BACTERIAL VAGINOSIS IN INDIAN WOMEN IN THE REPRODUCTIVE AGE GROUP

Background: Bacterial vaginosis is a vaginal infection in women in the reproductive age group with complex change in vaginal flora. Many women are asymptomatic but some women present with abnormal vaginal discharge. It can lead to complications like preterm birth, infertility, post partum endometritis and first trimester loss. Nugent’s criteria are used to diagnose bacterial vaginosis. Objectives: This study was done with the objective of analyzing the type of bacteria causing vaginosis in different age groups during the reproductive period of a woman’s life. 100 women with vaginal discharge (test group) and 50 women (control group) attending the gynaecology outpatient for other problems were included in the study. Three high vaginal swabs were taken and examined for clue cells and mobiluncus spp. pH of the vaginal secretions was noted. Gram stain was done to quantify bacterial morphotypes. Diagnosis was done using the Nugent’s scoring system. Results: A significantly high incidence (p<0.05) was found in the test group. 53% of women with vaginal discharge were in the age group of 21-30 years indicating that vaginosis is very common in the early reproductive years. Mobiluncus spp. was found only in the test group. 46% had an abnormal Nugent’s score and 53% of test group women had all the 4 criteria to diagnose as bacterial vaginosis. Conclusion: Screening asymptomatic women and quantifying the bacteria in symptomatic patients to provide appropriate treatment would reduce the incidence and prevalence of bacterial vaginosis in the population.


Introduction:
Bacterial vaginosis is a common vaginal infection in women of reproductive age group with abnormal vaginal discharge. It is characterized by a complex change in the vaginal flora with a reduction in the numbers of lactobacilli and an increase in Gardnerella vaginalis and resident anaerobic bacilli 1 . Many women are asymptomatic but some women with bacterial vaginosis present with thin, foul smelling, homogenous, frothy vaginal discharge. 1,2 . Apart from the discomfort of infection, the disease can lead to complications like preterm birth, pelvic inflammatory disease, post partum endometritis, infertility and first trimester loss. 1,2 . Several studies have demonstrated the possibility of an association between bacterial vaginosis and transmission of HIV 3 . One of the methods of diagnosis of bacterial vaginosis is by Nugent's criteria based on evaluation of normal flora in gram stained smears of vaginal discharge 4,5 . Bacterial vaginosis is of public health concern in India due to the high burden of reproductive and pregnancy related morbidity. Very few studies on bacterial vaginosis are available from few states of India 6,7 . The present study was undertaken with the objective of analyzing the type of bacteria causing bacterial vaginosis in different age groups during the reproductive period of a woman's life.

Material and Methods:
150 women attending the Gynaecology outpatient Department in Government Maternity Hospital, Nayapul, Hyderabad over a period of one year from 2006 to 2007 were included in the study to determine the incidence of vaginitis. Hundred women with vaginal discharge were included in the test group and 50 women attending the Gynaecology Outpatient for other problems were included in the control group. Menstruating women and women on antibiotics in the preceeding four weeks were excluded from the study. A detailed history and information regarding age, symptoms, character and quantity of discharge, odour and pruritis were taken from the patients. A thorough clinical examination to examine the condition of vagina and cervix was done. An informed consent was taken from all the patients both test and control. The institutes Ethics committee clearance was also obtained.

Methods:
A thorough speculum examination without antiseptic cream was done and the nature of discharge and condition of vagina and cervix were noted. Three high vaginal swabs were taken from the posterior fornix, two of them were inoculated immediately in culture media and the third swab was used for making smears. A multi range pH paper was dipped in pooled vaginal secretion and the pH noted.

Observation and Results:
Statistical analysis was done using percentages and proportions. A significantly high incidence of bacterial vaginosis was found in the test group showing that bacterial vaginosis presents with symptoms of abnormal vaginal discharge and incidence of bacterial vaginosis in asymptomatic women is less.  Incidence of Bacterial vaginosis (BV) is highest (53.1%) between 21 to 30 years followed by 28.1% in 31 to 40 years age group indicating that there is a high incidence of vaginal infections in young individuals in the reproductive age group.  and pH of vaginal fluid may also be an important cause for bacterial vaginosis. Clue cells were absent in 10.3% of cases of bacterial vaginosis. As per our results, Nugent's score showed a positive association with bacterial vaginosis which coincides with other studies 8,9 In more than 50% of the cases vaginal pH was found to be more than 4.5 indicating that Lactobacilli which secrete lactic acid and maintain acidic pH in vaginal flora are replaced by other organisms.

Conclusion:
The present study may be used as a rationale for screening asymptomatic women and treating patients presenting with symptoms. References: