Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : December | Volume : 5 | Issue : 8 | Page : 1548 - 1551

Microbiological Profile of Vaginosis among Women of the Reproductive Age Group, Who Attended a Tertiary Care Hospital

Renu Mathew, Sudhakshina R, M Kalyani, S Jayakumar, Binesh Lal, Shameem Banu

1. M.D., Professor of Microbiology 2. MSc (Medical Microbiology) 3. M.D., Professor of Microbiology 4. M.D., Associate Professor of Microbiolog 5. M.D., Assistant Professor of Microbiology 6. M.D., Professor & Head of Microbiology INSTITUTION TO WHICH STUDY: Saveetha Medical College, Thandalam, Kanchipuram District

Correspondence Address :
Renu Mathew, Professor of Microbiology,
Saveetha Medical College & Hospital,
Saveetha University, Saveetha Nagar,
Thandalam, Chennai – 602 105
Tamilnadu, India.
Phone: 9841101062/Land line: 044-49522213
Fax: 044-26811999
Email: renumathews@yahoo.com

Abstract

Background: An abnormal vaginal discharge is a common complaint in women and it can be due to vaginal infections like bacterial vaginosis, candidiasis and trichomoniasis .

Aim: A descriptive cross sectional study was done to find out the common pathogens which caused vaginosis in patients of the reproductive age group, who attended the Obstetrics and Gynaecology Department at the Saveetha Medical College Hospital, Thandalam, Kanchipuram District, from 1st April to 30th September, 2010.

Materials and Methods: All the 140 vaginal discharge samples were subjected to gram staining to view the morphological nature of the bacteria which caused bacterial vaginosis and gram positive, budding yeast cells, wet film for the motility of Trichomonas and Chlamydial antigen detection by ELISA.

Results: The overall positivity was 44%, which included bacterial vaginosis (36.4%). The positivity of candidiasis was 4.2%, that of trichomoniasis was 2.1% and that of chlamydiasis was 1.4%.

Conclusion: Bacterial vaginosis was found to be the commonest cause of the abnormal vaginal discharge in women of the reproductive age group.

Keywords

Bacterial vaginosis, Nugent’s criteria, Vaginal candidiasis, Trichomoniasis, Chlamydiasis

How to cite this article :

Renu Mathew, Sudhakshina R, M Kalyani, S Jayakumar, Binesh Lal, Shameem Banu. MICROBIOLOGICAL PROFILE OF VAGINOSIS AMONG WOMEN OF THE REPRODUCTIVE AGE GROUP, WHO ATTENDED A TERTIARY CARE HOSPITAL. Journal of Clinical and Diagnostic Research [serial online] 2011 December [cited: 2019 Sep 22 ]; 5:1548-1551. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=December&volume=5&issue=8&page=1548-1551&id=1724

Introduction
Vaginal infections such as bacterial vaginosis, candidiasis as the common yeast infection, and trichomoniasis, are the common causes of abnormal vaginal discharge (1). Bacterial vaginosis (BV) is one of the important causes of vaginal infections among women of the child bearing group, because of its potential to cause upper genital tract infection (2). Chlamydia trachomatis today, has become the most common bacterial sexually transmitted infection (STI), all over the world. Most of the times, it is asymptomatic in the female reproductive tract; but if left untreated, it leads to dreaded consequences like pelvic inflammatory disease (PID), infertility, ectopic pregnancy and chronic pelvic pain. It can cause endometritis, inflammation of the tubes, and at times, also peritonitis with the Fitz Hugh Curtis syndrome (3).

Hence, knowledge on the microbiological profile of vaginosis becomes necessary to diagnose and treat abnormal vaginal discharges. A descriptive cross sectional study was done to study the common pathogens which caused vaginosis in patients of the reproductive age group, who attended the Obstetrics and Gynaecology Department at the Saveetha Medical College Hospital, Thandalam, Kanchipuram District, Tamilnadu.

Aim
To identify the common causes of abnormal vaginal discharge, like bacterial vaginosis, vaginal candidiasis, trichomoniasis and chlamydial infections among women of the reproductive age group in a tertiary care hospital.

Material and Methods

The present study was carried out at the Saveetha Medical College, which is a tertiary care hospital in Thandalam, Kanchipuram district. The study period was from 1st April to 30th September, 2010. Vaginal swabs were collected from 140 patients with abnormal vaginal discharge, who attended the Saveetha Medical College and Hospital.

Inclusion Criteria
All the female patients in the reproductive age group (17 to 50 years), with the complaint of excessive vaginal discharge were included in this study.

