Result for comparative study of automatic analyzer and vaginal smear test for diagnosis of vaginal secretion / Монголын Анагаах Ухаан

Introduction @#Women’s age and reproduction system are always changed from many factors such as communicative and non- communicative diseases, pregnancy and menopause et cetera. Especially, the kinds of vaginal microflora and their proportions are changed too. In the world, the expansion of women’s vaginitis from bacteria was over 29.2% in 2021. For our country, 7486 as 6.9% vaginitis cases occurred within 10,000 people and 3683 as 26.3% cervical inflammation cases occurred by 2019. Vaginitis is asymptomatic for 50-75% of women. Sometimes it is not easy to diagnose vaginitis from bacteria because the fact that it doesn’t create a single type of bacteria. To diagnose vaginitis from bacteria in practice, Amsel’s criteria and Nugent testing methods are mostly used. The methods need much time, doctors’ skills and laboratory devices. It is a disadvantage of these methods. Thus, it needs to find a special method it meets people’s satisfaction, money-saving and more effective. @*Goal@#Comparative research on the traditional and automatic testing methods for vaginal secretion @*Materials and Methods@#We included 47 women in menopause age in analytic study design. All test of participants was tested with Nugent score and automatic analyzer. Data were analyzed using SPSS 25.0 version interpreted according to frequency distribution and percentage. A chi – square test and risk test was used to determine significant association wherever applicable with a p-value of less than 0.05 regarded as significant. The sensitivity, specificity, positive predictive value, and negative predictive value of Automat analyzer were calculated, and each component of Automat analyzer was compared to the Nugent scoring system. </br>This study protocol was approved by the ethics committee of “Mongolian National University of Medical Sciences” university. @*Results@#Evaluating the vaginal discharge from participants in the research by Nugent score, 17% (8/47) of them had bacterial vaginitis, 34% (16/47) was uncertain or they needed to be tested again, 17% (9/47) was normal. But evaluating their test of vaginal discharge by GMD-S600 automatic analyzer, 17% (8/47) had Fungal vaginitis, 57,4% (27/47) had Bacterial vaginitis, 25,5% (12/47) lost their uterus acidic balance. Evaluating the reason of vaginitis with device test by Nugent test, it fits 17%. The test diagnoses it very effective in statistics. @*Conclusion@#Comparing traditional method to automatic analyzer testing method for vaginal secretion, the automatic analyzer method is more effective to diagnose and it has an advantage of detecting vaginal abnormality. Also, working unhealthy condition, smoking, making wash are the defends of having vaginitis.

Prevalence of asymptomatic and symptomatic bacterial vaginosis in pregnant women attending antenatal clinic in a tertiary care rural hospital

Background: Bacterial vaginosis (BV) is one of the most common lower genital tract conditions, occurring in 35% of women attending sexually transmitted infection (STI) clinics, 15% to 20% of pregnant women, and 5% to 15% of women attending gynaecology clinic. It has been associated with serious pregnancy complications, including premature rupture of the membranes, preterm delivery and postpartum endometritis. The diagnosis of BV is usually based on clinical criteria including homogeneous vaginal discharge, an elevated vaginal pH, the presence of clue cells, and an amine odour. Objective of this study was to study the prevalence of asymptomatic and symptomatic BV in pregnant women attending antenatal clinic in a tertiary care rural teaching hospital.Methods: Sample size of 301 patients over 6 months study duration in an observational cross sectioned prospective type of study. An unfixed vaginal smear was collected from pregnant women and sent to microbiology for staining and fixing and diagnosis was established.Results: The age range in pregnant women enrolled was 18 to 42 with mean age 26.10 years. As per the Nugent score criteria, 68 (23%) women tested positive for BV (Nugent score 7-10) and 77 (25%) had an intermediate score (Nugent score 4-6). While in 156 (52%) pregnant women’s Nugent score was in between 0-3 indicating no BV but 10% cases amongst these were showing presence of fungal elements mainly budding yeast cells with or without hyphae. In only 53% of cases of BV characteristic clue cells were present. In this study 69% cases of BV were observed in multigravida while 31% were present in primigravida.Conclusions: Screening of asymptomatic pregnant women’s by taking vaginal swab and evaluating gram smear using Nugent score system will play vital role early diagnosis of reproductive tract infections.

