High Prevalence of Bacterial Vaginosis Due to Gardnerella Species and Intra Genital Hygiene Impact Practices among Rural and Urban Women in Yaoundé, Cameroon

Background: Bacterial vaginosis represents a public health problem due to its high frequency in our various health facilities. Vaginal douching used by women as a means to achieve hygienic measures could be potentially dangerous. The objective of the study is to aim at bringing forth epidemiological data on intra-genital hygiene practices, determine the prevalence of bacterial vaginosis and the association between these vaginal practices and this genital infection. Methods: A cross-sectional study was conducted on March 2022 on patients received in Human Biology Laboratory of Institute of Medical Research and Medicinal Plants Studies, in Yaoundé. Data were collected by questionnaire after an oral and written consent obtained from the patients. Vaginal swabs were collected and inoculated on to Blood Agar, Chocolate with polyvitex. Identification was done using morphologically appearance, Gram staining and biochemicals tests. Statistical analysis was done using SPSS 20 software. Results: A total of 120 patients were enrolled during the study. The most represented age group of participants was 25 to 35 years with 62.5%. The overall prevalence of bacterial vaginosis was 29.16%. The prevalence of bacterial vaginosis varied according to the number of lifetime male sexual partners, women who reported having only one sexual partner in their life had a prevalence rate of 23.32%. The prevalence of bacterial vaginosis was higher in patients living in urban areas (23.33%). No significant correlation was observed between bacterial vaginosis and regularly vaginal douching and practice of intimate vaginal cleansing (p = 0.980). Conclusion: Our findings indicated that sexual behaviour traits may have an impact on the relatively high prevalence of bacterial vaginosis. This suggests that comprehensive health education programmes may be necessary to lower the incidence of bacterial vaginosis, which indicate the need for comprehensive and programmed health education programs aimed at reducing the prevalence of bacterial vaginosis.

Effectiveness of Gardnerella vaginalis culture and Nugent scoring in identifying bacterial vaginosis in pregnant women

Background:Bacterial vaginosis(BV),a lower genital tract syndrome,has been linked to adverse pregnancy outcomes and is regarded as the prevalent type of vaginal infection in females of childbearing age.Objectives:To determine the accuracy of Nugent scoring and Gardnerella vaginalis culture in the diagnosis of bacterial vaginosis(BV)among pregnant women attending antenatal clinic in Nnamdi Azikiwe University Teaching Hospital,Nnewi,Nigeria.Method:This cross-sectional study evaluated biospecimen from 333 pregnant women enrolled through systematic random sampling technique.Biospecimens of vaginal discharge were tested for BV infection using Amsel’s criteria,Nugent’s score and culture of G.Vaginalis.Using Amsel’s criteria as a“gold standard”,the Nugent’s score and culture of G.vaginalis were estimated.Results:Prevalence of 26.12%,25.82% and 28.20% of BV was found using Amsel criteria,Nugent’s method and culture of G.vaginalis,respectively.No statistical relationship exists between socio-demographic characteristics and BV(P>0.05).Sexual exposure,and vaginal hygienic practices influences BV(P<0.05)infection and also with fishy odor during or after sexual intercourse,Gardnerella morphotypes,Bacteroides morphotypes and BV(P<0.05).An inverse relationship existed between lactobacilli morphotypes and BV.The prevalence of HIV was 5.41% and 16 out of 18 had BV diagnosed using Amsel criteria.Nugent method correlated strongly with Amsel criteria(P<0.05).In comparison with Amsel criteria,it had 78.16% sensitivity,92.68% specificity,79.07% positive predictive value,92.31% negative predictive value and 88.89% accuracy rate.This was in contrast distinction to the culture of G.vaginalis,which had 56.32%sensitivity,81.70% specificity,52.13% positive predictive value,84.10% negative predictive value and 75.08% accuracy rate.Conclusion:Nugent method correlated strongly with Amsel criteria(P<0.05)and had 78.16% sensitivity,92.68% specificity,79.07% positive predictive value,92.31% negative predictive value and 88.89% accuracy rate.Contrariwise,the culture of G.vaginalis had 56.32% sensitivity,81.70% specificity,52.13% positive predictive value,84.10% negative predictive value and 75.08% accuracy rate for BV diagnosis.

