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Omosa-Manyonyi GS, de Kam M, Tostmann A, Masido MA, Nyagah N, Obimbo MM, van der Ven AJAM, Oever JT. Evaluation and optimization of the syndromic management of female genital tract infections in Nairobi, Kenya. BMC Infect Dis 2023; 23:547. [PMID: 37608250 PMCID: PMC10463802 DOI: 10.1186/s12879-023-08442-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/04/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Genital tract infections pose a public health concern. In many low-middle-income countries, symptom-based algorithms guide treatment decisions. Advantages notwithstanding, this strategy has important limitations. We aimed to determine the infections causing lower genital tract symptoms in women, evaluated the Kenyan syndromic treatment algorithm for vaginal discharge, and proposed an improved algorithm. METHODS This cross-sectional study included symptomatic non-pregnant adult women presenting with lower genital tract symptoms at seven outpatient health facilities in Nairobi. Clinical, socio-demographic information and vaginal swabs microbiological tests were obtained. Multivariate logistic regression analyses were performed to find predictive factors for the genital infections and used to develop an alternative vaginal discharge treatment algorithm (using 60% of the dataset). The other 40% of data was used to assess the performance of each algorithm compared to laboratory diagnosis. RESULTS Of 813 women, 66% had an infection (vulvovaginal candidiasis 40%, bacterial vaginosis 17%, Neisseria gonorrhoea 14%, multiple infections 23%); 56% of women reported ≥ 3 lower genital tract symptoms episodes in the preceding 12 months. Vulvovaginal itch predicted vulvovaginal candidiasis (odds ratio (OR) 2.20, 95% CI 1.40-3.46); foul-smelling vaginal discharge predicted bacterial vaginosis (OR 3.63, 95% CI 2.17-6.07), and sexually transmitted infection (Neisseria gonorrhoea, Trichomonas vaginalis, Chlamydia trachomatis, Mycoplasma genitalium) (OR 1.64, 95% CI 1.06-2.55). Additionally, lower abdominal pain (OR 1.73, 95% CI 1.07-2.79) predicted sexually transmitted infection. Inappropriate treatment was 117% and 75% by the current and alternative algorithms respectively. Treatment specificity for bacterial vaginosis/Trichomonas vaginalis was 27% and 82% by the current and alternative algorithms, respectively. Performance by other parameters was poor to moderate and comparable between the two algorithms. CONCLUSION Single and multiple genital infections are common among women presenting with lower genital tract symptoms at outpatient clinics in Nairobi. The conventional vaginal discharge treatment algorithm performed poorly, while the alternative algorithm achieved only modest improvement. For optimal care of vaginal discharge syndrome, we recommend the inclusion of point-of-care diagnostics in the flowcharts.
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Affiliation(s)
| | - Marloes de Kam
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, NL, Netherlands
| | - Alma Tostmann
- Department of Medical Microbiology, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, NL, Netherlands
| | | | | | - Moses M Obimbo
- Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Andre J A M van der Ven
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, NL, Netherlands
| | - Jaap Ten Oever
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, NL, Netherlands
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Omosa-Manyonyi GS, Koyio LN, Mwangi EW, Gathura H, van der Ven A, Oever JT. Inadequacies in service delivery for the diagnosis and treatment of vaginitis and vaginosis in Nairobi, Kenya. Int J STD AIDS 2022; 33:584-596. [PMID: 35380482 DOI: 10.1177/09564624221087533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vulvovaginal candidiasis (VVC), a common cause of vaginitis, affects 75% of women in their lifetime. In Kenya, vaginitis/VVC is managed using the vaginal discharge syndrome guidelines. We assessed how frequently healthcare workers consider the diagnosis of vaginitis/VVC in symptomatic women, and adherence to the syndromic guidelines, outpatient records at Nairobi City County health facilities, of non-pregnant symptomatic females aged ≥15 years were abstracted. Descriptive statistics were applied, and analysis of determinants of practice determined using multivariable logistic regression models. Of 6,516 patients, 4,236 (65%) (inter-facility range 11-92%) had vaginitis of which 1,554 (37%) were considered VVC (inter-facility range 0-99%). Vaginitis was associated with facility, adjusted odds ratio (aOR) 2.80 (95% confidence interval (CI) 1.64-4.76) and aOR 0.03 (95% CI 0.02-0.04); and month, aOR 0.33 (95% CI 0.25-0.43). Vaginal examination was in 53% (inter-facility range 0-98%). Adherence to syndromic treatment was 56% (inter-facility range 0-83%), better with older patients (aOR 7.73, 95% CI 3.31-18.07). Vaginitis and VVC are commonly diagnosed in symptomatic patients in Nairobi; adherence to the syndromic guidelines is low and differs across the health facilities. Interventions to improve adherence are needed.
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Affiliation(s)
| | | | | | | | | | - Jaap Ten Oever
- 569645Radboud University Medical Center, Nijmegen, Netherlands
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3
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Riang'a RM, Nangulu AK, Broerse JEW. Perceived causes of adverse pregnancy outcomes and remedies adopted by Kalenjin women in rural Kenya. BMC Pregnancy Childbirth 2018; 18:408. [PMID: 30340547 PMCID: PMC6194609 DOI: 10.1186/s12884-018-2041-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/04/2018] [Indexed: 11/15/2022] Open
Abstract
Background There have been few studies about the basis on which women in developing regions evaluate and choose traditional rather than western maternal care. This qualitative study explores the socio-cultural perceptions of complications associated with pregnancy and childbirth and how these perceptions influence maternal health and care-seeking behaviours in Kenya. Methods Kalenjin women (n = 42) aged 18–45 years, who were pregnant or had given birth within the last 12 months, were interviewed. A semi-structured interview guide was used for data collection. A further nine key informant interviews with Traditional Birth Attendants (TBAs) who were also herbalists (n = 6), community health workers (CHWs) (n = 3) and a Maternal and Child Health (MCH) nursing officer (n = 1) were conducted. The data were analysed using MAXQDA12 software and categorised, thematised and analysed based on the symbolic dimensions of Helman’s (2000) ill-health causation aetiologies model. Results Pregnancy complications are perceived as the consequence of pregnant women not observing culturally restricted and recommended behaviour during pregnancy, including diet; physical activities; evil social relations and spirits of the dead. These complications are considered to be preventable by following a restricted and recommended diet, and avoiding heavy duties, funerals, killing of animals and eating meat of animal carcasses, as well as restricting geographical mobility, and use of herbal remedies to counter evil and prevent complications. Conclusion Delay in deciding to seek maternal care is a result of women’s failure to recognise symptoms and maternal health problems as potential hospital cases, and this failure stems from culturally informed perceptions of symptoms of maternal morbidity and pregnancy complications that differ significantly from biomedical interpretations. Some of the cultural maternal care and remedies adopted to prevent pregnancy complications, such as restriction of diet and social mobility, may pose risks to the pregnant woman’s health and access to health facilities whereas other remedies such as restricting consumption of meat from animal carcasses and heavy duties, as well as maintaining good social relations, are cultural adaptive mechanisms that indirectly control the transmission of disease and improve maternal health, and thus should not be considered to be exclusively folk or primitive. Electronic supplementary material The online version of this article (10.1186/s12884-018-2041-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roselyter Monchari Riang'a