Study on bacterial vaginosis in pregnant women and associated factors on maternal and fetal outcome

Background: Bacterial vaginosis (BV) is a condition in which the normal, lactobacillus-predominant vaginal flora is replaced with anaerobic bacteria, gardnerella vaginalis and mycoplasma hominis1. It is one cause of vaginitis among pregnant and non-pregnant women and an extremely prevalent vaginal condition.Methods: The present study was conducted on all antenatal women attending OPD satisfying the inclusion criteria was taken during the study period 1st October 2012 to 30th June 2014 in GSL General Hospital, Rajahmundry was examined for bacterial vaginosis using Nugent score. All pertinent obstetric and neonatal data covering antenatal events during the course of pregnancy, delivery, puerperium and condition of each newborn at the time of birth was collected. BV was detected by both Gramstain (Nugent criteria) and gold standard clinical criteria (Amsel’s composite criteria).Results: In this study bacterial vaginosis is seen in 313 cases of educated women (62.6%) as most of them have got primary education and 187 (37.4%) cases are uneducated. In this study, symptomatic bacterial vaginosis is more common in multigravida (Bladder -23; Discharge -50) 73 (22%) when compared with primigravida 11 (6.5%) probably because of longer period of marital life. In this study antenatal risk factors like previous IUCD (4.2%) use, H/O STD’s (1.4%), husband having h/o of multiple sexual partners (1.8%) are 7.4%.No cases of smoking, alcohol, drug abuse, douching were reported.Conclusions: Both primigravida and multigravida asymptomatic cases are more when compared to symptomatic cases leading to the need for routine screening. Routine screening of antenatal women resulted in the decrease of adverse pregnancy outcome.

The Effect of Supplementation of Standard Antibiotic Therapy with Oral Probiotics for Bacterial Vaginosis

Background: Bacterial vaginosis is a common cause of vaginal infection worldwide in women of child bearing age. It can be asymptomatic or mild infection but can lead to many complications especially during pregnancy. Recurrence is also frequently seen in women suffering from bacterial vaginosis. This infection usually occurs when normal lactobacillus flora in vagina is disrupted and replaced by pathogens. Administration of probiotics will restore normal vaginal flora and maintain normal pH and it could prove to be a reliable alternative to antibiotics in future. Objective: To assess the effect of supplementation of standard antibiotic therapy with oral probiotics (Lactobacillus) for treatment of bacterial vaginosis. Material Methods: It was an open labeled prospective study in which 100 women diagnosed with bacterial vaginosis were randomly divided into two groups. Diagnosis was made using Amsel’s criteria and Nugent scoring was done. Group A was given Oral Metronidazole, 400 mg BD for 7 days along with oral probiotic tablet containing Lactobacillus rhamnosus BD for 6 weeks whereas Group B was administered Oral Metronidazole, 400 mg BD for 7 days. Patients were assessed at 7 days for symptomatic improvement and again at the end of 6 weeks using Nugent scores. Results obtained were then compared. Results: Out of all patients 2 patients in Group A and 5 patients in Group B could not complete the study. At the end of 7 days, there was improvement in symptoms ie decrease in itching, odour and discharge. There was a significant difference in mean Nugent score before and after treatment between group A and group B at the end of 6 weeks. Conclusion: This study concluded that improvement in patients taking probiotics along with standard antibiotic therapy was significantly more as compared to antibiotics alone.