Bacterial vaginosis:a synthesis of the literature on etiology,prevalence,risk factors,and relationship with chlamydia and gonorrhea infections

Bacterial vaginosis(BV) is a common vaginal disorder in women of reproductive age. Since the initial work of Leopoldo in 1953 and Gardner and Dukes in 1955, researchers have not been able to identify the causative etiologic agent of BV. There is increasing evidence, however, that BV occurs when Lactobacillus spp., the predominant species in healthy vaginal flora, are replaced by anaerobic bacteria, such as Gardenella vaginalis, Mobiluncus curtisii, M. mulieris, other anaerobic bacteria and/or Mycoplasma hominis. Worldwide, it estimated that 20%–30% of women of reproductive age attending sexually transmitted infection(STI) clinics suffer from BV, and that its prevalence can be as high as 50%–60% in high-risk populations(e.g., those who practice commercial sex work(CSW). Epidemiological data show that women are more likely to report BV if they: 1) have had a higher number of lifetime sexual partners; 2) are unmarried; 3) have engaged in their first intercourse at a younger age; 4) have engaged in CSW, and 5) practice regular douching. In the past decade, several studies have provided evidence on the contribution of sexual activity to BV. However, it is difficult to state that BV is a STI without being able to identify the etiologic agent. BV has also emerged as a public health problem due to its association with other STIs, including: human immunodeficiency virus(HIV), herpes simplex virus type 2(HSV-2), Chlamydia trachomatis(CT) and Neisseria gonorrhoeae(NG). The most recent evidence on the association between BV and CT/NG infection comes from two secondary analyses of cohort data conducted among women attending STI clinics. Based on these studies, women with BV had a 1.8 and 1.9-fold increased risk for NG and CT infection, respectively. Taken together, BV is likely a risk factor or at least an important contributor to subsequent NG or CT infection in high-risk women. Additional research is required to determine whether this association is also present in other low-risk sexually active populations, such as among women in the US military. It is essential to conduct large scale cross-sectional or population-based case-control studies to investigate the role of BV as a risk factor for CT/NG infections. These studies could lead to the development of interventions aimed at reducing the burden associated with bacterial STIs worldwide.

An evaluation of OSOM BV blue test in the diagnosis of bacterial vaginosis

Objective:To determine the prevalence of bacterial vaginosis(BV) in patients with vaginal discharge and evaluate the efficacy of OSOM BV blue test in diagnosis.Methods:OSOM BV blue test,a rapid diagnostic test based on the principle of detection of bacterial sialidase activity in vaginal fluid specimens was conducted.A total of 405 patients in the reproductive age group(15- 45 years) having vaginal discharge were included in the study along with 10 healthy age-matched controls.Two high vaginal swabs were collected aseptically from each patient.One swab was used to make smear for gram staining,and the other was for OSOM BV blue test.Amine test and vaginal pH test were taken as well.Results:The prevalence of bacterial vaginosis was 60.7%. OSOM BV blue test showed good efficacy,as compared with gram staining in diagnosing BV.The sensitivity and specificity of OSOM BV blue test were 97.6%and 97.5%respectively.Amsel’s criteria diagnosed 180(44.4%) cases of BV and had sensitivity and specificity of 67.1%and 90.6%respectively.Thus the performance of OSOM BV blue was better than the methods based on Amsel’s criteria.Conclusions:OSOM BV blue test is an efficacious bed side test,helpful in rapidly making an accurate diagnosis of BV in setups lacking laboratory facilities or expert microbiologists.

