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Study on reproductive tract infection among the female patients attending the gynecology OPD in one of the teaching hospitals of Gujarat--India.

Introduction

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. [1] 400,000 new cases of STIs occur daily in the South East Asian Region (SEAR) alone as per WHO. [2] 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. [3] 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.

Results

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).

Discussion

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 [4] 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 [5] 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 [6] 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 [7] found in their study that commonest presentation of RTI was vaginal discharge followed by lower abdominal pain. Bohara et al [4] 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)

Conclusion

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.

References

[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 (nimishas@charutarhealth.org)

DOI: 10.5455/ijmsph.2013.161020131

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)
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Article Details
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Title Annotation:RESEARCH ARTICLE
Author:Shethwala, Nimisha; Mulla, Summaiya
Publication:International Journal of Medical Science and Public Health
Article Type:Report
Geographic Code:9INDI
Date:Feb 1, 2014
Words:1495
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