The Effect of Supplementation of Standard Antibiotic Therapy with Oral Probiotics for Bacterial Vaginosis

Background: Bacterial vaginosis is a common cause of vaginal infection worldwide in women of child bearing age. It can be asymptomatic or mild infection but can lead to many complications especially during pregnancy. Recurrence is also frequently seen in women suffering from bacterial vaginosis. This infection usually occurs when normal lactobacillus flora in vagina is disrupted and replaced by pathogens. Administration of probiotics will restore normal vaginal flora and maintain normal pH and it could prove to be a reliable alternative to antibiotics in future. Objective: To assess the effect of supplementation of standard antibiotic therapy with oral probiotics (Lactobacillus) for treatment of bacterial vaginosis. Material Methods: It was an open labeled prospective study in which 100 women diagnosed with bacterial vaginosis were randomly divided into two groups. Diagnosis was made using Amsel’s criteria and Nugent scoring was done. Group A was given Oral Metronidazole, 400 mg BD for 7 days along with oral probiotic tablet containing Lactobacillus rhamnosus BD for 6 weeks whereas Group B was administered Oral Metronidazole, 400 mg BD for 7 days. Patients were assessed at 7 days for symptomatic improvement and again at the end of 6 weeks using Nugent scores. Results obtained were then compared. Results: Out of all patients 2 patients in Group A and 5 patients in Group B could not complete the study. At the end of 7 days, there was improvement in symptoms ie decrease in itching, odour and discharge. There was a significant difference in mean Nugent score before and after treatment between group A and group B at the end of 6 weeks. Conclusion: This study concluded that improvement in patients taking probiotics along with standard antibiotic therapy was significantly more as compared to antibiotics alone.

Comparison of the efficacy of metronidazole and metronidazole plus probiotics capsule in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary hospital: A single blind randomized controlled trial / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Bacterial vaginosis (BV) is the most prevalent cause of symptomatic vaginitis. In the Philippines, prevalence of BV is at 28.16%. The mainstay for the treatment of BV is Metronidazole. Although antibiotic therapy has been shown to eliminate BV associated organisms, there is extremely high recurrence rate.OBJECTIVE: To compare the efficacy of metronidazole and metronidazole plus lactobacilli tablet in the treatment of bacterial vaginosis among non-pregnant patients seen at the outpatient department of a tertiary medical center.METHODOLOGY: The population included non-pregnant women ages 15 t0 44 years old, with bacterial vaginosis diagnosed by Amsel's criteria and Nugent's scoring. The participants were randomly assigned to their treatment group, one is Metronidazole only and other received Metronidazole plus Lactobacillus tablet. All participants followed up on day 8,15,22 and 56 from initiation of treatment resolution or persistence of symptoms and collection of vaginal specimen for gram stain and inquire on adverse effects.RESULTS: On day 8 treatment, there were significantly more participant in the metronidazole plus probiotic arm with an estimated lactobacilli count of more than 30/hpf as comapred to metronidazole alone. On day 15 post treatment, there was no statistically significant difference with the estimated Gardnerella vaginalis count, lactobacilli count, presence or absence of malodorous vaginal discharge between the metronidazole plus probiotic and the metronidazole alone arm. With metronidazole plus probiotic group, the proportion of women with less than 30 per hpf Gardnella vaginalis count and absent foul smelling vaginal discharge were accounted among 100% of the participants from day 8 to 56 post treatment. The early reduction in the causative agent and symptoms can be attributed to an increase in the estimated lactobacilli count sustained until 56 days post treatment metronidazole plus probiotic. However, from day 15 to 22 and 56 post- treatment, the proportion of participants who had a nugent's score of less than 4 were greater for both the metronidazole plus probiotic (100%) and metronidazole alone (95%) arm, when compared to day 8 post-treatment. This finding for the metronidazole plus probiotic group is due to sustained reduction in the Gardnella vaginalis count and increase in lactobacilli counts. Potentially , the metronidazole plus probiotic treatment was found to be more favorable in sustaining the normal flora and probiotic can be used as an adjunct may enhance the efficacy of metronidazole in the treatment of BV.CONCLUSION: Metronidazole plus probiotic and metronidazole only treatment are comparable in treating bacterial vaginosis. In terms of restoring and maintaining the normal flora, metronidazole plus probiotic appears to be more significantly efficacious. Probiotic in the form of lactobacilli is a promising adjunct to enhance the efficacy of metronidazole in the treatment of bacterial vaginosis.

