Comparison of Affirm VPIII and Papanicolaou tests in the detection of infectious vaginitis

Point-of-Care Testing for Sexually Transmitted Infections

Point-of-care testing for sexually transmitted infections is essential for controlling transmission and preventing sequelae in high-risk populations. Since the World Health Organization published the ASSURED criteria, point-of-care testing has improved for use in large population screening and rapid testing that prevents loss of clinical follow-up. Recent advancements have been advantageous for low-resource areas allowing testing at a minimal cost without reliable electricity or refrigeration. Point-of-care nucleic acid detection and amplification techniques are recommended, but are often inaccessible in low-resource areas. Future advancements in point-of-care diagnostic testing should focus on improving antibody-based assays, monitoring viral loads, and detecting antimicrobial resistance.

Prevalence of Trichomonas vaginalis and Candida albicans among Brazilian Women of Reproductive Age

INTRODUCTION

There are no studies assessing the simultaneous occurrence of Candida albicans (C. albicans) and Trichomonas vaginalis (T. vaginalis) in the primary health care in Brazil. Despite different conditions to establishment of each one, the co-detection of both has been reported by some authors in previous studies from other regions.

AIM

To compare the prevalence of T. vaginalis and C. albicans in correlation with associated variables.

MATERIALS AND METHODS

A cross-sectional study conducted in a family health clinic in the Federal District of Brazil, between November 2014 and March 2015. Vaginal swabs were collected from 201 women of the reproductive age selected from women registered at the family health clinic. Minors and pregnant women were excluded. The rates of T. vaginalis and Candida albicans prevalence were evaluated with vaginal pH, the whiff test, sexual practices and other social and demographic variables. Difference between proportions was assessed by Z-Test.

RESULTS

C. albicans was present in 20% of the women, while 16% of them had T. vaginalis. The simultaneous occurrence of the agents was found in 1.5%. Significant differences were found between prevalence rates for the variables race/skin colour, practice of anilingus and lifetime number of sexual partners.

CONCLUSION

The prevalence of T. vaginalis exceeds C.albicans among women with higher numbers of sexual partners. The prevalence of C. albicans was higher than T. vaginalis among white women and those who practice active and receptive anilingus. The simultaneous occurrence of the two microorganisms was uncommon.

Prevalence and Associated Factors of Genital and Sexually Transmitted Infections in Married Women of Iran

OBJECTIVES

This study aimed to determine the prevalence of genital and sexually transmitted infections and its related factors in married women in Iran.

METHODS

We conducted a cross-sectional study of 4 274 married women living in urban and rural areas of the Zanjan province from 2012 to 2013. We used stratified cluster sampling to select the participants. Data collection included demographic characteristics, reproductive status, and cervical cytology results.

RESULTS

The prevalence of lower genital infections and sexually transmitted infections were 20.1% and 7.4%, respectively. The most common vaginal infection was bacterial vaginosis with a prevalence of 8.5%, and the most common sexually transmitted infection was Trichomonas vaginalis (1.4%). The use of the intrauterine device (IUD) as a contraceptive, living in an urban area, and experiencing vaginal discharge were significantly related to genital tract and sexually transmitted infections.

CONCLUSIONS

There was a high prevalence of genital infection among women living in Zanjab. Screening and treatment of genital infection are necessary to prevent adverse consequences in women who use an IUD or live in urban areas.

Cannonballs in Pap Smears: Double Whammy of Bacterial Vaginosis and Associated Infections

INTRODUCTION

Cannonballs are structures consisting of neutrophils adherent to epithelial cells, often seen in vaginal Pap smears of patients with trichomoniasis and chlamydiasis. We frequently observed these cannonballs in inflammatory Pap smears showing evidence of bacterial vaginosis.

OBJECTIVE

To study the association between cannonballs and bacterial vaginosis with associated infections in inflammatory Pap smears.

STUDY DESIGN

This was a retrospective study performed over a period of 6 months between April 2014 and September 2014. Three hundred consecutive Pap smears assessed during the study period were retrieved from the archives and studied.

RESULTS

A total of 280 smears were studied. Neutrophilic infiltrates were seen in 83.6%, cannonballs in 82.3%, and bacterial vaginosis in 70.7% of the smears. Cannonballs were found in 84.4% of the smears showing evidence of bacterial vaginosis with associated inflammatory infiltrates. There was a significant association between cannonballs and bacterial vaginosis (p = 0.0001). The odds ratio was 13.8 (95% CI: 7.2-26.2).