- School of Arts and Social Sciences, Moi University, P.O. Box 3900-30100, Eldoret, Kenya. .,Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Anne Kisaka Nangulu
- School of Arts and Social Sciences, Moi University, P.O. Box 3900-30100, Eldoret, Kenya.,Commission for University Education, Red Hill Road, off Limuru Road, Gigiri, PO Box 54999 - 00200, Nairobi, Kenya
| | - Jacqueline E W Broerse
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
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Ameri B, Abolhassani M, Mehravar F. Prevalence and Risk Factors of Cervicitis in Married Women in Shahroud, Northeast of Iran. JOURNAL OF CLINICAL AND BASIC RESEARCH 2018. [DOI: 10.29252/jcbr.2.1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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5
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Masha SC, Wahome E, Vaneechoutte M, Cools P, Crucitti T, Sanders EJ. High prevalence of curable sexually transmitted infections among pregnant women in a rural county hospital in Kilifi, Kenya. PLoS One 2017; 12:e0175166. [PMID: 28362869 PMCID: PMC5375155 DOI: 10.1371/journal.pone.0175166] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/21/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Women attending antenatal care (ANC) in resource-limited countries are frequently screened for syphilis and HIV, but rarely for other sexually transmitted infections (STIs). We assessed the prevalence of curable STIs, defined as infection with either Chlamydia trachomatis or Neisseria gonorrhoeae or Trichomonas vaginalis, from July to September 2015. METHODS In a cross-sectional study, women attending ANC at the Kilifi County Hospital, Kenya, had a urine sample tested for C. trachomatis/N. gonorrhoeae by GeneXpert® and a vaginal swab for T. vaginalis by culture. Bacterial vaginosis (BV) was defined as a Nugent score of 7-10 of the Gram stain of a vaginal smear in combination with self-reported vaginal discharge. Genital ulcers were observed during collection of vaginal swabs. All women responded to questions on socio-demographics and sexual health and clinical symptoms of STIs. Predictors for curable STIs were assessed in multivariable logistic regression. RESULTS A total of 42/202 (20.8%, 95% confidence interval (CI):15.4-27.0) women had a curable STI. The prevalence was 14.9% for C. trachomatis (95% CI:10.2-20.5), 1.0% for N. gonorrhoeae (95% CI: 0.1-3.5), 7.4% for T. vaginalis (95% CI:4.2-12.0), 19.3% for BV (95% CI: 14.1-25.4) and 2.5% for genital ulcers (95% CI: 0.8-5.7). Predictors for infection with curable STIs included women with a genital ulcer (adjusted odds ratio (AOR) = 35.0, 95% CI: 2.7-461.6) compared to women without a genital ulcer, women who used water for cleaning after visiting the toilet compared to those who used toilet paper or other solid means (AOR = 4.1, 95% CI:1.5-11.3), women who reported having sexual debut ≤ 17 years compared to women having sexual debut ≥18 years (AOR = 2.7, 95% CI:1.1-6.6), and BV-positive women (AOR = 2.7, 95% CI:1.1-6.6) compared to BV-negative women. CONCLUSION One in five women attending ANC had a curable STI. These infections were associated with genital ulcers, hygiene practices, early sexual debut and bacterial vaginosis.
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Affiliation(s)
- Simon Chengo Masha
- Centre for Geographic Medicine Research–Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Laboratory Bacteriology Research, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pwani University, Faculty of Pure and Applied Sciences, Department of Biological Sciences, Kilifi, Kenya
| | - Elizabeth Wahome
- Centre for Geographic Medicine Research–Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Mario Vaneechoutte
- Laboratory Bacteriology Research, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Piet Cools
- Laboratory Bacteriology Research, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Tania Crucitti
- HIV/STI Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eduard J. Sanders
- Centre for Geographic Medicine Research–Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Headington, United Kingdom
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Pintye J, Drake AL, Unger JA, Matemo D, Kinuthia J, McClelland RS, John-Stewart G. Male partner circumcision associated with lower Trichomonas vaginalis incidence among pregnant and postpartum Kenyan women: a prospective cohort study. Sex Transm Infect 2016; 93:137-143. [PMID: 27519258 DOI: 10.1136/sextrans-2016-052629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/09/2016] [Accepted: 07/18/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Trichomonas vaginalis is the world's most common curable STI and has implications for reproductive health in women. We determined incidence and correlates of T. vaginalis in an HIV-uninfected peripartum cohort. METHODS Women participating in a prospective study of peripartum HIV acquisition in Western Kenya were enrolled during pregnancy and followed until 9 months post partum. T. vaginalis was assessed every 1-3 months using wet mount microscopy. Correlates of incident T. vaginalis were determined using Cox proportional hazards models. RESULTS Among 1271 women enrolled, median age was 22 years (IQR 19-27) and gestational age was 22 weeks (IQR 18-26); most (78%) were married and had uncircumcised male partners (69%). Prevalent T. vaginalis was detected in 81 women (6%) at enrolment. Among women without T. vaginalis at enrolment, 112 had T. vaginalis detected during 1079 person-years of follow-up (10.4 per 100 person-years). After adjustment for socio-economic factors, male partner circumcision status, pregnancy status and other STIs, T. vaginalis incidence was higher during pregnancy than post partum (22.3 vs 7.7 per 100 person-years, adjusted HR (aHR) 3.68, 95% CI 1.90 to 7.15, p<0.001). Women with circumcised male partners had a 58% lower risk of incident T. vaginalis compared with women with uncircumcised partners (aHR 0.42, 95% CI 0.23 to 0.76, p=0.004). Employed women had lower risk of incident T. vaginalis than unemployed women (aHR 0.49, 95% CI 0.31 to 0.79, p=0.003); recent STI was associated with increased T. vaginalis risk (aHR 2.97, 95% CI 1.49 to 5.94, p=0.002). CONCLUSIONS T. vaginalis was relatively common in this peripartum cohort. Male circumcision may confer benefits in preventing T. vaginalis.