Exclusion Criteria
1. Patients with bleeding per vagina 2. Patients of age group below 17 years and above 50 years3. Patients with genital tract malignancies (cervical and endometrial carcinomas)

The specimens were collected by using sterile cotton swabs and they were transported to the lab for further processing. The following tests were done in the laboratory according to standard procedures (4),(5).

1. Smears from swabs 2. pH testing 3. Gram staining 4. Wet mount 5. KOH mount 6. Whiff test 7. Chlamydial antigen detection by using ELISA

For bacterial vaginosis, the results were interpreted by using Nugent’s critera (2), as shown in (Table/Fig 1) and (Table/Fig 2).

Results

Among the 140 cases which were studied, 20 (14%) were inpatients and 120 (86%) were outpatients. The samples were collected from patients of the age group of 17- 50 years. The age wise distribution of the patients is shown in (Table/Fig 3). The maximum number of patients (26.40%) were from the age group of 36-40 years.

Out of the 140 patients, 80 patients had excessive vaginal discharge and lower abdominal pain. Twenty patients had excessive vaginal discharge and lower abdominal pain along with itching. Itching was the only presenting symptom in 10 patients. Twenty patients complained of a foul smelling discharge along with the itching. Five patients had infertility and 5 patients had menstrual problems like irregular menstruation and excessive bleeding. The presenting symptoms with the number of patients are depicted in (Table/Fig 4).

The colour and nature of the vaginal discharge with the number of patients are shown in (Table/Fig 5).

The pH of all the samples was tested. The pH distribution is shown in (Table/Fig 6). Out of the 140 patients, 81 had normal pH (4 and <4). An increase in pH (4.5 and > 4.5) was found in 59 patients.

All the 140 samples were subjected to gram staining, KOH mount, wet film and antigen detection for Chlamydia. Gram staining was done to view the morphological nature of the bacteria which caused vaginosis. The presence of gram variable rods and gram negative rods indicated bacterial vaginosis (Table/Fig 7). Candida were seen as gram positive budding yeast cells (Table/Fig 8). KOH mount was also done for observing Candida and wet film was done to study the motility of Trichomonas. Antigen detection by ELISA was done for Chlamydia. The gram stained smear of bacterial vaginosis was scored by using the Nugent’s scoring system. The 51 positive cases of bacterial vaginosis were scored as shown in (Table/Fig 9). The positivity of bacterial vaginosis was 36.4% according to Nugent’s criteria.

Among the 140 cases, 62 cases were proven to have vaginosis. The percentage of the positivity was 44%. This positivity included bacterial vaginosis, candidiasis, trichomoniasis and chlamydiasis as depicted in (Table/Fig 10). The positivity of candidiasis was 4.2%, that of trichomoniasis was 2.1% and that of chlamydiasis was 1.4%.

Among the 51 positive cases of bacterial vaginosis, the bacterium which caused vaginosis in most of the cases was Gardnerella(86.2%), which was identified by its morphological features. Mobiluncus (curved gram negative bacilli) was always found in association with Gardnerella in 11.6% cases.

The Whiff’s test is found to be positive in all the 51 cases that were positive for bacterial vaginosis. The Whiff’s test was found to be negative in the vaginal discharge that was positive for vaginosis due to Candida, Trichomonas and Chlamydia.

Bacterial vaginosis was found to be associated with patients who had a white and mucopurulent discharge, a yellow discharge with Candidiasis and a yellow and frothy discharge with Trichomoniasis. The increase in pH was due to the growth of organisms other than lactobacilli. This led to vaginosis. Clue cells were observed in all the positive cases of bacterial vaginosis. The clue cells were embedded with the gram variable bacterium (Gardnerella).

Candidiasis was the other important cause of vaginosis, where the discharge was yellow in colour. Among the 62 positive vaginosis patients, the number of positivity was 6 (4.2%). It was detected by gram staining and the KOH mount. Candidiasis was seen more in patients with Diabetic mellitus.

Trichomoniasis was found in 3 patients who had a yellowish frothy discharge. It was detected by doing a wet mount preparation by using normal saline. Its positivity was confirmed by its characteristic morphology and its motility under the microscope.

Chlamydia was detected by the rapid antigen detection method. Among 140 patients, 2 were diagnosed to be chlamydial antigen positive. Both these patients had infertility.

