Microbiology of vaginal discharge with emphasis on gardnerella vaginalis.
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Date
1990
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Abstract
The microbiological aetiology of vaginal discharge was studied in 208 women
attending various outpatient clinics at King Edward VIII Hospital.
Specimens from the lower genital tract were collected for microscopy and
culture. Vaginal wet smear examination, amine liberation test and vaginal pH
estimation were performed and assessed for their reliability for the rapid
diagnosis of vaginal infections.
Vaginal and endo-cervical infections were present in 163 (78,4%) women. G.
vaginalis (65,4%), T. vaginalis (37,9%), genital yeasts (37,0%), M. hominis
(59,6%), g. urealyticum (48,1%), anaerobic bacteria (32,6%), N. gonorrhoeae
(11,1%), f. trachomatis (22,1%) and Herpes simplex virus (0,9%) were
detected. Of the 104 women in • whom vaginal infections were detected,
bacterial vaginosis was present as the sole infection in 32 (22,2%), I.
vaginalis in 35 (24,3%) and C. albicans in 23 (15,9%). Bacterial vaginosis
occurred concurrently with T. vaginalis and f. albicans in 24 (16,5%) and 11
(7,5%) women respectively; whilstT. vaginalis and f. albicans occurred
concurrently in 14 (9,7%) women. In 6 (4,1%) women all three infections were
present. No vaginal or endo-cervical pathogens were detected in 45 (21,6%)
women.
Women with bacterial vaginosis were found to be significantly colonised with
G. vaginalis, M, hominis, anaerobic bacteria and curved Gram-negative
bacilli (p < 0,05).
Vaginal wet smear microscopy detected T.. vaginalis in 29% and "clue" cells
in 41,3% of smears. The presence of "clue" cells (91,8%) and a positive
amine test (76,7%) was significantly associated with bacterial vaginosis.
Although a raised vaginal pH was also significantly associated with
bacterial vaginosis, this test was less specific (65,2%) than "clue" cells
(85,9%) and the amine test (95,5%). The vaginal Gram stain, as performed in
this study, was found to be unreliable for the detection of "clue" cells.
G. vaginalis biotypes 1 and 5 were significantly associated with bacterial
vaginosis, however the serotyping scheme did not distinguish between strains
isolated from women with and without bacterial vaginosis. The antimicrobial
susceptibility pattern of 93 strains of G. vaginalis was not typical of
either Gram-positive or Gram-negative bacteria.
Serological tests revealed reactive syphilis serology in 47 (22,6%) and the
presence of hepatitis B surface antigen in 16 (7,7%) women. Antibody to
human immunodeficiency virus was detected in 4 (1,9%) women attending the
colposcopy clinic.
This study clearly demonstrates the high prevalence of vaginal and/or
endo-cervical infections in women locally, the majority of whom were
asymptomatic. The high frequency of concurrent infections is of concern and
there is a need for the recognition, and appropriate management of such
infections.
Description
Thesis (M. Med. Sci.)- University of Natal, Department of Microbiology. 1990
Keywords
Vagina--Diseases