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Affiliation(s)
- Jillian Pintye
- Department of Global Health, University of Washington, Seattle, USA.,Department of Nursing, University of Washington, Seattle, USA
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, USA
| | - Jennifer A Unger
- Department of Global Health, University of Washington, Seattle, USA.,Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
| | - Daniel Matemo
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - R Scott McClelland
- Department of Global Health, University of Washington, Seattle, USA.,Department of Medicine, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, USA.,University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, USA.,Department of Medicine, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, USA.,Department of Pediatrics, University of Washington, Seattle, USA
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7
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van der Eem L, Dubbink JH, Struthers HE, McIntyre JA, Ouburg S, Morré SA, Kock MM, Peters RPH. Evaluation of syndromic management guidelines for treatment of sexually transmitted infections in South African women. Trop Med Int Health 2016; 21:1138-46. [PMID: 27350659 DOI: 10.1111/tmi.12742] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the performance of three different guidelines for the management of vaginal discharge syndrome (VDS) for women living in a rural setting in South Africa. METHODS We conducted a secondary analysis of data from a cross-sectional study in Mopani District, South Africa. The 2015 and 2008 guidelines of the South African Department of Health (DoH) and the most recent WHO guidelines were evaluated for adequate treatment of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis infection. RESULTS Of the 489 women included in this analysis, 35% presented with VDS according to the DoH and 30% per WHO definition of VDS. Fifty-six per cent of the women with VDS would be treated adequately for these STI when using the 2015 DoH guideline, whereas 76% (P = 0.01) and 64% (P = 0.35) would receive adequate treatment with the 2008 DoH and WHO guidelines, respectively. Of the symptomatic women who tested negative for all four STI, STI treatment would have been indicated for 36% as per 2015 DoH guideline vs. 69% (P < 0.001) per 2008 DoH and 67% (P < 0.001) per WHO guidelines. CONCLUSION A considerable proportion of symptomatic women infected with these common curable STI would receive adequate treatment when using a syndromic management approach, and significant differences exist between the three guidelines. Many symptomatic women without these STI receive broad-spectrum antibiotics, so new approaches are needed to improve syndromic STI control.
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Affiliation(s)
- Lisette van der Eem
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,African Woman Foundation, Amsterdam, The Netherlands
| | - Jan Henk Dubbink
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,Institute for Public Health Genomics, University of Maastricht, Maastricht, The Netherlands.,Department of Medical Microbiology & Infection Control, VU University Medical Centre, Amsterdam, The Netherlands
| | - Helen E Struthers
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
| | - James A McIntyre
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Sander Ouburg
- Department of Medical Microbiology & Infection Control, VU University Medical Centre, Amsterdam, The Netherlands
| | - Servaas A Morré
- Institute for Public Health Genomics, University of Maastricht, Maastricht, The Netherlands.,Department of Medical Microbiology & Infection Control, VU University Medical Centre, Amsterdam, The Netherlands
| | - Marleen M Kock
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.,Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
| | - Remco P H Peters
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
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Abstract
Pregnant women are particularly susceptible to a number of infectious diseases, such as influenza, hepatitis E, malaria, and tuberculosis. The management of many other infections-including urinary tract infections, human immunodeficiency virus, and sexually transmitted diseases-is also made more complex by pregnancy; even if some infections do not pose a great risk to the expectant mother, they can impact fetal and neonatal development, thus posing a treatment challenge to physicians. By focusing on the most important diseases that physicians may encounter in pregnant patients, this review outlines the challenges associated with managing important infectious diseases in the pregnant population and references the most recent evidence and international treatment guidelines.
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Affiliation(s)
- Hugh Adler
- Mater Misericordiae University Hospital, Dublin, Ireland
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9
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Kostick KM, Schensul SL, Jadhav K, Singh R, Bavadekar A, Saggurti N. Treatment seeking, vaginal discharge and psychosocial distress among women in urban Mumbai. Cult Med Psychiatry 2010; 34:529-47. [PMID: 20533080 DOI: 10.1007/s11013-010-9185-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Vaginal discharge (safed pani in Hindi, meaning "white water") is one of the leading symptoms for which women in India seek care. Treatment-seeking for safed pani is disproportionately high among poor women, representing a physical, emotional and financial burden for low-income families. Safed pani is only rarely indicative of a reproductive tract or sexually transmitted infection. The discrepancy between symptom reports and observed pathology has led some researchers to characterize safed pani as a culturally based expression of more generalized negative life situation. Data are drawn from two prevention intervention studies (2002-2006 and 2007-2012) conducted in economically marginal communities in Mumbai. Results show that husbands as problem generators and spousal abusers and women's greater perceived empowerment and reported tension are significantly associated with safed pani. These results provide the basis for identifying women at greater risk for psychosocial distress and providing supports at the locations at which they seek treatment.
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Affiliation(s)
- Kristin M Kostick
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-1912, USA.
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10
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Cesar JA, Mendoza-Sassi RA, González-Chica DA, Menezes EHM, Brink G, Pohlmann M, Fonseca TMV. Prevalência e fatores associados à percepção de ocorrência de corrimento vaginal patológico entre gestantes. CAD SAUDE PUBLICA 2009; 25:2705-14. [DOI: 10.1590/s0102-311x2009001200017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 09/09/2009] [Indexed: 11/22/2022] Open
Abstract
Este estudo teve por objetivo medir a prevalência e identificar fatores associados à percepção de corrimento vaginal patológico por gestantes residentes em Rio Grande, Rio Grande do Sul, Brasil. Aplicou-se questionário padronizado a todas as parturientes nas maternidades do município em 2007. Utilizou-se teste do qui-quadrado para comparar proporções e análise multivariável por regressão de Poisson. A prevalência de corrimento vaginal foi de 40%. Análise ajustada mostrou as seguintes razões de prevalência: 1,6 (1,4-1,8) para adolescentes; 1,3 (1,1-1,6) para aquelas com até oito anos de escolaridade; 1,3 (1,1-1,5) para aquelas que ingeriram álcool; 2,0 (1,8-2,2) para aquelas que referiram corrimento vaginal em gestação anterior; 1,4 (1,3-1,6) para infecção urinária na gestação atual; prematuridade em gestação anterior mostrou-se protetor com RP = 0,8 (0,7-0,9). Os serviços de saúde deveriam priorizar diagnóstico e tratamento de corrimento vaginal entre gestantes adolescentes, de baixa renda familiar e escolaridade, com história prévia de corrimento em gravidez anterior e infecção urinária na gravidez atual.
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Affiliation(s)
- Juraci A. Cesar
- Universidade Federal do Rio Grande, Brasil; Universidade Federal de Pelotas, Brasil
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11
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Abstract
OBJECTIVES Bacterial vaginosis (bv) is a common cause of abnormal or altered vaginal discharge in women of childbearing age. Its association with obstetric and gynecologic complications and HIV are increasingly recognized. Few population-based surveys of BV have been conducted in Africa. The objective of the study was to examine the role of genital infections including Herpes simplex virus type 2 (HSV-2) and demographic factors on the prevalence of BV among pregnant women in Burkina Faso. METHODS Consenting pregnant women from Burkina Faso answered a face-to-face interview on their demographic characteristics. Then, genital and blood swabs were collected and tested for BV and other genital infections. Univariable and multivariable models were used to investigate the risk factors of BV. RESULTS Among the 2133 women included in the analyses (over 2284 enrolled), the prevalence of BV was 6.4% [95% confidence interval (CI), 5.5%-7.6%], ranging from 3% to 12% between regions. In multivariable analyses, HSV-2 [odds ratio (OR), 1.64; 95% CI 1.04-2.59) was the only genital infection that remained significantly associated with BV. Other factors related to BV were history of abortion (OR, 1.57; 95% CI, 1.01-2.43) and geographical origin. HIV infection (OR, 1.98; 95% CI, 0.90-5.20) and polygamy (OR, 1.48; 95% CI, 1.00-2.36) tended to be associated with BV without reaching statistical significance. CONCLUSION The prevalence of BV among pregnant women was lower than expected, with large geographical disparities. Our data confirm the potential interaction between BV and HSV-2.