CONCLUSION

The present study shows a significant association between cannonballs and bacterial vaginosis and associated vaginal infections.

Gynecologic infections seen in ThinPrep cytological test in Wuhan, China

This study aimed to analyze the prevalence of bacterial, Candida, Trichomonas, and human papillomavirus (HPV) infections in ThinPrep cytological test (TCT) performed on women of Wuhan, China. ThinPrep smears were screened by two independent experienced pathologists and reported from 2008 to 2010. A total of 46 866 ThinPrep smears were studied, and smears with inflammation were analyzed. Of the 44 162 enrolled patients, inflammation changes were observed in 21 935 (49.7%) and specific infections in 6884 (31.4%). The infections detected were as follows: bacteria, 5663 (82.3%); Candida, 825 (12.0%); Trichomonas, 273 (4.0%); and HPV, 148 (2.1%). Significant changes were found in the prevalence of bacteria and Candida among women who underwent TCT before and after 2010. χ(2) revealed an increasing proportion of specific infections found in smears after 2010 (P = 0.000). In conclusion, bacterial infection was the most detectable in the ThinPrep smears, followed by Candida and Trichomonas. The prevalence of infection identified by TCT was found to be similar in previous literature in China.

Prevalence of Trichomoniasis, Vaginal Candidiasis, Genital Herpes, Chlamydiasis, and Actinomycosis among Urban and Rural Women of Haryana, India

Despite being curable reproductive tract infections (RTIs) including sexually transmitted infections continue to be a major health problem in developing countries. The present study was undertaken to know the prevalence of trichomoniasis, vaginal candidiasis, genital herpes, chlamydiasis, and actinomycosis in rural and urban women of Haryana by using wet mount, PAP smear, and fluorescent microscopic examination. Patients suspected of suffering from bacterial vaginosis were given treatment and were not included in the study. RTIs were seen in 16.6% of urban and 28.7% of rural women. The highest prevalence seen was that of trichomoniasis in both rural (24.2%) and urban (15.7%) women, followed by candidiasis (4.2% in rural and 0.6% in urban women), genital herpes (0.3% in rural and 0.2% in urban women), and chlamydiasis (0.02% in rural and 0.05% in urban women). Pelvic actinomycosis was seen in 1.4% of rural and 0.06% of urban women using intrauterine contraceptive devices. Mixed infection of Trichomonas vaginalis with Candida spp. was seen in 6.3% of rural women only. It is desirable to have a baseline profile of the prevalence of various agents causing RTIs in a particular geographic area and population which will help in better syndromic management of the patients.

Comparison of nucleic acid amplification assays with BD affirm VPIII for diagnosis of vaginitis in symptomatic women

A commercially available, nonamplified, nucleic acid probe-based test system (BD Affirm VPIII) was compared with nucleic acid amplification (NAA)-based assays for determining the etiology of vaginitis in a cohort of 323 symptomatic women. First, a semiquantitative, multiplexed PCR assay (BV-PCR) and the Affirm VPIII Gardnerellavaginalis test were compared with a unified bacterial-vaginosis (BV) reference standard incorporating both Nugent Gram stain scores and Amsel clinical criteria. In the evaluable population of 305 patients, BV-PCR was 96.9% (191/197) sensitive and 92.6% specific (100/108) for BV, while Affirm VPIII was 90.1% sensitive (179/197) and 67.6% specific (73/108). Second, a multiplexed PCR assay detecting Candida albicans and Candida glabrata (CAN-PCR) was compared with the Affirm VPIII Candida test using a reference standard for vulvovaginal candidiasis (VVC) of yeast culture plus exclusion of alternate vaginitis etiologies. In the population evaluated (n = 102), CAN-PCR was 97.7% sensitive (42/43) and 93.2% specific (55/59) and Affirm VP III was 58.1% sensitive (25/43) and 100% specific (59/59) for VVC. Finally, the results of a commercial NAA test (GenProbe Aptima Trichomonas vaginalis assay; ATV) for T. vaginalis were compared with the Affirm VPIII Trichomonas vaginalis test. In the absence of an independent reference standard for trichomonal vaginitis (TV), a positive result in either assay was deemed to represent true infection. In the evaluable cohort of 388 patients, the sensitivity of ATV was 98.1% (53/54) versus 46.3% (25/54) for Affirm VPIII. The diagnostic accuracy of the combined NAA-based test construct was approximately 20 to 25% higher than that of the Affirm VPIII when modeled in populations with various prevalences of infectious vaginitis.