Clinical and laboratory evidence of Trichomonas vaginalis infection among women of reproductive age in rural area.

Background: Vaginitis is a commonly encountered complaint and one of the most frequent reasons for patient visit to obstetrician-gynaecologists. Three vaginal infections are frequent causes of a vaginal discharge: (1) bacterial vaginosis, (2) vulvovaginal candidiasis and (3) trichomonas vaginitis. Differences in the clinical presentation are helpful in diagnosis. Characteristic signs and symptoms for these three vaginal infections are distinct, but on many occasions, they are overlapping. The aim of the present study was to find the prevalence and correlation between the clinical spectrum and laboratory evidence of Trichomonas vaginalis infection by simple, reliable, confirmatory and specific method, i.e. microscopic examination of wet mount preparation and acridine stain of vaginal fluid. Materials and Methods: Irrespective of HIV status, a total of 156 women with vaginal discharge were studied for establishing diagnosis of genital tract infection. The cases of bacterial vaginosis and vulvovaginal candidiasis were excluded from the study. Vaginal speculum assisted high vaginal swabs were collected from women with discharge, during collection vagina was inspected for obvious signs. Results: Of the 156 women with vaginal discharge, 19 (12.06 %) showed T. vaginalis infection. All the women belonged to active reproductive age group, i.e. 20-40 years. Itching dysuria, and offensive, malodorous, thin, yellowish vaginal discharge were the main and consistent complaints. Only in 2 (1.52%) cases, vaginal speculum examination revealed erythema and punctuate haemorrhage, the so-called "strawberry' vagina. The pH was recorded to be >4.5. Conclusion: Clinical differentiation of various forms of infectious vaginitis is unreliable. The prevalence of T. vaginalis infection at 12.06% was found among rural young women of reproductive age using simple and reliable screening wet mount microscopy.

Outcome of syndromic management in cases of chronic vaginal discharge

To see the outcome of syndromic management in 100 patients of chronic vaginal discharge. This descriptive study was conducted in outpatient department of Obstetrics and Gynaecology, Hayatabad Medical Complex, Peshawar from 1[st] January 2007 to 30[th] June 2007. Patients aged from 16 to 50 years with chronic vaginal discharge of more than 6 months duration were included in the study. Pregnant patients and those with the history of Cervical Intraepithelial Neoplasia [CIN], Carcinoma of the cervix, ovary or endometrium were excluded from the study. A detailed history and examination was done and a Proforma was filled. All these patients were treated with the syndromic management as recommended by the World Health Organization [WHO] in which no laboratory tests are done and patients are treated empirically with the antibiotics as per criteria of WHO. The mean age of the patients was 32 +/- 8.08 years. Vaginal infection improved in 56% of the cases with a single course of antibiotic, in 84% with a second course, 12 patients were lost to follow up and 5 patients who did not improve with two courses of antibiotics had big cervical erosions, were subjected to Cryo therapy. In settings, where bedside tests like microscopy Potassium Hydroxide, wet mount films and tests for Chlamydia and gonorrhea are not available, syndromic management is a reasonable way of treating cases of chronic vaginal discharge

Vaginal foreign body causing recurrent discharge and vaginal stenosis--a case report.

Chronic vaginal discharge in children and adolescents is a common gynaecological complaint which is often resistant to antibiotic treatment. We present a 14 years old, premenarcheal girl who presented to us with the complaints of recurrent, foul smelling purulent occasionally blood stained vaginal discharge for eight years, where a foreign body in the upper vagina was found after releasing a dense adhesion of the lower vagina which was unable to detect by pelvic ultrasound.

Accuracy of Nugent's score and each Amsel's criteria in the diagnosis of bacterial vaginosis.

OBJECTIVE: To determine the diagnostic accuracy of Nugent's score and each Amsel's criterion in the diagnosis of bacteria vaginosis (BV), considering Amsel's criteria as the gold standard. DESIGN: Cross-sectional, descriptive study (diagnostic test) Setting: Family planning clinic, Siriraj Hospital, Mahidol University. SUBJECTS: A total of 217 women who attended the Family Planning Clinic at Siriraj Hospital between August and December 2003. METHOD: Pelvic examination was performed on each participant. Samples of vaginal discharge was tested for BV infection using both Amsel's criteria and Nugent's score. Interpretation was made blinded without knowledge of each test result. Using Amsel's criteria as a gold standard, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Nugent's score and each of Amsel's criteria were estimated. RESULTS: Considering Amsel's criteria as the gold standard, Nugent's score showed a sensitivity of 65.6% (95%CI 46.8%, 80.8%), specificity of 97.3% (95%CI 93.5%, 99.0%), positive predictive value (PPV) of 80.8% (95%CI 60.0%, 92.7%), negative predictive value (NPV) of 94.2% (95%CI 89.7%, 96.9%) and accuracy of 92.6% (95%CI 88.1%, 95.6%). Both vaginal pH and whiff test demonstrated 100% sensitivity. However, vaginal pH showed lower specificity than the whiff test (58.9% and 97.3% respectively). CONCLUSION: Nugent's score might not be suitable to use as a screening test for diagnosis of BV due to its low sensitivity. The whiff test is the best clinical criteria of Amsel's criterion in the diagnosis of BV due to its high sensitivity and specitivity.

A study of HIV/STD infections amongst commercial sex workers in Kolkata (India). Part-III, clinical features of sexually transmitted diseases.

The clinical features of sexually transmitted disease (STD) infection in female sex workers found in a community based study in different red light areas of Kolkata are discussed in this paper. Out of 867 sex workers clinically examined in the clinics in their respective areas, 80.16% were having different signs and symptoms of sexually transmitted diseases. The vaginal discharge was the commonest feature present in 49.6% sex workers. The chronic vaginal discharge of more than a month was found in 47.44%, while 37.90% sex workers had vaginal discharge of less than one month. The genital ulcer was present in 25.03% (217) sex workers. The other sexually transmitted infection that was found includes genital warts 13.73%, scabies 12.11 and Inguinal bubo in 1.73% sex workers. The sex workers were also having other symptoms e.g. chronic weight loss, prolonged fever and chronic diarrhoea in 13.73% (119), 10.03% (87) and in 1.96% (17) sex workers respectively.

Etiology of vaginal hypersecretion syndrome in patients at Consulting Department of the Institute of Dermatology and Venereology from January to Septeber 2002

A study was carried out on 987 women with etiology of vaginal hypersecretion syndrome at Consulting Department of the Institute of Dermatology and Venerology from January to September 2002. The patients’ age was 18-25 and having sex previously. Results of the study: the rate of 24.4% infected with Candida fungi; 2.6% with gonococci, 2% with Trichomonas, 19.1% with Chlamydia trachomatis and 7.2% with anaerobic bacteria

Foreign body in vagina--an uncommon cause of vaginitis in children.

An intravaginal foreign body of long duration can pose diagnostic dilemma in children. We present a case of eight and a half years old girl who was suffering from blood stained vaginal discharge for 3 years for which she was treated by few gynaecologists. A vaginal examination performed under general anaesthesia revealed a foreign body (lead pencil). In cases of pediatric vaginitis one should always look for foreign body in vagina.

Ovarian abscess with spontaneous vaginal drainage

The occurrence of a rare ovarian abscess, spontaneously drained through the vagina after an abdominal hysterectomy is described. The treatment was an oophorectomy. The various forms of primary ovarian abscess are discussed in connection with these observations. This case illustrates the need for adequate manipulation of the gonad during pelvic surgery in order to avoid parenchymal contamination and the subsequent formation of such abscesses.