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Puente Puente S, Ramírez-Olivencia G, Cervero Jiménez M, Pérez-Molina J. [Immigration and HIV: pulmonary, cutaneous and genitourinary syndromes. Eosinophilia]. Enferm Infecc Microbiol Clin 2008; 26 Suppl 5:31-41. [PMID: 18590664 DOI: 10.1157/13123265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Infectious diseases are the leading cause of mortality in less developed countries, many of which are located in tropical areas. These diseases have particular features than can hamper diagnosis unless clinicians are familiar with their characteristics. The present article describes the clinical pattern of pulmonary, cutaneous and genitourinary tropical diseases and the main principles of their diagnosis. Emphasis is placed on their geographical distribution and the influence of HIV infection.
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Chico RM, Pittrof R, Greenwood B, Chandramohan D. Azithromycin-chloroquine and the intermittent preventive treatment of malaria in pregnancy. Malar J 2008; 7:255. [PMID: 19087267 PMCID: PMC2632633 DOI: 10.1186/1475-2875-7-255] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 12/16/2008] [Indexed: 11/12/2022] Open
Abstract
In the high malaria-transmission settings of sub-Saharan Africa, malaria in pregnancy is an important cause of maternal, perinatal and neonatal morbidity. Intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) reduces the incidence of low birth-weight, pre-term delivery, intrauterine growth-retardation and maternal anaemia. However, the public health benefits of IPTp are declining due to SP resistance. The combination of azithromycin and chloroquine is a potential alternative to SP for IPTp. This review summarizes key in vitro and in vivo evidence of azithromycin and chloroquine activity against Plasmodium falciparum and Plasmodium vivax, as well as the anticipated secondary benefits that may result from their combined use in IPTp, including the cure and prevention of many sexually transmitted diseases. Drug costs and the necessity for external financing are discussed along with a range of issues related to drug resistance and surveillance. Several scientific and programmatic questions of interest to policymakers and programme managers are also presented that would need to be addressed before azithromycin-chloroquine could be adopted for use in IPTp.
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Affiliation(s)
- R Matthew Chico
- Department of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E7HT, UK.
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Chase PB, Hansen KL, Rothers J, Biros MH, Cartwright CP. Nucleic-acid amplification testing of urine vs. patient complaint-driven evaluation. J Emerg Med 2008; 38:572-7. [PMID: 18462909 DOI: 10.1016/j.jemermed.2007.10.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 07/12/2007] [Accepted: 10/30/2007] [Indexed: 10/22/2022]
Abstract
The present pilot study compared the ability of a conventional patient complaint-driven approach to that of nucleic-acid amplification testing (NAAT) of urine to identify those individuals among an adult, urban, Emergency Department (ED) population infected with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV). Urine for NAAT was collected for testing after individuals had completed a questionnaire and before being seen by a physician. A total of 614 subjects were enrolled, and complete physical examinations were performed on 348 (56.6%) individuals, with women being significantly more likely to receive such an evaluation (odds ratio [OR] 3.09; 95% confidence interval [CI] 1.96-4.86); p < 0.001). A total of 153 (24.9%) of the study cohort tested positive for a least one sexually transmitted disease (STD), and only a reported history of STD (OR 1.74; 95% CI (1.18-2.57); p = 0.005) and a history of a new sexual partner in the last 3 months (OR 1.79; 95% CI 1.13-2.82); p = 0.012) were predictive of a positive STD test. NAAT of urine samples on patients who did not receive a complete physical examination resulted in a 33% (51/153) increase in diagnostic yield in this cohort of ED attendees.
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Affiliation(s)
- Peter B Chase
- Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona 85724-5057, USA
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15
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Stanback J, Shelton JD. Pelvic inflammatory disease attributable to the IUD: modeling risk in West Africa. Contraception 2008; 77:227-9. [DOI: 10.1016/j.contraception.2008.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Accepted: 12/18/2007] [Indexed: 11/28/2022]
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Grijsen ML, Graham SM, Mwangome M, Githua P, Mutimba S, Wamuyu L, Okuku H, Price MA, McClelland RS, Smith AD, Sanders EJ. Screening for genital and anorectal sexually transmitted infections in HIV prevention trials in Africa. Sex Transm Infect 2008; 84:364-70. [PMID: 18375645 DOI: 10.1136/sti.2007.028852] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To demonstrate the value of routine, basic sexually transmitted infection (STI) screening at enrolment into an HIV-1 vaccine feasibility cohort study and to highlight the importance of soliciting a history of receptive anal intercourse (RAI) in adults identified as "high risk". METHODS Routine STI screening was offered to adults at high risk of HIV-1 upon enrolment into a cohort study in preparation for HIV-1 vaccine trials. Risk behaviours and STI prevalence were summarised and the value of microscopy assessed. Associations between prevalent HIV-1 infection and RAI or prevalent STI were evaluated with multiple logistic regression. RESULTS Participants had a high burden of untreated STI. Symptom-directed management would have missed 67% of urethritis cases in men and 59% of cervicitis cases in women. RAI was reported by 36% of male and 18% of female participants. RAI was strongly associated with HIV-1 in men (adjusted odds ratio (aOR) 3.8; 95% CI 2.0 to 6.9) and independently associated with syphilis in women (aOR 12.9; 95% CI 3.4 to 48.7). CONCLUSIONS High-risk adults recruited for HIV-1 prevention trials carry a high STI burden. Symptom-directed treatment may miss many cases and simple laboratory-based screening can be done with little cost. Risk assessment should include questions about anal intercourse and whether condoms were used. STI screening, including specific assessment for anorectal disease, should be offered in African research settings recruiting participants at high risk of HIV-1 acquisition.
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Affiliation(s)
- M L Grijsen
- Centre for GeographicMedicine Research-Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
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Abstract
PURPOSE OF REVIEW Trichomonas vaginalis is the most common curable sexually transmitted infection. Despite a number of serious health consequences including facilitation of HIV transmission, pelvic inflammatory disease and adverse outcomes of pregnancy it remains an under-recognized condition. This review aims to update the reader on the global epidemiology and control of T. vaginalis. RECENT FINDINGS The burden of T. vaginalis infection is found in resource-limited settings and high-risk groups in industrialized settings. Utilization of polymerase chain reaction-based diagnostics has enhanced our understanding of the epidemiology of T. vaginalis both at the population level and in sexual partners. High rates of asymptomatic infection in male partners of infected females and subsequent re-infection have significant implications for control programmes. Further studies investigating the role of T. vaginalis in facilitating HIV transmission has highlighted its significance and the need to develop and implement control interventions. SUMMARY Future research to develop cheap, point-of-care diagnostic tests will allow a greater understanding of T. vaginalis epidemiology. In addition, the effect of treatment on outcome of pregnancy and HIV acquisition requires further study. This will in turn facilitate operational studies evaluating optimal control strategies and their impact on the complications of T. vaginalis.
