Corrimentos vaginais em gestantes: comparacao da abordagem sindromica com exames da pratica clinica da enfermagem / Flujo vaginal en gestantes: comparacion entre el abordaje sindromico y las pruebas en la practica clinica de enfermeria / Vaginal discharge in pregnant women: comparison between syndromic approach and examination of clinical nursing practice

Estudo avaliativo de abordagem quantitativa, com amostra de 104 gestantes, com o objetivo de comparar os achados de infecções vaginais em gestantes obtidos por meio do fluxograma de corrimento vaginal com exames presentes na prática clínica da Enfermagem. Os dados foram coletados por meio de entrevista e exame ginecológico realizados de janeiro a julho de 2011. O fluxograma não se mostrou eficaz na identificação de candidíase e tricomoníase, apresentou baixa sensibilidade (0,0%; 50%) e valor preditivo positivo (0,0%; 3,6%) para as duas infecções e baixa especificidade para tricomoníase (46%). Mostrou-se satisfatório para vaginose bacteriana, com alta sensibilidade (100%), valor preditivo negativo (100%) e acurácia (74%). Conclui-se que o emprego do fluxograma precisa ser reavaliado, visto que não foi eficaz em identificar infecções importantes em gestantes. Os esforços para o desenvolvimento de testes eficazes devem ser contínuos, com intuito de prevenir a disseminação de infecções e reduzir tratamentos desnecessários.

Estudio evaluativo con enfoque cuantitativo, con una muestra de 104 gestantes, cuyo objetivo fue comparar los resultados de infecciones vaginales en las gestantes, obtenidos a partir del diagrama de flujo vaginal y las pruebas presentes en la práctica clínica de enfermería. Los datos fueron recolectados por entrevista y examen ginecológico, realizados de enero a julio del 2011. El diagrama de flujo no fue eficaz en la identificación de candidiasis y tricomoniasis, presentando baja sensibilidad (0,0%; 50%) y valor predictivo positivo (0,0%; 3,6%), para las dos infecciones y baja especificidad para tricomoniasis (46%). Para vaginosis bacteriana, se mostró satisfactoria, con alta sensibilidad (100%), valor predictivo negativo (100%) y precisión (74%). Se concluye que el uso del diagrama necesita ser revisado, ya que no fue eficaz en la identificación de infecciones importantes en las gestantes. Los esfuerzos para desarrollar pruebas efectivas deben ser continuos, con el objetivo de prevenir la propagación de infecciones y reducir tratamientos innecesarios.

This is a study for assessment of a quantitative approach in pregnant women (N=104), in which findings of vaginal infection were compared. The findings were obtained by two means, flowchart of vaginal discharge, and typical examinations in the clinical nursing practice. Data were collected from January to July 2011 through interviews and gynecological examinations. The flowchart showed no efficacy to identify candidiasis and trichomoniasis. Furthermore, it showed low sensitivity (0.0%; 50%) and positive predictive value (0.0%; 3.6%) for both infections, and low specificity for trichomoniasis (46%). The flowchart was shown to be satisfactory for bacterial vaginosis, with high sensitivity (100%), negative predictive value (100%), and accuracy (74%). We conclude that use of the flowchart should be reassessed, as it was not able to identify important infections in pregnant women. A continuous effort must be directed for development of effective tests in order to prevent the spread of infection and reduce the number of unnecessary treatments.

Utility of pH test & Whiff test in syndromic approach of abnormal vaginal discharge.

Background & objective: In India, National AIDS Control Organization (NACO) introduced syndromic approach to treat patients with abnormal vaginal discharge without a need for laboratory tests. Simple tools like pH test and Whiff test can be done without high expertise, microscope and even speculum. This can improve diagnostic value of syndromic approach of abnormal vaginal discharge. The present study was conducted to evaluate sensitivity and specificity of pH test and Whiff test in diagnosis of abnormal vaginal discharge, considering microscopic diagnosis as gold standard. Methods: This prospective hospital-based study included 564 women with abnormal vaginal discharge. All women were subjected to gynaecological examination, pH test and Whiff test. The findings were compared with microscopic examination. Statistical analysis was done by calculating proportions, percentage, sensitivity and specificity. Results: Vaginitis was diagnosed in 301 (53.37%) women. Bacterial vaginosis (BV) was the commonest type of vaginitis (39.01%). Cervical erosion was the second most common cause (17.91%) and physiological discharge was the third (14.36%). pH > 4.5 and positive Whiff test had sensitivity of 94.09 per cent and specificity 87.5 per cent in diagnosing BV. Similarly pH < 4.5 and positive or negative Whiff test had sensitivity of 83.72 per cent in diagnosing candidiasis. Interpretation &conclusion: pH test and Whiff test can improve diagnostic value of speculum examination where microscope facilities are not available.