Importance of Lactic Acid in Maintaining Vaginal Health: A Review of Vaginitis and Vaginosis Etiopathogenic Bases and a Proposal for a New Treatment

The most frequent cause of visits to the gynecologist in the western world is vaginal discomfort (vaginitis and vaginosis) whose origin lies in the uncontrolled proliferation of bacteria, such as haemophilus vaginalis or Candida-type fungi, normally considered as saprophytes. Such uncontrolled development of saprophytes is caused by some types of aggression against?Doderlein bacilli and/or by a significant decrease in the amount of lactic acid (use of broad-spectrum antibiotics, douches with aggressive products, etc.). Consequently, as the vagina creates a progressively alkalinized and increasingly inadequate environment for the lactobacilli activity, a more favorable environment for the growth of saprophytes is created. The more alkaline the medium becomes, the lower the production of lactic acid. Therefore a vicious circle is created, resulting in the bacillus acidophilus near the lack of metabolism and the disappearance of lactic acid, hydrogen peroxide and bacteriocins. All of the above make it possible for saprophytic bacteria to proliferate and become pathogenic. So far, all vaginitis and vaginosis treatments have solely been focused on attacking the disproportionately developed bacteria but have not addressed the restoration of a vaginal acidic environment, i.e. the environment allowing the proliferation of lactic acid-producing bacillus acidophilus. This explains the high rate of relapse occurring after the treatment of these vaginal profiles. In this paper we propose a new treatment focused on the use of lactic acid to prevent recurrence after a vaginitis or vaginosis treatment.

Evaluation of an Orally Administered Multistrain Probiotic Supplement in Reducing Recurrences Rate of Bacterial Vaginosis: A Clinical and Microbiological Study

Background: Bacterial vaginosis (BV) is the most common urogenital disease in women, affecting about 19% - 24% of them in reproductive ages annually and after treatment, a single recurrence or more may occur in up to 58% of women within 12 months. Objective: The aim was to evaluate the effectiveness of a new orally administered food supplement, containing different probiotic strains, on women of childbearing age after the antibiotic treatment when compared with no probiotic intake. Methods: A prospective study was undertaken on 62 patients with BV. All patients were cured with metronidazole vaginal formulations (5 g of 0.75% gel once daily for 5 days or 500 mg ovules once daily for 7 days), then after was offered the option of using a new an orally administered food supplement containing: Lactobacillus plantarum PBS067, Lactobacillus rhamnosus LRH020 and Bifidobacterium animalis lactis BL050, with a total viability of 3 × 109 CFU/capsule (Intimique&#174;Femme). Among these women, 50 accepted to use the new orally food supplement, while 25 patients decided to use only metronidazole (control group). Results: The recurrence rate of BV after treatment with Intimique&#174;Femme was about 16%, compared to 40% in the control group. The incidence of abnormal vaginal microbiota decreased in both groups, but it was significantly higher in the Intimique&#174;Femme group at the end of treatment. Conclusion: This study showed that, in case of BV diagnosis, the complementary treatment of a strain-specific probiotic complex after antibiotics prophylaxis, is mandatory to reduce potential recurrences and cyclic use of further antibiotics.

Longitudinal association of gonorrhea and bacterial vaginosis with repeat chlamydia diagnoses among U.S. Army women: A retrospective cohort analysis

Background: Historically, sexually transmitted infections have affected the health of the U.S. military. To determine whether gonorrhea, bacterial vaginosis, genital herpes, and trichomoniasis are predictors of repeat chlamydia diagnoses among U.S. Army women, medical data reported into the Defense Medical Surveillance System during the 2006–2012 period were analyzed.Methods: For all inpatient and outpatient medical records, the first and second International Classification of Diseases,version 9(ICD-9) diagnostic positions were reviewed for each chlamydia case to determine the occurrence of repeat diagnoses. The Andersen-Gill regression model, an extension of the Cox model for multiple failure-time data, was used to study associations between predictors and repeat chlamydia diagnoses.Results: Among 28,201 women with a first chlamydia diagnosis, 5145(18.2%), 1163(4.1%), 267(0.9%), and 88(0.3%)had one, two, three, and four or more repeat diagnoses, respectively. Overall, the incidence of repeat chlamydia was8.31 cases per 100 person-years, with a median follow-up time of 3.39 years. Gonorrhea(hazard ratio(HR)=1.58, 95%CI: 1.44–1.73) and bacterial vaginosis(HR=1.40, 95% CI: 1.09–1.79) were significant predictors for repeat chlamydia.These estimated hazard ratios were attenuated, but remained significant, after controlling for age, race/ethnicity,marital status, and military rank. No significant association was found for genital herpes(HR=1.13, 95% CI: 0.55–2.29)and trichomoniasis(HR=1.43, 95% CI: 0.43–4.68).Conclusions: This large cohort study suggests that gonorrhea and bacterial vaginosis were associated with repeat chlamydia diagnoses among U.S. Army women. These findings can be used in formulating new interventions to prevent repeat chlamydia diagnoses.