Discussion

In the present study, during a period of 6 months (April to September 2010), 140 samples of abnormal vaginal discharge were analyzed. The Nugent’s scoring system was employed for diagnosing bacterial vaginosis (2). The Nugent’s scoring system appears to be a reliable and convenient method for the laboratory evaluation of the cases of bacterial vaginosis, as in similar studies which were done by R. Mathew et al, Chennai and Mohanty S, et al, New Delhi (2),(6).

Among the 140 cases which were studied, 20(14%) were inpatients and 120 (86%) were outpatients. In our study, out of the 140 samples, the maximum (37) were from the age group of 36- 40 years. The most prevalent cause of vaginosis was bacterial vaginosis, which was 36.4% according to Nugent’s criteria. The positivity of candidiasis was 4.2%, that of trichomoniasis was 2.1% and that of chlamydiasis was 1.4%. Most of the patients complained of excessive vaginal discharge (57%), lower abdominal pain (54.2%), infertility (3.5%) and menstrual problems (3.5%). Most of the patients had combined complaints also.

A similar study which was done by R.Mathew et al, Chennai on the prevalence of bacterial vaginosis in antenatal women, included 150 symptomatic women and 50 asymptomatic women who were in the second trimester of pregnancy and between 20-30 years of age. The smears were examined and evaluated by the scoring system of Nugent et al. In their study, the positivity of the symptomatic women was 38.5% for bacterial vaginosis and the positivity in asymptomatic women was 8%. The morphological predominance of the organisms were Gardnerella (26), followed byMobiluncus (20) and clue cells (19) (2). The percentage of positivity for bacterial vaginosis was 36.4% in our study, which was in accordance with this study.

Thulkar J, et al, New Delhi, studied the utility of the pH test and the Whiff’s test in a syndromic approach of abnormal vaginal discharge, whose study included 564 women with abnormal vaginal discharge. Vaginitis was diagnosed in 301 (53.37%) women. Bacterial vaginosis (BV) was the commonest type of vaginitis (39.01%). A pH of > or = 4.5 and a positive Whiff’s test had a sensitivity of 94.09 per cent and a specificity of 87.5 per cent in diagnosing bacterial vaginosis. Similarly, a pH of < 4.5 and a positive or negative Whiff’s test had a sensitivity of 83.72 per cent in diagnosing candidiasis. They concluded that the pH test and the Whiff’s test can improve the diagnostic value for vaginosis.7 In the present study, the pH test and the Whiff’s test were very useful for the diagnosis of bacterial vaginosis. The Whiff’s test, if it was poorly positive, the microscopic examination revealed an intermediate stage of bacterial vaginosis. If it was strongly positive, the microscopic finding confirmed bacterial vaginosis. A negative Whiff’s test showed a negative microscopic finding. The pH was > than 4.4 in the bacterial vaginosis samples and it was < 4.4 in the normal samples.

Mania-Pramanik J et al studied the use of vaginal pH in the diagnosis of infections and its association with reproductive manifestations. The C. trachomatis infection or different reproductive manifestations do not lead to a change in the vaginal pH, but a high vaginal pH was correlated with bacterial vaginosis and it should be used as a simple tool for its diagnosis (8). A high vaginal pH (more than 4.5) was seen in all the cases of bacterial vaginosis in our study, which was correlated well with the findings of previous studies.

Bacterial vaginosis was found to be the most prevalent (36.4%) form of vaginosis which affected women of the reproductive age group in our study. A related study on the diagnosis and prevalence of vaginosis, which was done by SP Saharan et al, had reported the positivity of bacterial vaginosis as 37.5% (9). Bacterial vaginosis is generally considered to be a condition of premenopausal women. In our study, the maximum number of patients who were affected were in the age group of 36-40 years. Among the individual criteria which were used to diagnose bacterial vaginosis, a raised pH was recognized as the most sensitive but the least specific criterion. The 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. Gram staining is an easy method of diagnosing bacterial vaginosis (10).

Though bacterial vaginosis was found to be the most common cause (36.4%) of vaginosis, which affected women of the reproductive age group in our study, there are a few studies where a higher prevalence of bacterial vaginosis was reported. Bhalla P, et al, New Delhi, studied on the prevalence of bacterial vaginosis among women in Delhi. Vaginal specimens for the gram-stain evaluation of the vaginal flora for the diagnosis of bacterial vaginosis and the culture of Trichomonas vaginalis and Candida spp, blood samples for the serology of HIV and syphilis and urine for the detection of Neisseria gonorrhoeae and Chlamydia trachomatis were collected from women (15-49 yrs) from the rural and urban areas. Information on the demographic characteristics, the risk factors and the clinical symptoms was obtained. Bacterial vaginosis was diagnosed in 70 (32.8%) subjects. A high percentage of women, though they wereasymptomatic (31.2%), were found to have bacterial vaginosis. The highest prevalence was seen in urban slums (38.6%), followed by rural (28.8%) and urban middle class communities (25.4%). All the women with vaginal trichomoniasis were found to have bacterial vaginosis, while 50 per cent of the subjects who had syphilis also had bacterial vaginosis. In our study, 90% of the positive BV cases were from rural areas and 10% were from urban areas (11).