[Diagnostic value of Pap smear test in screening of bacterial vaginosis]

Bacterial vaginosis alters normal vaginal flora and leads to gynecologic complications. Early diagnosis of bacterial vaginosis is so important, because of being asymptomatic of about fifty percent of patients. This study was conducted to study the diagnostic value of the Papanicolaou smear in the screening of bacterial vaginosis compared with vaginal Gram stain as a standard method. This analytic cross- sectional study was conducted on 150 consecutive patients referred to a gynecologic clinic. Each patient had a standard Papanicolaou smear and Gram stain of vaginal discharge. Detection of clue cell in Pap smear, and fulfill of Nugent criteria in Gram stain of vaginal discharge was diagnosed as bacterial vaginosis. Sensitivity, specificity, positive predictive value, and negative predictive value of the Papanicolaou smear were calculated compared with the results of Gram stain as the standard method for diagnosis of bacterial vaginosis. In our study, Pap smear had sensitivity of 69.23%, specificity of 99.24%, positive predictive value of 94.73% and negative predictive value of 94.28% in the diagnosis of bacterial vaginosis. This study showed that vaginal Pap smear is a valid and reliable method in detecting bacterial vaginosis

Effect of ablution the genital area on result of urine culturing among 3-12 years old girls referring to Amir Kabir hospital, Arak, Iran

Urine tract infection [UTI] is the most prevalent bacterial infection and the second prevalent infection after viral flu among children. With respect to the importance of urine culturing, we decided to assess the effect of ablution the genital area on the result of urine culturing among 3-12 years old girls referring to Amir Kabir hospital, Arak, Iran. This randomized clinical trial was achieved on 620 girls referring to our hospital. Children were randomly assigned in two groups, with and without ablution. In ablution group, the appropriate technique of genital area ablution with water and soap was trained as well as how to collect middle-urine sampling, however, the other group received recommendations on how to appropriately collect middle-urine sample. Of 310 children of the ablution-trained group, UTI was reported in 11 [3.5%], contamination in 3 [1%] while 296 children were normal [95.3%]. However, these figures were 14 [4.7%], 6 [2%] and 290 [93.3%] in the other group, respectively. Contamination rate did not differ significantly between the 2 groups [P=0.49]. Genital area ablution is not associated with a significant decrease in rate of urine culture contamination, hence, it should not be routinely recommended for children

Foreign body as a cause vaginal discharge in childhood

Vaginal purulent discharge in children is mainly due to nonspecific enteric bacterial agents and specific agents such as group A beta-hemolytic streptococcus, hemophilus influenzae and staphylococcus aureus. Lack of protective effects of estrogen in vaginal mucosa is the main predisposing factor. Persistent or recurrent foul smelling and/or serosanguineous vaginal discharge, not responsive to medical therapy in most cases, might be caused by a missed vaginal foreign body We present a 7-year old girl because of persisting foul smelling, occasionally blood stained vaginal discharge for about 4 years despite a few courses of medical therapy by gynecologists. Ultrasonography didn't achieve to demonstrate the presence of the foreign body, but pelvic x-ray showed a radio-opaque body resembling a roll plaque. Vaginoscopy discovered a cap of eyebrow pencil in the upper vagina. This removed by forceps led to improvement of the disease. In a child presenting with vaginal discharge not responsive to hygienic measures and medical therapy, possibility of vaginal foreign body must be considered. Although MRI is the most proper technique for evaluation, sonography and/or x-ray are more available and helpful in most cases