Prevalencia de vaginosis bacteriana y factores asociados en veinte ciudades del Perú / Prevalence of bacterial vaginosis and associated factors in twenty peruvian cities

RESUMEN Objetivos. Determinar la prevalencia de vaginosis bacteriana (VB) y factores asociados en mujeres peruanas de 18 a 29 años de edad en 20 ciudades a partir de datos del proyecto PREVEN. Materiales y métodos. Estudio de tipo transversal, la definición de VB se realizó previa selección de una muestra de secreción vaginal en una lámina portaobjetos. Las láminas fueron teñidas usando la tinción Gram para ser observadas al microscopio usando el puntaje de Nugent, el diagnóstico de VB se aplicó a los puntajes 7-10. Se estimaron razones de prevalencias (RP) y sus intervalos de confianza al 95% (IC 95%) mediante el uso de modelos lineales generalizados. Resultados. Un total de 6322 mujeres contestaron la encuesta epidemiológica y proporcionaron muestras vaginales. La prevalencia de VB fue de 23,7% (IC95%: 22,6-24,7) y se asoció con tener un mayor número de parejas sexuales en los últimos 12 meses (RP: 1,22, IC 95%: 1,03-1,44, p=0,020; para dos parejas y RP: 1,46, IC 95%: 1,23-1,74, p<0,001 para tres o más parejas), no usar condón en la última relación sexual (RP: 1,16, IC 95%: 1,01-1,34, p=0,034), ser residente de la sierra (RP: 1,18, IC 95%: 1,05-1,31, p=0,004) y tener flujo vaginal anormal o con mal olor (RP: 1,20, IC 95%: 1,09-1,33, p<0,001). Conclusiones. La alta prevalencia de VB encontrada remarca la necesidad de fortalecer los servicios de salud para la detección y tratamiento de esta condición.

ABSTRACT Objetives. To determine the prevalence of bacterial vaginosis (BV) and associated factors among 18-29-year-old women in 20 Peruvian cities using PREVEN project data. Materials and Methods. In this cross-sectional study, BV was defined using previously provided vaginal discharge samples on slides, which were Gram stained and observed under a microscope to determine the Nugent scores. A BV diagnosis was applied to samples with scores of 7-10. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were estimated using generalized linear models. Results. A total of 6,322 women participated in the epidemiological survey and provided vaginal swabs. The prevalence of BV was 23.7% (95% CI: 22.6-24.7) and was associated with a greater number of sexual partners in the last 12 months (PR: 1.22, 95% CI: 1.03-1.44, p=0.020 for two partners; PR: 1.46, 95% CI: 1.23-1.74, p<0.001 for three or more partners), not using a condom during last intercourse (PR: 1.16, 95% CI: 1.01-1.34, p=0.034), being a sierra resident (PR: 1.18, 95% CI: 1.05-1.31, p=0.004), and having abnormal vaginal discharge or a bad smell (PR: 1.20, 95% CI: 1.09-1.33, p<0.001). Conclusions. The high prevalence of BV highlights the need to strengthen health services aimed at the detection and treatment of this condition.

Correlation of H2O2 Production of Lactobacillus species with Nugent Scores of Young Nigerian Women.