In the present study, bacterial vaginosis was found to be mainly due to anaerobic bacteria which morphologically resembled Gardnerella vaginalis and Mobiluncus. Similar results were seen in a study by Sumati AH et al, where high vaginal swabs were taken from 174 female patients who complained of abnormal vaginal discharge. BV was diagnosed by clinical composite criteria and by gram staining. BV was diagnosed in 68.39% of the cases by using clinical composite criteria and in 58.4% of the cases by gram staining. They concluded that anaerobic bacteria are important pathogens in the causation of bacterial vaginosis, along with other aerobic organisms. The percentages of bacteroides and peptostreptococci were significantly raised in BV (12).

In another study by Uma S et al on bacterial vaginosis in female sex workers in Chennai, they investigated both the prevalence of BV and its association with STDs among 582 female sex workers. The vaginal swabs which were collected were gram stained and analyzed for BV by using Nugent’s scoring criteria. Of the women who were studied, 45% were positive, 39.5% were negative and 16% were intermediate for BV (13). In our study, positive bacterial vaginosis was 42 and the intermediate stage of BV was 9. In these studies, co-morbid conditions were associated with vaginosis, which could be a possible reason for the higher prevalence. The co-morbid conditions included recurrent vaginitis, various contraceptive methods, demographic characteristics, sex workers, etc (10),(13).

The percentage of Trichomoniasis was 2.1% in this study, which was similar to the results of some other studies. Sood S et al, New Delhi, who studied on the In Pouch TV culture for the detection of Trichomonas vaginalis, revealed that among 601 women, 22 (7%) were found to be positive for Trichomonas vaginalis by wet mount detection (14).

In a study by Rao VG et al on sexually transmitted infections in the tribal populations of central India, trichomoniasis, gonorrhoea, bacterial vaginosis and syphilis sero-reactivity were diagnosed by the standard microbiological techniques. Chlamydia infection was detected by using the polymerase chain reaction (PCR). A definite laboratory diagnosis of STIs could be established in 36.5% of the individuals. The most common STI in females was trichomoniasis. The highest proportion of individuals with STIs (39.2%) was in the age group of 30-39 years. When compared to this study, the prevalence of Trichomonas vaginalis in our study was found to be low (5%), since it was from the general population. The wet mount detection was not as sensitive as the PCR technique (15).

Vidhani S et al, studied on the seroprevalence of the Chalmydia trachomatis infection amongst patients with pelvic inflammatory diseases (PID) and infertility. The study evaluated the seroprevalence of the chlamydial infection in patients with pelvic inflammatory disease (ND) and infertility and in the control population of healthy normal females. The seroprevalence was found to be 82.7% in the patients and 32% in the controls by Enzyme Linked Immuno Sorbent Assay (ELISA) for any one or more classes of antichlamydial antibodies (IgG/IgM/ IgA). This study demonstrates the importanceof serology in monitoring the trends of chlamydial infections in women with PID and infertility. In our study, the rapid detection of the Chlamydial Antigen revealed a 4% positivity which was much lower than that in the study by Vidhani et al. The probable reason was that the population which was studied had PID and infertility in the latter study.

Conclusion

Bacterial vaginosis was found to be the commonest cause of abnormal vaginal discharge in women of the reproductive age group in our study, followed by Candidiasis.

Key Message

The predominant cause of the vaginosis was bacterial vaginosis. Among the 62 positive vaginosis samples, 51 were due to bacterial vaginosis. The positivity of candidiasis was 4.2%, that of trichomoniasis was 2.1% and that of chlamydiasis was 1.4%. Candidiasis was the other important cause of vaginosis in the abnormal vaginal discharge patients. Candidiasis was seen more in patients with Diabetic mellitus.

Acknowledgement

We acknowledge Dr.Lakshmi Devi, Professor and Head of Obstetrics and Gynaecology, Saveetha Medical College for the support which was rendered by her.

References

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