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Fonseca TMVD, Cesar JA, Hackenhaar AA, Ulmi EF, Neumann NA. [Self-reported vaginal discharge among pregnant women in an urban area in Southern Brazil: prevalence and associated factors]. CAD SAUDE PUBLICA 2008; 24:558-66. [PMID: 18327443 DOI: 10.1590/s0102-311x2008000300009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 07/30/2007] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to determine the prevalence and risk factors associated with self-reported vaginal discharge among pregnant women in the city of Rio Grande, South Brazil. Using a cross-sectional design, a standard interview was applied to pregnant women at home by previously trained interviewers, covering the following: demographic, reproductive, and socioeconomic data, household conditions, health care, and illnesses during pregnancy, including vaginal discharge. The chi-square test was used to compare proportions, and Poisson regression was used in the multivariate analysis. Among the 339 pregnant women interviewed, 52% reported vaginal discharge. The following variables were significantly associated with the outcome: age (prevalence rate, PR = 1.49), marital status (PR = 1.31), urinary tract infection (PR = 1.56), hyperglycemia (PR = 1.48), use of an intrauterine device (PR = 2.35), and history of preterm delivery (PR = 1.37), with oral contraception showing a protective effect (PR = 0.79). Prevalence of self-reported discharge was high among this group of pregnant women. Several risk factors were also identified for the disease under study. These findings can contribute to the implementation of preventive interventions.
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Romoren M, Velauthapillai M, Rahman M, Sundby J, Klouman E, Hjortdahl P. Trichomoniasis and bacterial vaginosis in pregnancy: inadequately managed with the syndromic approach. Bull World Health Organ 2007; 85:297-304. [PMID: 17546311 PMCID: PMC2636319 DOI: 10.2471/blt.06.031922] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 10/02/2006] [Accepted: 11/16/2006] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To measure the prevalence of Trichomonas vaginalis (TV) infection and bacterial vaginosis (BV) among pregnant women in Botswana, and to evaluate the syndromic approach and alternative management strategies for these conditions in pregnancy. METHODS In a cross-sectional study, 703 antenatal care attendees were interviewed and examined, and specimens were collected to identify TV, BV, Candida species, Chlamydia trachomatis and Neisseria gonorrhoeae. Information on reproductive tract infections earlier in pregnancy was obtained from a structured interview and the antenatal record. FINDINGS TV was found in 19% and BV in 38% of the attendees. Three-fourths of women with TV or BV were asymptomatic. Syndromic management according to the vaginal discharge algorithm would lead to substantial under-diagnosis and over-treatment of TV and BV. Signs of vaginal discharge were more predictive of the presence of these conditions than were symptoms. Among the 546 attendees on a repeat antenatal visit, 142 (26%) had been diagnosed with vaginal discharge earlier in their pregnancy--14 of them twice. In 143 cases, an attendee was diagnosed with vaginal discharge in the second or third trimester; however, metronidazole had been prescribed only 17 times (12%). CONCLUSION Diagnosis and treatment of TV and BV among pregnant women in sub-Saharan Africa presents major challenges. Half the pregnant women in this study were diagnosed with TV or BV, but these conditions were not detected and treated during antenatal care with syndromic management. Also, health workers did not adhere to treatment guidelines. These results indicate that management guidelines for TV and BV in antenatal care should be revised.
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Affiliation(s)
- M Romoren
- Faculty of Medicine, University of Oslo, Oslo, Norway.
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Chen XS, Yin YP, Chen LP, Thuy NTT, Zhang GY, Shi MQ, Hu LH, Yu YH. Sexually transmitted infections among pregnant women attending an antenatal clinic in Fuzhou, China. Sex Transm Dis 2006; 33:296-301. [PMID: 16554698 DOI: 10.1097/01.olq.0000194580.02116.6b] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the prevalence of sexually transmitted infections (STIs) among women attending an antenatal clinic in urban China and to show whether reported symptoms and findings on clinical examination predicted STIs in this population. STUDY DESIGN Cross-sectional descriptive study was conducted among 504 pregnant women attending an antenatal clinic in Fuzhou, China. Structured questionnaires were used to collect demographic and behavioral information, and clinical and gynecologic examinations were performed to detect clinical signs of STIs. Blood samples, vaginal swabs, and cervical swabs were collected, respectively, to test for antibodies to syphilis, culture Trichomonas vaginalis (T. vaginalis), and perform PCR to detect Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonorrhoeae). RESULTS C trachomatis was detected in 51 (10.1%), N gonorrhoeae in 4 (0.8%), T vaginalis in 16 (3.2%), and syphilis in 1 (0.2%) of the 504 pregnant women. Fifty-two (73%) of 71 women with any STI were asymptomatic. Multiple logistic regression analysis indicated that age <or=25 years (OR=2.72) and monthly income >RMB 2000 yuan (OR=3.57) were significant independent risk factors for chlamydial infection (P<0.05). The reported symptom of vaginal discharge or the clinical sign of either vaginal or cervical discharge poorly predicted infection with C trachomatis, N gonorrhoeae, or T vaginalis, with a positive predictive value <25% for each STI. CONCLUSION A substantial prevalence of STIs, including a large proportion of asymptomatic infections, was found among pregnant women in the study area. These results support a strategy of screening pregnant women for bacterial STIs (followed by treatment of infections), which could be integrated into routine pregnancy care in China.
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Affiliation(s)
- Xiang-Sheng Chen
- National Center for STD Control, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC) Institute of Dermatology, Nanjing, China.
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Råssjö EB, Kambugu F, Tumwesigye MN, Tenywa T, Darj E. Prevalence of sexually transmitted infections among adolescents in Kampala, Uganda, and theoretical models for improving syndromic management. J Adolesc Health 2006; 38:213-21. [PMID: 16488818 DOI: 10.1016/j.jadohealth.2004.10.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Accepted: 10/26/2004] [Indexed: 11/24/2022]
Abstract
PURPOSE To estimate the prevalence of treatable sexually transmitted infections (STI) in adolescents visiting a youth health clinic. To evaluate the algorithm for management of the abnormal vaginal discharge (AVD) syndrome recommended in Uganda's national guidelines and compare it with other theoretical flowchart models. METHODS Sexually experienced adolescents who were visiting an urban youth health clinic in Kampala, Uganda were examined and interviewed (with their consent) about their socio-demographic background, sexual risk factors, and genital symptoms. Samples taken for Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG), and Trichomonas vaginalis (TV) were analyzed by polymerase chain reaction (PCR). Rapid plasma reagin (RPR) was used with confirming treponema pallidum hem agglutination (TPHA) for syphilis diagnosis. One hundred ninety-nine females and 107 males were examined. Performance of the national algorithm was compared with different theoretical algorithms. RESULTS Prevalence of CT, NG, TV and syphilis was 4.5%, 9.0%, 8.0%, and 4.0%, respectively, for girls and 4.7%, 5.7%, 0%, and 2.8%, respectively, for boys. We found that 20.6% of the females and 13.2% of the males had at least one STI. The national AVD flow chart had a sensitivity of 61%, a specificity of 38.5% and a positive predictive value (PPV) of 11.6%. All the models had PPV of less than 20% and sensitivity less than 85%. The best performing algorithm using risk and protective factors, rather than symptoms, implicated a sensitivity/specificity and PPV of 82.6%/47% and 17.3%, respectively (p = .012). CONCLUSIONS An algorithm for management of STI using behavioral and demographic factors in this population demonstrated enhanced sensitivity, specificity, and PPV.
