Study on reproductive tract infection among the female patients attending the gynecology OPD in one of the teaching hospitals of Gujarat--India.
Reproductive tract infections (RTIs), including sexually transmitted infections (STIs) are major public health problem in many parts of the world. Around 340 million new cases of curable STIs occur each year in developing countries. South Asia alone contribute around 150 million cases of the RTI/STI.  400,000 new cases of STIs occur daily in the South East Asian Region (SEAR) alone as per WHO.  Centers for Disease Control (CDC) estimates that 19 million new infections occur each year, almost half of them among young people age 15 to 24 years.  Stigma associated with RTI prevents individuals from getting treatment. It is very important to treat infections at the earliest otherwise they may lead to devastating complications among the sufferers. Cervical cancer, infertility, disability are few of the alarming complications. Syndromic approach is most appropriate technology in diagnosing and treating RTI/STI. In present study authors have assessed various socio-demographic profiles of the patients. Also the findings of clinical parameters are correlated with that of confirmatory tests.
Materials and Methods
Present study was carried out in Microbiology Department of one of the Government Medical College, from March to September 2005. Total 150 women attending the OPD for the first time in the Gynecology with the following complaints were screened for Reproductive Tract Infection: (a) Vaginal Discharge; (b) Cervical Discharge with Vaginitis; (c) Genital Warts; (d) Genital Ulcer; (e) Combination of above complaints. The patients were interviewed using structured questionnaire which included information regarding Socio-demographic characteristics, medical history, Sexual behaviour and reproductive history. Per speculum examination was done to notice the presence of any discharge or inflammation. Vaginal and cervical specimens were collected during pelvic examination for laboratory investigation to confirm the diagnosis of genital tract infection. 5 ml blood was drawn in sterile vacutainer for serology. Informed consent was taken before conducting the interview. Different laboratory tests were done among all the patients (table 1). Data were entered in Microsoft excel and analyzed using SPSS software.
Out of 150 females patients of reproductive tract infection, 82 (54.7%) were more than 25 years of age whereas 68 (45.3%) were less than 25 years. Mean age of the study population was 27.37 [+ or -] 5.52 years. Out of 150, 143 (95.3%) were married. Majority (133, 88.7%) of the females were housewives (Table 2). The most common symptom reported was vaginal discharge (147, 98%), followed by lower abdominal pain (114, 76%), menstrual abnormality (27, 18%), dysuria and dyspareunia (15, 10%) (Table 3). Cervical erosion (43.3%) was the commonest among all the clinical signs observed among the patients. Homogenous white discharge was present in 43 (28.7%) case. 42 (28%) presented with curdy white discharge (Table 4). Out of 150 patients, 34 (22.6%) had bacterial vaginosis, 27 (18%) had candidiasis whereas, 24 (16%) were found to have HSV-II. 4 (2.7%) patients were having positive test for syphilis (Table 5).
Present study was carried out among the female patients attending the gynecology OPD at one of the teaching hospitals of Gujarat. Total 150 patients were enrolled under the study. The mean age of the study group was 27.4 yrs. Majority (95%) of them were married. Bohra et all  who carried out similar study in Nepal mentioned that symptoms related to RTIs was common in young married women.
Proportion of women reported with abnormal vaginal discharge was 98% in present study. Lower abdominal pain was present in 76% of cases whereas 10 % were reported with complains of Dysuria and dyspareunia. Study by Howkey et al  found that 94 % women reported abnormal vaginal discharge, 40 % reported lower abdominal pain, 55% were having genital itching and genital ulceration was present in 1% of cases. Gupta et al  who carried out a study in Dehradun mentioned that the most common symptoms reported were vaginal discharge (85.6%) and urinary symptoms (49.5%). Most common clinical sign observed were cervical erosion (27.3%) and Vaginitis (25.2%), endocervicitis (19.4%). Rochika Ranjan  found in their study that commonest presentation of RTI was vaginal discharge followed by lower abdominal pain. Bohara et al  found in their study that thirteen percent had trichomonasis and 7% had gonorrhoea identified in Gram stained smears and cultures. Bacterial vaginosis was diagnosed in 15% and vaginal candidiasis in 25% of women as per their findings. Findings of present study revealed that sensitivity of Homogenous white discharge (compared with gram stain) to detect the Bacterial vaginosis was 69.4% but the specificity was higher (84.2%), which suggest that if a diagnosis made by syndromic approach, bacterial vaginosis can be detected among two thirds (69.4%) of patients. Similarly correlation of Green Yellow frothy (GYF) discharge with culture examination for detection of trichomoniasis revealed, sensitivity of 68.8% and specificity of 99%, which means that all the cases labelled as "not having GYF discharge" also tested negative for trichomoniasis by culture. Sensitivity of curdy white discharge in detecting candidiasis was 69.1% and specificity was 99.1 %. (Table 6)
Young married women are more prone to Reproductive Tract Infection (RTI). Abnormal vaginal discharge should never be overlooked as it is the most common presenting feature among the sufferers of RTI/STI. Syndromic approach is having high specificity in diagnosing RTI.