Bacteriological studies on mycoplasma infection of bovine genital tract

A total of 70 vaginal swabs were collected from cows [forty five from cows suffering from congestion and purulent vaginal discharge, and 25 from apparently healthy cows]. Also ten vaginal swabs were collected from buffaloes suffering from congestion and purulent vaginal discharge. The collected vaginal swabs were subjected to bacteriological examination for Mycoplasma pathogens and the recovered species were identified using PCR. Vaginal swabs from apparently healthy cows were negative for Mycoplasma isolation, while seven isolate were recovered from vaginal swabs of diseased cows with an incidence of 15.6%. On the other hand, five isolates were recovered from the vaginal swabs of diseased buffaloes with an incidence of 50%. All Mycoplasma isolates were identified by PCR using M. bovis, M. bovigenitalium, and M. bovine group 7 specific primers. No isolates reacted with M. bovine group 7, while 2 and 6 isolates had amplified fragments at 442 and 928 bp against M.bovis, M.bovigenitalium, respectively. The obtained data indicated that M. bovis was recovered from vaginal swabs of cows and buffaloes with an incidence of 2.2% and 10%, respectively, while the incidence of M. bovigenitalium was 11 .1% and 10%, respectively. Ureaplasma could be identified from the collected samples of cows and buffaloes with an incidence of 2.2% and 20%, respectively. Furthermore, another Mycoplasma isolate [unidentified] was recovered from buffalo samples

prevalence of trichomonans vaginalis in association with other micro-organisms among women with vaginal discharge in Mosul

To screen women with vaginal discharge for Trichomonas vaginalis as well as other pathogens and to follow them up. Outpatient Gynaecologic Clinic, Family Planning Clinic, and Antenatal Clinic at Al-Batool Teaching Hospital for Gynaecology and Obstetrics. 440 women with vaginal discharge [July 1997 to June 1999]. Full medical, gynaecologica, sexual and social history was recorded. Clinical examination was carried out. Laboratory investigations including vaginal, cervical and urethral swabs for direct examination, gram-stained smear, as well as culture on appropriate media. The total number of Trichomonas vaginalis infection was 68 [15.5 percent]. The isolated microorganisms in association with Trichomonas vaginalis were Candida albicans in 19 wmoen [27.9 percent]. Staphylococcus epidemidis in 10 women [14.7 percent], and Lactobacilli in six women constituting [8.8 percent]. Both Diphtheroids and Neisseria gonorrheae showed lower incidences, as only eight women were positive [5.9 percent] for each Escherichia. Coli was present in one patient [1.5 percent] 24 patients were positive for Trichomonas vaginalis only [35.3 percent]. The remaining 372 women who were negative for Trichomonas vaginalis showed a high rate of infection with Candida species [21.5 percent], followed by Staphylococcus epidermidis [18.3 percent] and lactobacilli [15.3 percent]. Other isolates included Streptococcus species [8.6 percent]., E. coli [5.9 percent], Klebsiella [3.8 percent], Enterococcus fecalis [3.0 percent], Gardnerella vaginalis [2.6 percent], Neisseria gonorrheae [2.4 percent], Proteus [2.2 percent], Diphtheroid [1.9 percent], Staphylococcus aureus [1.3 percent] and Pseudomonas aeruginosa [0.8 percent]. Moreover, 46 [10.5 percent] of women showed no growth. 50.0 percent of infection with Trichomonas vaginalis was at age 26-35 years. Considering marital status, the highest rate [76.4 percent] of infection was among married women followed by divorced [14.7 percent], windows [5.8 percent] and singles [2.9 percent]. Pregnant women positive for Trichomonas vaginalis represented [45.6 percent] of cases. 61.7 percent of infection was among illiterate women. Metronidazole [flagyl] was given to all in a dose of 250mg orally thrice daily for seven days. Metronidazole was prescribed at the same time to husbands of infected women. Other specific medications [antifungal, antimicrobial agents] were given when indicated either alone or in combination with metronidazole. Two weeks later only 112 women came for reassessment clinical and by repeating direct smear and culture, that showed fifteen positive cases. Five of them still having Trichomonas vaginalis, eight were having Candiada albicans, and two showed normal smears. Further courses of treatment were given as indicated. Vaginal discharge is common among women in reproductive life. Culture is indicated for precise diagnosis