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Affiliation(s)
- Eva-Britta Råssjö
- Department of Women's and Children's Health, University Hospital, Uppsala, Sweden.
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Pickering JM, Whitworth JAG, Hughes P, Kasse M, Morgan D, Mayanja B, Van der Paal L, Mayaud P. Aetiology of sexually transmitted infections and response to syndromic treatment in southwest Uganda. Sex Transm Infect 2005; 81:488-93. [PMID: 16326853 PMCID: PMC1745059 DOI: 10.1136/sti.2004.013276] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the aetiology of genital ulcers and discharges in rural south western Uganda and to assess response to syndromic treatment. METHOD A longitudinal, prospective study using laboratory testing and questionnaires to evaluate 561 adult men and women presenting with clinically verified genital ulcers, urethral, or vaginal discharge at a general outpatient clinic and two health centres between December 1999 and July 2001. RESULTS One third of patients had genital ulcers and two thirds discharges. There was good response to treatment in 461/508 patients (90.7%). Herpes simplex virus type 2 was found in 95/217 (43.8%) genital ulcers. In 24.1% of ulcer cases there was also a genital discharge. HIV seropositivity was high in ulcer cases (63.2%), with significantly more HSV2 and secondary bacterial infection than in seronegative cases. Neisseria gonorrhoeae was found in 135/204 (66.2%) male genital discharges. Female genital discharges were mostly associated with bacterial vaginosis (36.1%), Trichomonas vaginalis (18.9%), and candidiasis (18.6%). CONCLUSIONS The aetiological pattern of STI syndromes reported will help inform revision of national STI guidelines. The importance of herpes simplex virus type 2, the variation in causes of genital ulcers according to HIV serostatus, the high frequency of multiple infections and secondary bacterial contamination of genital ulcers are notable. These results help explain the lack of effect of an STI intervention on HIV incidence in a recent trial in this area.
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Affiliation(s)
- J M Pickering
- Medical Research Council Clinical Trials Unit, 222 Euston Road, London NW1, UK.
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Myer L, Kuhn L, Stein ZA, Wright TC, Denny L. Intravaginal practices, bacterial vaginosis, and women's susceptibility to HIV infection: epidemiological evidence and biological mechanisms. THE LANCET. INFECTIOUS DISEASES 2005; 5:786-94. [PMID: 16310150 DOI: 10.1016/s1473-3099(05)70298-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Intravaginal practices such as "dry sex" and douching have been suggested as a risk factor that may increase women's susceptibility to HIV infection. These behaviours appear common in different populations across sub-Saharan Africa, where practices include the use of antiseptic preparations, traditional medicines, or the insertion of fingers or cloths into the vagina. We systematically review the evidence for the association between women's intravaginal practices and HIV infection. Although a number of cross-sectional studies have shown that prevalent HIV infection is more common among women reporting intravaginal practices, the temporal nature of this association is unclear. Current evidence suggests that bacterial vaginosis, which is a likely risk factor for HIV infection, may be a mediator of the association between intravaginal practices and HIV. Although biologically plausible mechanisms exist, there is currently little epidemiological evidence suggesting that intravaginal practices increase women's susceptibility to HIV infection. Further research into factors that increase women's susceptibility to HIV will help to inform the design of vaginal microbicides and other HIV prevention interventions.
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Affiliation(s)
- Landon Myer
- Infectious Diseases Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
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Mullick S, Watson-Jones D, Beksinska M, Mabey D. Sexually transmitted infections in pregnancy: prevalence, impact on pregnancy outcomes, and approach to treatment in developing countries. Sex Transm Infect 2005; 81:294-302. [PMID: 16061534 PMCID: PMC1745010 DOI: 10.1136/sti.2002.004077] [Citation(s) in RCA: 165] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Sexually transmitted infections (STIs) are common in the developing world. Management of STIs in pregnancy in many developing countries has, however, been complicated by the lack of simple and affordable diagnostic tests. This review examines the prevalence and impact on pregnancy outcome of STIs in developing countries and recommends approaches to management of STIs in pregnancy for resource poor settings.
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Affiliation(s)
- S Mullick
- The Population Council, Frontiers in Reproductive Health, Hyde Park Lane Manor, EG001 Edinburgh Gate, Box 411744, Craighall 2024, Johannesburg, South Africa.
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Fonck K, Leye E, Els L, Kidula N, Ndinya-Achola J, Temmerman M. Increased risk of HIV in women experiencing physical partner violence in Nairobi, Kenya. AIDS Behav 2005; 9:335-9. [PMID: 16133903 DOI: 10.1007/s10461-005-9007-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2003] [Revised: 01/25/2005] [Indexed: 10/25/2022]
Abstract
As part of a study on etiology of sexually transmitted infections (STI) among 520 women presenting at the STI clinic in Nairobi, data on partner violence and its correlates were analyzed. Prevalence of lifetime physical violence was 26%, mainly by an intimate partner (74%). HIV seropositive women had an almost twofold increase in lifetime partner violence. Women with more risky sexual behavior such as early sexual debut, number of sex partners, history of condom use and of STI, experienced more partner violence. Parity and miscarriage were associated with a history of lifetime violence. We found an inverse association between schooling and level of violence. Six percent of the women had been raped. Gender-based violence screening and services should be integrated into voluntary counseling and testing programs as well as in reproductive health programs. Multi-sector approaches are needed to change prevailing attitudes towards violence against women.