[1.] World Health Organization. Global prevalence and Incidence of selected curable sexually transmitted infections. Overview and estimate. Geneva, Switzerland: WHO, 2001; 4: 49-13.
[2.] World Health Organization. SEAR region update on STIs. New Delhi, India: WHO, 2002; 5: 12-15.
[3.] Weinstock H, Berman S, Castes W. Sexually transmitted disease among American youth incidence and prevalence estimates. Perspect Sex Reprod Health. 2004;36:6-10.
[4.] Bohara MS, Joshi AB, Lekhak B, Gurung G. Reproductive tract infections among women attending gynaecology outpatient department Int J Infect Microbiol. 2012;1(1):29-33
[5.] Howlkey S, Morission L, Foster S et al. Reproductive tract infections in women in low income, low prevalence situations: assessment of syndromic management in mattab, Bangladesh. Lancet. 1999;354: 1776-1981
[6.] Gupta V, Chatterjee B, Prasad D et al. Clinical Spectrum and microbial etiology of reproductive tract infection in rural women in the hills of North India. J Obstet Gyn India. 2002; 52: 130-134
[7.] Ranjan R, Sharma AK, Mehta G. Evaluation of WHO Diagnostic Algorithm of Reproductive tract infections among married women. Indian J Community Med. 2003;28:81-4.
Source of Support: Nil
Conflict of interest: None declared
Nimisha Shethwala (1), Summaiya Mulla (2)
(1) Department of Microbiology, Pramukh Swami Medical College, Karamsad, Gujarat, India
(2) Department of Microbiology, Government Medical College, Surat, Gujarat, India
Correspondence to: Nimisha Shethwala (email@example.com)
Received Date: 12.09.2013
Accepted Date: 18.01.2014
Table-1: Laboratory tests Infections Test Performed Candidiasis Gram stain, Culture Bacterial Vaginosis Gram stain Trichomoniasis Wet mount microscopy Gonococci Gram stain HIV ELISA Syphilis RPR test Hepatitis Hepatitis B Surface antigen Table-2: Socio-demographic profile of study population Socio Demographic Frequency (%) Characteristics Age (Years) [less than or equal to]25 68 (45.3) >25 82 (54.7) Occupation House wife 133 (88.7) Working (employed) 17 (11.3) Location Urban 131 (87.3) Rural 19 (12.7) Migrant status 62 (41.3) Married 143 (95.3) Marital Status Divorcee 1 (0.7) Widow 6 (4) Total 150 (100) Table-3: Varied distribution of symptoms Symptoms * No. of Cases (%) Vaginal Discharge 147 (98) Lower abdominal pain 114 (76) Menstrual abnormality 27 (18) Pruritis Vulva 18 (2) Dysuria 15 (10) Dyspareunia 15 (10) Genital Ulcer 1 (0.66) * Multiple responses Table-4: Distribution of signs observed in the patients Signs * No. of Cases (%) Homogenous white discharge 43 (28.7) Green yellow frothy discharge 7 (4.7) Curdy white discharge 42 (28) Muco purulent discharge 22 (14.7) Strawberry vagina 8 (5.3) Cervical Erosion 50 (43.3) * Multiple responses Table-5: Laboratory diagnosis of patients Laboratory Diagnosis No. of Cases (%) Bacterial Vaginosis 34 (22.6) Syphilis 4 (2.7) HIV 7 (4.7) Hepatitis 1 (0.7) HSV-II 24 (16) Candidia 27 (18) Trichomonas 16 (19.7) Table-6: Correlation of clinical signs with related diagnostic tests Clinical Signs Lab. Sensitivity Specificity Test (%, CI 95%) (%, CI 95%) Green yellow Wet 68.8 99.3 frothy discharge+ Mount (41.5-87.9) (95.3-100) Strawberry vagina (Trichomoniasis) Curdy white Gram 61.9 99.1 discharge Stain (45.6-76.0) (94.2-100) (Candidiasis) Homogenous Gram 69.3 84.2 white discharge Stain (51.4-83.1) (75.9-90.1) (Bacterial vaginosis) Cervical erosion Serology 67.5 75.7 (HSV-II) Ig M (47.7-80.3) (66.6-83.7) Clinical Signs Positive Negative Predictive Predictive Value Value Green yellow 91.7 96.4 frothy discharge+ (59.8-91.6) (91.3-98.7) Strawberry vagina (Trichomoniasis) Curdy white 96.3 87 discharge (79.1-99.2) (79.4-92.2) (Candidiasis) Homogenous 58.1 89.7 white discharge (42.2-72.6) (82-94.5) (Bacterial vaginosis) Cervical erosion 45.1 87.9 (HSV-II) (31.4-59.5) (79.4-93.3)
|Printer friendly Cite/link Email Feedback|
|Title Annotation:||RESEARCH ARTICLE|
|Author:||Shethwala, Nimisha; Mulla, Summaiya|
|Publication:||International Journal of Medical Science and Public Health|
|Date:||Feb 1, 2014|
|Previous Article:||Non-surgical management of oral hemangioma.|
|Next Article:||Morphometric study of interparietal bone in Gujarat region.|