A DISCUSSION OF BACTERIOLOGICAL EXAMINATION OF VAGINAL INFECTION IN FEMALE STUDENTS

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A DISCUSSION OF BACTERIOLOGICAL EXAMINATION OF VAGINAL INFECTION IN FEMALE STUDENTS

ABSTRACT

This study sought to determine if vaginal infections could be diagnosed without using a speculum. Matched pairs of vaginal specimens were collected from participants before and during speculum exam for diagnosis of trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis. Female students age 20 to 35 years presenting to the Imo State University Teaching Hospital (IMSUTH), Orlu who required a pelvic examination were eligible to participate. A convenience sample of 586 patients was recruited. Paired vaginal specimens were evaluated with blinded microscopic evaluation. Analysis consisted of: 1) comparison of collection method sensitivities; and 2) assessment of proportions of infections detected by one method that were also detected by the other method. Sensitivities of speculum and nonspeculum collection methods were 75% and 77% (difference = −2%; 95% confidence interval, −11%, 7%) for trichomoniasis, 64% and 68% (difference = −4% [−10%,3%] ) for bacterial vaginosis, and 85% and 80% (difference = 5% [−12%, 22%] ) for vulvovaginal candidiasis. The speculum method identified 88% (trichomoniasis), 90% (bacterial vaginosis), and 81% (vulvovaginal candidiasis) of infections detected by the nonspeculum method. The nonspeculum method identified 91% (trichomoniasis), 95% (bacterial vaginosis), and 76% (vulvovaginal candidiasis) of infections detected by the speculum method. It be concluded that vaginal infections can be adequately diagnosed without a speculum. Once urine-based diagnosis of gonorrhea and chlamydia becomes well established, it may be possible to perform evaluations for uncomplicated genitourinary complaints without using a speculum.

CHAPTER ONE

INTRODUCTION

1.1 Background to the study

Most females have been there. When infected, they are distracted and squirming in their chair because it doesn’t feel right down there. Perhaps there’s a smell that’s a little, well, funkier, than usual. Vaginal infection is caused by bacteria, yeast, trichomonas etc. Chemicals in soaps, sprays, or even clothing that come in contact with this area could be irritating the delicate skin and tissues. Vaginal infections are the number one reason for adult women to see their healthcare providers. In North America, these infections account for more than 10 million visits to physicians’ offices each year.1 In 2003, Canadian pharmacy sales of nonprescription vaginal yeast infection products were $23.6 million and pharmacists made an average of nine recommendations per month of these products (Wolfe, 2014). Vaginal infections are caused by microorganisms, but women can take precautions, such as wearing loose, absorbent underwear, to reduce their risk of getting infections. Infections usually cause a discharge with itching, redness, and sometimes burning and soreness (Sihvo, Ahonen and Mikander, 2012).

Vaginitis is an inflammation of the vagina that may be caused by an infection. The two most common vaginal infections are yeast infections (monilia or candida) and bacterial vaginosis. Vaginal yeast infections are common among women, with about 75 per cent being affected during their lifetime and 40 to 50 per cent having recurrent episodes (Wolfe, 2014). In one study, 6.5 per cent of women reported that they had had at least one episode of a vaginal yeast infection during the previous two months (Foxman, Barlow and Arcy, 2010). Bacterial vaginosis is the most prevalent cause of vaginal discharge or malodour, although up to 50 to 60 per cent of women can be asymptomatic. Bacterial vaginosis is reported in anywhere from 10 per cent to 41 per cent of women, depending upon the group of women studied (McGregor and French, 2013).

1.2 Statement of the problem

The ailment is common and more severe in female with weakened immune system and accordingly, hormonal change is one of the factors that contribute to lowered immunity (Monif, Baker, Monif and Baker, 2010). Vaginal infections can cause vaginal discharge, discomfort, and vaginal odor. However, these symptoms do not necessarily indicate an infection. Instead, they may result from other conditions that affect the vagina. For example, chemicals or other materials (such as hygiene products, bubble bath, laundry detergents, contraceptive foams and jellies, and synthetic underwear) can irritate the vagina and cause a discharge and discomfort. The inflammation that results is called noninfectious (inflammatory) vaginitis (Khan, Amir, Ahaf and Tanveer, 2009).

A vaginal discharge may be caused by a disorder that affects other reproductive organs, rather than the vagina. For example, a discharge can result from certain sexually transmitted diseases such as chlamydial infection or gonorrhea. The bacteria that cause these diseases can spread from the vagina to the cervix (the lower, narrow part of the uterus that opens into the vagina) and the uterus, causing pelvic inflammatory disease. Genital herpes, which can cause blisters on the vulva (the area around the opening of the vagina), in the vagina, and on the cervix, can also cause a vaginal discharge (Khan, Amir, Ahaf and Tanveer, 2009).

Abebe, Olumide and Oke, (2011) reported higher incidence and greater persistence of the infection in HIV seropositive women (Abebe, Olumide and Oke, 2011). Similarly, Dahl, Keath, Fraser and Powderly, (2009) reported that Candida albicans occurs as one of the commonest complications of HIV infection, affecting HIV seropositive female in Imo State, Nigeria. A survey conducted in West Africa by Jumbo, Akpera, Hemba and Eyongo (2011), among 150 female on symptomatic vulvovaginal candidiasis, revealed an infection rate of 47.7%. It is generally believed that high oestrogen levels and higher glycogen content in vaginal secretions during infection increase a woman’s risk of developing vaginal candidiasis. This is most common in women during their child bearing age (Monif, Baker, Monif and Baker, 2010).

1.3 Objective of the study

The objective of this study is bacteriological examination of vaginal infection in female students of Imo State polytechnic.

Specific objectives are:

1. To examine the prevalence of vaginal infection among the sampled female students in Imo State

2. To detect the bacterial vaginosis among the sampled female students in Imo State

3. To detect the trichomoniasis among the sampled female students in Imo State

4. To detect the vulvovaginal candidiasis among the sampled female students in Imo State

5. To identify the sensitivities of speculum method and nonspeculum method in detecting trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis

6. To recommend appropriate measures of control.

1.4 Research questions

1. What is the prevalence of vaginal infection among the sampled female students in Imo State?

2. How can bacterial vaginosis be detected among the sampled female students in Imo State

3. How can trichomoniasis be detected among the sampled female students in Imo State

4. How can vulvovaginal candidiasis be detected among the sampled female students in Imo State

5. What are the sensitivities of speculum method and nonspeculum method in detecting trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis

6. What are the appropriate recommended measures of control?

1.5 Significance of the study

This is to bring to the knowledge of the general public that female students are infected by vaginal infection; this infection can be influence by weakened immune system. The study will examine vaginal infection to determine parameters in diagnosis. Furthermore, improved education will enhance female students’ understanding and the reasons to prevent vaginal infection. In addition, the results of this study will add to the existing literature and will as well provide reference materials for the academic society and further research

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