Prevalence of genital mucoplasmas among patients with discharge in Gesira Provice

This study was carried out during the period August, 1995 to July, 1996 in Wad Medani Teaching hospital department of dermatology and Venereology to assess the prevalence of genital mycoplasma among patients with urethral or vaginal discharge. The risk factors involved in the infection and the association of mycoplasma with other sexually transmitted infections. Eighty adult patients 40 males and 40 females with urethral or vaginal discharge were included in the study. Mycoplasma infection was confirmed in 19 patients [16 females and 3 males] giving a% of 24. The highest prevalence was amongst female prostitutes [42%] followed by monogamous females [39%] with the least prevalence amongst males [8%]. Mycoplasma was found to be more prevalent amongst young adults [20- 24 years of age], married, nonemployed and non educated. The main complaint was whitish mucoid urethral or vaginal discharge without other significant symptoms or signs. Amongst patients with Mycoplasma infection, gonorrhoea was detected in 3 patients, syphilis in 3 and trichomonas vaginalis in one patient. No association with yeast infection or HIV was detected

Frequency and diagnosis of bacterial vaginosis

To determine the frequency of bacterial vaginosis [BV] in women with vaginal discharge, and to compare different diagnostic tests for its diagnosis. Cross-sectional study. The Aga Khan University Hospital from June 1998 to May 2000. All women attending the Obstetrics and Gynecology clinics at The Aga Khan University Hospital, with the complaints of vaginal discharge, were examined with the help of a speculum. The vaginal pH was measured, samples for bacterial cultures were obtained. A slide was prepared for the gram's stain and Whiff-test was also performed. BV was diagnosed, when the vaginal discharge fulfilled at least three of the composite clinical criteria [Amsel's criteria], a st and ard method for the diagnosis of bacterial vaginosis: homogenous [pasty] discharge, pH more than 4.5, positive Whiff-test and the presence of clue cells. The frequency of BV was observed to be 16.1%. The culture for Gardnerella vaginalis was compared with the composite clinical criteria. The sensitivity, specificity, positive and negative predictive values of the culture, calculated for the diagnosis of BV were 93.8%, 70%, 37.7% and 98% respectively. The use of laboratory tests in conjunction with clinical findings is necessary for diagnosis of BV. The composite clinical criteria for the diagnosis of BV are rapid, reliable and inexpensive method

[Vaginal infections due to non-fastidious germs: place of Gardnerella vaginalis]

Gardnerella vaginalis is the most common frequently involved cause of bacterial vaginosis. The purpose of this study is to determine the frequency of G vaginalis infection among other non-fasidious etiological causes in women suffered from vaginosis diagnosed in our laboratory. Results were compared with data of literature, and discussed for guiding the best management of these infections. We analyzed the registered data of microbiological results of examined vaginal discharges over a period of three years.[2001-2003]. Positive diagnosis, of G. vaginalis vaginosis depends on the evident detection of clue cells microscopically in a Gram stained smears according to Amsels criteria. The results were often given in the same day. And as the current treatment depends on metronidazole, we rarely used culture sensitivity tests. Among 219 vaginal smears, 125 [57%] were positive, and 143 micro-organism incriminated- ni leukorrhoea were detected in our patients [210 out patient [96%] and [4%] inpatient]. Candida albicans was responsible for [28-19.6%], followed by G. vaginalis [23-16.1%] and lastly Escherichia coli [18-12.6%]. G. vaginalis-related vaginosis is frequent. It represents, the second etiological cause inducing vaginal discharge among the non-fastidious germs diagnosed in our hospital. As there is a recent reports show an in-vitro resistance and also the presence of a therapeutic failure using metronidazole in treating G. vaginalis infections, insistence of using a culture on an appropiate media in order to identify the germ and test sensitivity to antibiotics used in treating these infections must be performed following the simple way of laboratory detection

case-control study of clinical and microbiological scorings for detection of the prevalence of bacterial vaginosis in diabetic pregnant women