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Affiliation(s)
- Karoline Fonck
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185 P3, 9000 Ghent, Belgium
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Bacterial vaginosis, vaginal flora patterns and vaginal hygiene practices in patients presenting with vaginal discharge syndrome in The Gambia, West Africa. BMC Infect Dis 2005; 5:12. [PMID: 15757510 PMCID: PMC1083415 DOI: 10.1186/1471-2334-5-12] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2004] [Accepted: 03/09/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) - a syndrome characterised by a shift in vaginal flora - appears to be particularly common in sub-Saharan Africa, but little is known of the pattern of vaginal flora associated with BV in Africa. We conducted a study aimed at determining the prevalence of BV and patterns of BV-associated vaginal micro-flora among women with vaginal discharge syndrome (VDS) in The Gambia, West Africa. METHODS We enrolled 227 women with VDS from a large genito-urinary medicine clinic in Fajara, The Gambia. BV was diagnosed by the Nugent's score and Amsel's clinical criteria. Vaginal swabs were collected for T vaginalis and vaginal flora microscopy, and for Lactobacillus spp, aerobic organisms, Candida spp and BV-associated bacteria (Gardnerella vaginalis, anaerobic bacteria, and Mycoplasma spp) cultures; and cervical swabs were collected for N gonorrhoeae culture and C trachomatis PCR. Sera were tested for HIV-1 and HIV-2 antibodies. Sexual health history including details on sexual hygiene were obtained by standardised questionnaire. RESULTS BV prevalence was 47.6% by Nugent's score and 30.8% by Amsel's clinical criteria. Lactobacillus spp were isolated in 37.8% of women, and 70% of the isolates were hydrogen-peroxide (H202)-producing strains. Prevalence of BV-associated bacteria were: G vaginalis 44.4%; Bacteroides 16.7%; Prevotella 15.2%; Peptostretococcus 1.5%; Mobiluncus 0%; other anaerobes 3.1%; and Mycoplasma hominis 21.4%. BV was positively associated with isolation of G vaginalis (odds-ratio [OR] 19.42, 95%CI 7.91 - 47.6) and anaerobes (P = 0.001 [OR] could not be calculated), but not with M hominis. BV was negatively associated with presence of Lactobacillus (OR 0.07, 95%CI 0.03 - 0.15), and H2O2-producing lactobacilli (OR 0.12, 95% CI 0.05 - 0.28). Presence of H2O2-producing lactobacilli was associated with significantly lower prevalence of G vaginalis, anaerobes and C trachomatis. HIV prevalence was 12.8%. Overall, there was no association between BV and HIV, and among micro-organisms associated with BV, only Bacteroides spp. and Prevotella spp. were associated with HIV. BV or vaginal flora patterns were not associated with any of the factors relating to sexual hygiene practices (vaginal douching, menstrual hygiene, female genital cutting). CONCLUSION In this population, BV prevalence was higher than in corresponding populations in industrialised countries, but the pattern of vaginal micro-flora associated with BV was similar. BV or vaginal flora patterns were not associated with HIV nor with any of the vaginal hygiene characteristics.
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Henn EW, Kruger TF, Siebert TI. Vaginal discharge reviewed: the adult pre-menopausal female. S Afr Fam Pract (2004) 2005. [DOI: 10.1080/20786204.2005.10873183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Pépin J, Deslandes S, Khonde N, Kintin DF, Diakité S, Sylla M, Méda H, Sobéla F, Asamoah-Adu C, Agyarko-Poku T, Frost E. Low prevalence of cervical infections in women with vaginal discharge in west Africa: implications for syndromic management. Sex Transm Infect 2004; 80:230-5. [PMID: 15170011 PMCID: PMC1744831 DOI: 10.1136/sti.2003.007534] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To measure prevalence and risk factors for cervical infections among a large sample of women consulting for vaginal discharge in west Africa and to evaluate its syndromic management through a two visit algorithm. METHODS In 11 health centres in Bénin, Burkina Faso, Ghana, Guinée, and Mali 726 women who presented with a vaginal discharge without abdominal pain and who denied being a sex worker (SW) were enrolled. Cervical samples were tested for the detection of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) with polymerase chain reaction (PCR) assays. All participants were treated with single dose (2 g) metronidazole and clotrimazole cream for 3 days. They were randomised to be told either to come back on day 7 only if there was no improvement in the discharge (group A), or to come back on day 7 regardless of response to treatment (group B). RESULTS Overall, the prevalence of NG and CT was only 1.9% (14/726) and 3.2% (23/726) respectively. Risk factors previously recommended by the WHO were not associated with the presence of cervical infection, with the exception of the number of sex partners in the past 3 months. When taken together, these risk factors had a positive predictive value of only 6.4% to identify cervical infections. Prevalence of cervical infection was not higher in women who came back on day 7, regardless of the strategy used. Prevalence of NG/CT was lower in Ghana and Bénin (5/280, 1.8%), where comprehensive interventions for SW have been ongoing for years, than in the three other countries (27/446, 6.1%, p = 0.01). CONCLUSIONS NG and CT infections are uncommon in west African women who consult for vaginal discharge and who are not SW. Syndromic management of vaginal discharge should focus on the proper management of vaginitis. The control of gonococcal and chlamydial infection should be redesigned around interventions focusing on sex workers.
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Affiliation(s)
- J Pépin
- Centre for International Health, University of Sherbrooke, Canada.
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Landers DV, Wiesenfeld HC, Heine RP, Krohn MA, Hillier SL. Predictive value of the clinical diagnosis of lower genital tract infection in women. Am J Obstet Gynecol 2004; 190:1004-10. [PMID: 15118630 DOI: 10.1016/j.ajog.2004.02.015] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We hypothesized that diagnostic approaches to lower genital tract infections are inaccurate and proposed this study to evaluate typical approaches. STUDY DESIGN Clinical diagnoses were made with symptoms, direct observation, wet mount, vaginal pH, and amines in 598 women with genital complaints. Laboratory testing for N gonorrhoeae, yeast, T vaginalis, C trachomatis, and bacterial vaginosis by Gram stain. RESULTS The most frequent symptoms were vaginal discharge (64%), change in discharge (53%), malodor (48%), and pruritus (32%). The infection rates were 46% bacterial vaginosis, 29% yeast, 12% trichomoniasis, 11% chlamydia or gonorrhea; 21% of the patients had no infection. The symptoms did not predict laboratory diagnosis. Clinical signs and symptoms with office-based tests and microscopy improved the accuracy of diagnoses. Amsel's clinical diagnosis of bacterial vaginosis was the most sensitive at 92%. The sensitivity of wet mount diagnosis of trichomoniasis was 62%, of yeast by microscopy was 22%, and of mucopus for the prediction of gonorrhea and/or chlamydia was 30%. CONCLUSION Symptoms alone should not be used to direct treatment in instances in which resources permit more complete evaluation with office-based testing that includes microscopy. Treatment failures or diagnostic uncertainty should prompt specific laboratory testing.
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Affiliation(s)
- Daniel V Landers
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh and Magee-Women's Research Institute, Pittsburgh, PA, USA.
