evaluated effectiveness of the syndromic approach in diagnosing STI/RTIs in pregnancy.Aims and Objectives:Validation of syndromic management for vaginal discharge syndrome in pregnancy.Materials and Methods:A cross-sectional study was carried out which included 233 pregnant females attending obstetric clinic. They were subjected to clinical examination, vaginal swab collection, and serological tests.Results:A total of 183 (78.54%) pregnant females had vaginal discharge on clinical examination and Candida albicans was the most common clinical diagnosis among them. Of 183 cases diagnosed clinically as vaginal discharge syndrome, 38 (20.7%) were tested positive in laboratory investigations. Out of 50 clinically negative cases, 9 (18%) were detected positive for one of the STIs on laboratory testing.Conclusion:Syndromic approach for management of vaginal discharge syndrome resulted in over-treatment of 78% (false positive) and under-diagnosis of 19.1% (false negative) pregnant females. Hence, integration of antenatal screening services in the form of laboratory tests for vaginal discharge is recommended.

Validation of vaginal discharge syndrome among pregnant women attending obstetrics clinic, in the tertiary hospital of Western India.

Sexually transmitted infections (STIs) are major public health problem. The laboratory tests for diagnosing STI are often unavailable or too expensive. Therefore, World Health Organization has recommended a syndromic approach for diagnosis and management of STI/reproductive tract infections (RTIs). Very few studies so far had evaluated effectiveness of the syndromic approach in diagnosing STI/RTIs in pregnancy. Validation of syndromic management for vaginal discharge syndrome in pregnancy. A cross-sectional study was carried out which included 233 pregnant females attending obstetric clinic. They were subjected to clinical examination, vaginal swab collection, and serological tests. A total of 183 (78.54%) pregnant females had vaginal discharge on clinical examination and Candida albicans was the most common clinical diagnosis among them. Of 183 cases diagnosed clinically as vaginal discharge syndrome, 38 (20.7%) were tested positive in laboratory investigations. Out of 50 clinically negative cases, 9 (18%) were detected positive for one of the STIs on laboratory testing. Syndromic approach for management of vaginal discharge syndrome resulted in over-treatment of 78% (false positive) and under-diagnosis of 19.1% (false negative) pregnant females. Hence, integration of antenatal screening services in the form of laboratory tests for vaginal discharge is recommended.

Sexually transmitted infections in women: A correlation of clinical and laboratory diagnosis in cases of vaginal discharge syndrome.

Aims:This study compares the clinical and laboratory diagnosis of vaginal discharge syndrome.Settings and Design:This cross-sectional study was carried out at the gynaecology outpatient department of a tertiary care hospital in Gujarat, India.Material and Methods:Total of 180 females diagnosed as vaginal discharge or cervicitis based on syndromic approach and were recruited for the study. Their clinical profile was noted and they were investigated for bacterial vaginosis, trichomoniasis, candidiasis, gonorrhoea and chlamydia infection.Results:Lower abdominal pain (35%) followed by burning micturition (23.9%) were the common associated complaints. Bacterial vaginosis was the most common clinical diagnosis, while trichomoniasis was least common. Upon laboratory investigation, 35.6% of cases of vaginal discharge and 12% of cases of cervicitis tested positive. Percentage of cases confirmed by laboratory investigation was 50, 27.8 and 41.7 for bacterial vaginosis, trichomoniasis and candidiasis respectively.Conclusion:Among all the females diagnosed as vaginal discharge syndrome, a very small percentage actually turned out to be positive upon laboratory testing.

Prevalence and Determinants of HIV among Symptomatic STI Cases in Southern Nations, Nationalities and People’s Regional States, Ethiopia

Background: Recognition of HIV/STI co infection has tremendous contribution for targeted intervention. Sexually transmitted infections have far reaching health, social and economic consequences. Sexually transmitted infections are very important because of their potential complication and interaction with HIV/AIDS. By evaluating the HIV/STI co infection it will be a signal to know the affected groups and major determinants. In doing so, the study finding would help in the planning, resource allocation and designed targeted prevention and control program. Objective: To determine the prevalence and determinants of HIV among symptomatic STI cases. Methods: Cross-sectional survey was conducted for HIV Sero prevalence and determinants among 415 symptomatic new STI cases that had been attended for treatment in eight hospitals in SNNPR, Ethiopia from November, 2011 to February, 2012. Standard rapid HIV antibody test was used to screen the sample blood following the national rapid HIV testing algorithm. Results: The overall HIV sero positivity was found to be 10.6%. Among 415 samples 371(89.4%) were negative and 44(10.6%) turned out to be positive.( Table 4) The rate varies among the major STI syndromes, namely, Urethral discharge syndrome (18.2%), vaginal discharge syndrome (56.8%), genital ulcer syndrome (15.9%), and lower abdominal pain (9.1%). (Table 4)Limitation of the study: Limitation of this study is the use of rapid HIV test kits which fails to detect recent infection. Moreover, the study is hospital based it can't be representative of the whole population, Conclusion and Recommendation: High prevalence of HIV in STI patients is explained by the role of STI in predisposing for HIV transmission which offers a unique opportunity for strengthening the prevention of HIV/STI co infection putting in place routine HIV test. Furthermore, public health intervention on consistent condom use and partner notification and referral should be given due emphasis targeted to the most at risk population.

P3.283 Trends and Associations of Neisseria Gonorrhoeae Infection in Men and Women with Genital Discharge Syndromes in Johannesburg, South Africa

BackgroundAnnual STI aetiological surveys undertaken at a primary healthcare facility in Johannesburg, South Africa, each year have determined the prevalence of gonorrhoea amongst men with male urethral discharge syndrome (MUDS)...

P2.136 Sexual Transmission Infection Situation in People Living with HIV (PLHIV)In 6 Provinces in Vietnam from 2008–2011

BackgroundMultiple studies have suggested that STIs (sexual transmission infections) are important cofactors in the transmission and acquisition of HIV infection. Thus control of one may have beneficial effects on the...

P3.296 Prevalence of Chlamydial Infections Within Eight South African Provinces (2006–2011)

BackgroundThe microbiological surveillance was undertaken in eight provinces of South Africa during 2006 –2011 to determine the aetiology of the male urethritis syndrome (MUS), vaginal discharge syndrome (VDS) and genital...