The relationship between diabetes mellitus and bacterial vaginosis in Egyptian pregnant women was studied in 50 pregnant women with gestational and pregestational diabetes and in 50 control subjects. All were selected after applying certain exclusion criteria. Both groups were matched in age, gestational age, gravidity and socioeconomic status. Bacterial vaginosis was diagnosed clinically according to Amsel et al. [1983] criteria and by using Nugent et al. [1991] scoring system of gram stained vaginal smears. The prevalence of bacterial vaginosis among the diabetic [22%] and the control [18%] groups was statistically insignificant [P > 0.05]. Candida was significantly higher among the diabetic group [26%] than the control group [10%] [P < 0.05]. But there was a negative correlation between fungal infection and bacterial vaginosis, which may be explained by the difference in pH of the vagina. There was a good correlation between clinical criteria and gram staining for diagnosis of bacterial vaginosis with 100% sensitivity for diabetic and control groups and 97% and 100% specificity for both groups respectively. Detection of clue cells was the most sensitive and specific [100%] for diagnosis of bacterial vaginosis. Diabetes was not proved to be a risk factor for bacterial vaginosis and further studies with larger number of cases are needed to assess this correlation. Also, the clinical criteria and gram staining of vaginal discharge, plus the history and clinical examination are useful for the diagnosis of cases with bacterial vaginosis

Prevalence of Chlamydia Trachomatis among women reporting to a tertiary care hospital with the complaint of vaginal discharge

A study was conducted in the out-patients of the Departments of Obstetrics and Gynaecology. Lady Wellington Hospital and Jinnah Hospitals of Lahore. Two hundred and seventy two women complaining of vaginal discharge were examined. These included 122 pregnant and 150 non-pregnant women, aged 15 to 45 years. History of PROM, still births, manual removal of placenta and home deliveries was ascertained. Besides vaginal discharge, these women complained of pain, Itching, irritation and cervical erosions. Chlamydiazyme Kit by Abbott was used for identifying the chlamydial Infection. The overall prevalence was 10.66 percent, being lower [8.19%] in pregnant and 12.55 percent in non- pregnant women

Diagnosis of symptomatic and asymptomatic trichomonas vaginalis infection by applying one tube nested pcr to vaginal discharge

One tube nested PCR targeting a species-specific Tv-E650 repeat family of T. vaginalis genome was applied to vaginal discharge specimen to diagnose symptomatic and asymptomatic trichomoniasis. The test was compared with axenic culture examination, wet mount preparation and Papanicolaou stained smears. A total of 450 cases, symptomatic and symptomatic, was collected over 2 years. Out of 290 symptomatic women with cervicovaginitis and 160 asymptomatic women, 35 were culture positive for trichomoniasis. All culture positive specimens were PCR- positive, giving a single product at 290 bp by agarose gel electrophoresis and recording 100% sensitivity similar to culture examination. Among the 35 culture positive specimens, 12 were positive by wet mount and 21 were positive by Pap smear, giving a 34.2% and 60% sensitivity, respectively. The standard and boiling DNA extraction methods were equally reliable, but the latter was more simple, rapid and cheap. No specimens negative by PCR for trichomoniasis were positive by culture, wet mount or Pap smear. Moreover, specimens from cases with cervicovaginitis of non- trichomonal origin were negative by PCR

Cytodiagnosis of discharge per vaginum.

Simple, rapid, inexpensive methods such as pH determination, wet mount, KOH mount, amine test, Gram staining of vaginal discharge were undertaken prior to Pap stained smears of 158 patients of leucorrhoea. We were able to detect non-specific vaginitis (44.30%), Trichomoniasis (16.45%), Candida vaginitis (9.49%), gonococcal vaginitis (0.63%) and senile vaginitis (12 cases). No specific pathology was shown in 26 cases. 1.69% of the cases were of cervical erosion and 3.79% cases suggestive of squamous malignancy.

The role of Gardnerella vaginalis in nonspecific vaginitis in intra uterine contraceptive device users.

Two Hundred Forty patients who had Intra Uterine Contraceptive Device (IUCD) and manifested of nonspecific vaginitis were investigated for the presence of G. vaginalis. Pure growth of this organism was obtained in 14(5.8%) cases while 116(48.3%) cases showed this organism in association with other organisms e.g. Esch. coli (11.7%), Klebsiella (9.2%), Candida (9.2%), Strept. faecalis (7.3%), Proteus species (5.8%) and Staph. albus (5%).