Aim: To correlate H2O2 production of Lactobacillus species with the Nugent scores of young Nigerian women in order to assess their vaginal health. Study Design: Cross-sectional study. Place and Duration of Study: Departments of Medical Microbiology & Parasitology, Biochemistry and Obstetrics and Gynaecology, College of Medicine of the University of Lagos, between May and august 2009. Methodology: Ninety- seven isolates of Lactobacillus from eighty-two women without Bacterial vaginosis (BV) and fifteen women with BV were used for the study. BV was diagnosed using Nugent scoring method. Lactobacilli were isolated using MRS agar and categorized into facultative anaerobes and strict anaerobes. Hydrogen peroxide was detected and measured by titration using dilute sulphuric acid and reaction stopped with potassium permanganate. Results: Out of 97 isolates studied, 76 (78%) were facultative anaerobes, while 21 (22%) were strict anaerobes. The facultative anaerobes were obtained from 11 of 15 women with BV and 65 of 82 women without BV. Forty- nine (50.51%) of the 97 isolates produced H2O2. Forty- four of the H2O2 producers were from women without BV while five were from women with BV. Majority (67%) of the strains obtained from women with BV were non-hydrogen peroxide producing. Proportion of H2O2 producing Lactobacillus by Nugent score were 70%, 43% and 33% in negative, intermediate and BV Nugent scores respectively. There was no significant difference between the mean concentrations of H2O2 production in the various Nugent scores. Conclusion: The overall rate of hydrogen peroxide production was low. While the rates of hydrogen peroxide production correlated with Nugent scores, being highest in negative Nugent scores and lowest with BV scores, the concentration of hydrogen peroxide produced had no association with Nugent scores. The Nigerian women studied might have a relatively high susceptibility rate to vaginal infections.

Evaluation of vaginal pH for detection of bacterial vaginosis.

Background & objectives: Bacterial vaginosis (BV) is highly prevalent among women in reproductive age group. Little information exists on routine vaginal pH measurement in women with BV. We undertook this study to assess the utility of vaginal pH determination for initial evaluation of bacterial vaginosis. Methods: In this cross-sectional study vaginal swabs were collected from women with complaints of white discharge, back ache and pain abdomen attending a government hospital and a community health clinic, and subjected to vaginal pH determination, Gram stain, wet mount and whiff test. Nugent score and Amsel criteria were used for BV confirmation. Results: Of the 270 women included in the analysis, 154 had BV based on Nugents’ score. The mean vaginal pH in women with BV measured by pH strips and pH glove was 5 and 4.9, respectively. The vaginal pH was significantly higher in women with BV. Vaginal discharge was prevalent in 84.8 per cent women, however, only 56.8 per cent of these actually had BV by Nugent score (NS). Presence of clue cells and positive whiff test were significant for BV. Vaginal pH >4.5 by pH strips and pH Glove had a sensitivity of 72 and 79 per cent and specificity of 60 and 53 per cent, respectively to detect BV. Among the combination criteria, clue cells and glove pH >4.5 had highest sensitivity and specificity to detect BV. Interpretation & conclusions: Vaginal pH determination is relatively sensitive, but less specific in detecting women with BV. Inclusion of whiff test along with pH test reduced the sensitivity, but improved specificity. Both, the pH strip and pH glove are equally suitable for screening women with BV on outpatient basis.

Different vaginal bacteria inspection method analysis and comparison / 中国医师进修杂志

ObjectiveTo investigate the characteristics of three vaginal bacteria inspection methods of Amsel method,gram staining Nugent score method and bacterial vaginosis (BV) Blue methodMethods The leucorrhea specimen of 99 vaginal fluid abnormal patients were examined by Amsel method,gram staining Nugent score method and BV Blue method,then compared and analyzedResultsThe positive rate was 28.28％ (28/99) in Amsel method,47.47％(47/99) in gram staining Nugent score method and 16.16％ (16/99) in BV Blue method.There were significant differences among three methods(P＜ 0.01 ).The specificity and sensitivity of gram staining Nugent score method was higher.ConclusionThe three vaginal bacteria inspection methods have advantage and shortcoming individually,suspecting patients should be followed up to detect and diagnose in chnic,or detected by many methods.The specificity and sensitivity of gram staining Nugent score method is higher,but BV Blue method is simple,faster,which has higher value in detection and diagnosis in BV.