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Kalinka J, Laudański T, Hanke W, Wasiela M. Do microbiological factors account for poor pregnancy outcome among unmarried pregnant women in Poland? Fetal Diagn Ther 2003; 18:345-52. [PMID: 12913347 DOI: 10.1159/000071979] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2002] [Accepted: 10/02/2002] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Being unmarried is a well-known risk factor for poor pregnancy outcome such as preterm delivery and intrauterine growth restriction. The aim of this prospective study was to assess the prevalence and risk of bacterial vaginosis (BV) and selected bacteria isolated from the lower genital tract and to determine the socioeconomic and microbiological characteristics that might be responsible for poor pregnancy outcome observed among unmarried pregnant women. METHODS The study population comprised 196 pregnant women attending 10 randomly selected outpatient maternity units in the Lodz region, central Poland. Cervicovaginal samples were obtained between 8 and 16 weeks of gestation. Based on Spiegel's criteria, gram-stained vaginal smears were examined for BV and the BV-associated flora was sought by culture. To evaluate the risk factors, relative risk ratios were calculated using EPI INFO software. RESULTS Among 196 pregnant women, 40 (20.4%) were unmarried. BV was diagnosed among 55 (28.1%) women studied. In the univariate analysis, unmarried pregnant women were characterized by younger age, primary educational level, poor economic situation and excessive smoking during pregnancy, as compared to married women. The unmarried status was a borderline risk factor for BV (OR = 1.83, 95% CI 0.94-4.9) after adjustment for age, smoking and education. An analysis of the microbiological culture from the lower genital tract revealed that unmarried pregnant women had a higher risk for several types of pathological microflora, as compared to married women. However, this finding was significant only for Mycoplasma hominis. The independent risk factors of M. hominis were the young age of the subject and a low concentration of Lactobacillus spp. CONCLUSIONS The observed socioeconomic, demographic and microbiological differences between unmarried and married women could be responsible for the poor pregnancy outcome among unmarried pregnant women in Poland. Unmarried pregnant women should be covered by comprehensive medical care even before pregnancy. Further studies taking into account the role of psychological stress, patterns of sexual behavior and substance abuse during pregnancy could help identify the factors responsible for adverse pregnancy outcome among unmarried pregnant women.
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Affiliation(s)
- Jarosław Kalinka
- Department of Perinatology, Institute of Gynecology and Obstetrics, Medical University of Łodź, Poland.
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Taffa N, Bjune G, Sundby J, Gaustad P, Alestrøm A. Prevalence of gonococcal and chlamydial infections and sexual risk behavior among youth in Addis Ababa, Ethiopia. Sex Transm Dis 2002; 29:828-33. [PMID: 12466727 DOI: 10.1097/00007435-200212000-00015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND No community-based study on the magnitude of sexually transmitted diseases (STDs) has ever been conducted among young people in Ethiopia. GOAL To assess the magnitude of Chlamydia trachomatis and Neisseria gonorrhoeae infections and status of sexual risk behavior among youths (15-24 years old) in Addis Ababa, Ethiopia. STUDY DESIGN Youths in or out of school residing in two (of the six) administrative zones in Addis Ababa served as the study population. Participants filled out a self-administered questionnaire related to sexuality and its sociocultural determinants. First-void urine (FVU) was analyzed for gonorrhea and chlamydial infection by polymerase chain reaction (PCR). RESULTS A total of 561 youths took part in the study. Urine PCR was performed for 522 of them. Nine subjects (1.7%) were found to have and N gonorrhoeae and C trachomatis infections. There were five cases (1.0%) involving each agent. Double infection was noted in one female subject. All but one of the infections were detected among the out-of-school youths (chi-square = 4.5; < 0.05). None of these subjects complained of symptoms suggestive of an active STD. One-third (188/561) reported having had sexual intercourse. The prevalence among sexually active youths was thus 4.8% (9/188) for both infections combined (2.7% for each agent). While 7/52 (13.5%) of the sexually active females were found to also have STDs, only 2/136 (1.5%) of the males had an STD (chi-square = 8.0; < 0.01). Report of sexual activity was significantly associated with being male, an age of >/=20 years, out-of-school status, and report of alcohol/khat (amphetamine-like substance) consumption. Females reported less condom use, whether they were in or out of school and independent of age. CONCLUSIONS Out-of-school youths, especially females, took more sexual risk and were exceedingly susceptible to STDs. This calls for alternative group-targeted strategies for sex education, disease prevention, and STD screening and management.
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Affiliation(s)
- Negussie Taffa
- Department of International Health, Institute of General Practice and Community Medicine, University of Oslo, Oslo, Norway
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Fonck K, Claeys P, Bashir F, Bwayo J, Fransen L, Temmerman M. Syphilis control during pregnancy: effectiveness and sustainability of a decentralized program. Am J Public Health 2001; 91:705-7. [PMID: 11344874 PMCID: PMC1446681 DOI: 10.2105/ajph.91.5.705] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study sought to assess the performance, effectiveness, and costs of a decentralized antenatal syphilis screening program in Nairobi, Kenya. METHODS Health clinic data, quality control data, and costs were analyzed. RESULTS The rapid plasma reagin (RPR) seroprevalence was 3.4%. In terms of screening, treatment, and partner notification, the program's performance was adequate. The program's effectiveness was problematic because of false-negative and false-positive RPR results. The cost per averted case was calculated to be US$95 to US$112. CONCLUSIONS The sustainability of this labor-intensive program is threatened by costs and logistic constraints. Alternative strategies, such as the mass epidemiologic treatment of pregnant women in high-prevalence areas, should be considered.
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Affiliation(s)
- K Fonck
- International Center for Reproductive Health, Ghent University, UZ P3, De Pintelaan, 9000 Ghent, Belgium
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Fonck K, Kidula N, Kirui P, Ndinya-Achola J, Bwayo J, Claeys P, Temmerman M. Pattern of sexually transmitted diseases and risk factors among women attending an STD referral clinic in Nairobi, Kenya. Sex Transm Dis 2000; 27:417-23. [PMID: 10949433 DOI: 10.1097/00007435-200008000-00007] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In Kenya, sexually transmitted disease (STD) clinics care for large numbers of patients with STD-related signs and symptoms. Yet, the etiologic fraction of the different STD pathogens remains to be determined, particularly in women. GOAL The aim of the study was to determine the prevalence of STDs and of cervical dysplasia and their risk markers among women attending the STD clinic in Nairobi. STUDY DESIGN A cross-section of women were interviewed and examined; samples were taken. RESULTS The mean age of 520 women was 26 years, 54% had a stable relationship, 38% were pregnant, 47% had ever used condoms (1% as a method of contraception), 11% reported multiple partners in the previous 3 months, and 32% had a history of STDs. The prevalence of STDs was 29% for HIV type 1, 35% for candidiasis, 25% for trichomoniasis, 16% for bacterial vaginosis, 6% for gonorrhea, 4% for chlamydia, 6% for a positive syphilis serology, 6% for genital warts, 12% for genital ulcers, and 13% for cervical dysplasia. Factors related to sexual behavior, especially the number of sex partners, were associated with several STDs. Gonorrhea, bacterial vaginosis, cervical dysplasia, and genital warts or ulcers were independently associated with HIV infection. Partners of circumcised men had less-prevalent HIV infection. CONCLUSION Most women reported low-risk sexual behavior and were likely to be infected by their regular partner. HIV and STD prevention campaigns will not have a significant impact if the transmission between partners is not addressed.
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Affiliation(s)
- K Fonck
- International Centre for Reproductive Health, Ghent University, Belgium
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