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|Year : 1993 | Volume
| Issue : 2 | Page : 72-3
Diagnosis and prevalence of bacterial vaginosis.
SP Saharan, C Surve, V Raut, M Bhattacharya
Dept of Obstetrics and Gynaecology, KEM Hospital, Bombay, Maharashtra.,
S P Saharan
Dept of Obstetrics and Gynaecology, KEM Hospital, Bombay, Maharashtra.
Source of Support: None, Conflict of Interest: None
A prospective study of 80 women was undertaken to estimate the prevalence of bacterial vaginosis, and to compare two methods of diagnosing the condition. Bacterial Vaginosis was detected by both Gram stain and compound criteria in 30 women. The prevalence was 37.5%. Gram stain provides a simple and inexpensive method for laboratory confirmation of bacterial vaginosis where facilities for using the compound criteria are not available.
Keywords: Adult, Aged, Comparative Study, Female, Human, Middle Age, Prevalence, Prospective Studies, Vaginosis, Bacterial, diagnosis,epidemiology,microbiology,
|How to cite this article:|
Saharan S P, Surve C, Raut V, Bhattacharya M. Diagnosis and prevalence of bacterial vaginosis. J Postgrad Med 1993;39:72
Bacterial vaginosis is the commonest cause of vaginal discharge occurring in women attending gynaecological clinics in our country. Patients often present with a malodorous vaginal discharge although many are asymptomatic. The diagnosis of vaginosis is established by detecting at least three of four compound criteria viz. a thin homogenous vaginal discharge, vaginal pH greater than 4.7, a characteristic 'amine' odour released when alkali (10% KOH wt/vol) is added to a specimen of vaginal fluid and at least 20% of epithelial cells having the appearance of 'clue cells' in a wet mount of vaginal fluid. Alternative 1aboratory-based tests include the use of Gram Stain.
A random study of 80 married women between 20-65 years was done in the out-patient department to estimate the prevalence of bacterial vaginosis and to compare two methods of diagnosing bacterial vaginosis. Verbal consent was taken. After introduction of vaginal speculum the presence or absence of vaginal discharge was noted. A sample of vaginal fluid was obtained from posterior vaginal fornix. This was smeared on a glass slide and heat fixed. The slides were stained by Gram's method. A second vaginal sample was taken to measure pH and was then placed on a slide for the addition of 10% KOH to detect an amine odour, the pH was measured using paper graded from 3-7. A third sample was mixed with a drop of normal saline and examined immediately for the presence of clue cells.
The presenting symptoms of women are listed in [Table - 1].
[Table - 2] represents list of diagnostic criteria alongwith number of women with bacterial vaginosis, the diagnosis of which was based on presence of atleast 3 of the 4 criteria. It also gives the number of women with the given criteria but in whom diagnosis of bacterial vaginosis cannot be made because they fail to fulfil the requirement of the definition.
Bacterial vaginosis is a polymicrobial condition in which a decrease in vaginal acidity and in the concentration of lactobacilli is accompanied by an increase of a 100 fold or more in the concentration of other micro-organisms. No single micro-organism is detected in all women with bacterial vaginosis, but Gardnerella vaginalis, Bacteroides species Mycoplasma hominis Mobiluncus have been associated with bacterial vaginosis in most studies.
The incidence of bacterial vaginosis varies in different population. Modern reviews show a wide diversity of incidence, probably resulting from more exacting objective criteria used to diagnose the condition in women without symptoms. The lowest reported prevalence of bacterial vaginosis is 5% while not regarded as a condition for which male partners require treatment. The epidemiology of the condition has some of the characteristics of a sexually transmitted disease.
The overall pevalence of bacterial vaginosis in this study was 37.5%. Bacterial vaginosis is generally considered to be a condition of premenopausal women. Among the individual criteria used to diagnose bacterial vaginosis, a raised pH is recognized as the most sensitive but least specific. Amine test is both highly sensitive and specific. False positive amine tests occur rarely. The Gram stain was strikingly positive in patients with bacterial vaginosis. It was 100% specific and sensitive in comparison with the compound criteria for the diagnosis of bacterial vaginosis. The prevalence of bacterial vaginosis is relatively high in this population due to improper sanitation, poor hygiene, malnutrition and high incidence of transmitted disease. Also the number of patients presenting with vaginal discharge were significant. Where facilities for using the compound criteria are not available, the Gram stain provides an easy method of diagnosing bacterial vaginosis.
| :: References|| |
Eschenbach DA, Hillier SH, Critchlow C, Holmes KK. Diagnosis and Clinical manifestations of bacterial vaginosis. Am J Obstet Gynaecol 1988 159:819-828. |
|2.||Amsel R, Totten PA, Spiegel, Eschenbach DA, Holmes KK. Non-specific vaginitis, diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983; 74:14-22. |
|3.||Hillier S, Holmes KK. Bacterial vaginosis. In: Sexually Transmitted Diseases, 2nd ed. New York: McGraw Hill; 1990, pp 547- 59. |
|4.||Hay PE, Taylor-Robinson D, Lamount RF. Diagnosis of bacterial vaginosis in a gynaecology clinic. Br J Obstet Gynaecol 1992; 99:63-66.
[Table - 1], [Table - 2]
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