Prevalence of bacterial vaginosis and its risk factors in HIV/AIDS patients with abnormal vaginal discharge

Objective:To determine the prevalence of bacterial vaginosis in the HIV/AIDS patients of primary health care clinics in Jos Plateau state,Nigeria.Methods:Female genital swabs were collected from primary health care centers,Jos and analyzed by microscopy,culture,etc.in Jos University Teaching Hospital from December 2006 to December 2007.Data on epidemiologic indices were collected,using structured interviewer-administered questionnaires.Results: The incidence of bacterial vaginosis in the study was 28%(n=196/700).Among the HIV/AIDS group,the bacterial vaginosis incidence was 36%(n=126/350),while in the control(non-HIV patients) group,the rate was 20%(70/350) with a statistically significant difference at 95 percent confidence level(P【0.05).HIV/AIDS and non-HIV(control) patients contributed 64%(n=126/196) and 36%(n=70/196),respectively.The risks to bacterial vaginosis included vaginal douching with disinfectant/detergent constituted(60%),poor use of condom 40%,a median age of 26 years,and a median number of 3 sex partners per week.Conclusions:There was a significant statistical difference in prevalence of bacterial vaginosis between the HIV/AIDS group and non-HIV(control) group of patients in the study.Risk behaviors that promote the incidence of bacterial vaginosis should be especially paid attention.

Effect of Hypericum perforatum L. compared with metronidazole in bacterial vaginosis:a double-blind randomized trial

Objective:To compare effect of Hypericum perforatum(H.perforatum) vaginal gel with metronidazole on bacterial vaginosis(BV) in terms of initial response to treatment and preventing recurrence(primary outcomes) and also patient complaints(secondary outcomes).Methods:In this double-blind,double dummy trial,married women aged 18-49 with BV were randomized into two groups and administered 5 g of 3%H.perforatum and placebo of metronidazole(n=82),or 5 g of 0.75%metronidazole and placebo of H.peiforatum(n=80)vaginally for 5 d.Amsel criteria were used for diagnosis and assessing cure and recurrence of BV.The comparisons was done using Chi-square,Fisher's exact and logistic regression.Results:At 10-12 d.cure rate was 82%in the H.perforatum and 85%in metronidazole group(risk ratio 0.9.95%confidence interval 0.6 to 1.3).Among the cured women,recurrence rate was 9%in the H.perforatum and 13%in the metronidazole group at the 30-35 d visit(risk ratio 0.8,95%confidence interval 0.4 to 1.3),There was no statistically significant difference between the groups regarding any patient complaints,except itching which was less in H.perforatum group(5%vs.16%,P=0.018 at the first and 13%vs.43%,P<0.001 at the second follow-up).No significant adverse event was reported at any groups.Conclusions:H.peiforatum could be a good option for treatment of BV.However,further studies arc needed for its public use.

Efficacy of standard therapy with synbiotic or without synbiotic to reduce Gardnerella vaginalis,Atopobium vaginae and Megaesphaera phylotypeⅠin pregnant women with bacterial vaginosis

Objective: To evaluate whether addition of symbiotic to clindamycin could reduce Gardnerella vaginalis,Atopobium vaginae,and Megasphaera phylotypeⅠin pregnant women with bacterial vaginosis.Methods: This randomized controlled trial(RSUP Dr.Wahidin Sudirohusodo Makassar clinical trial registry UH17010021)included 61 samples.The intervention group was given clindamycin and synbiotic while the control group was given clindamycin and placebo(without synbiotic).Wilcoxon test and hypothesis test of two independent samples were used to compare the treatment efficacy.Results: This study showed a significant difference in Nugent score before and after treatment in each group.But there was no difference in Nugent score between the intervention group and the control group after treatment or in Nugent scores reduction in both groups.The most common type of bacteria found was Megasphaera phylotypeⅠ.There were no significant differences in the three types(Gardnerella vaginalis,Atopobium vaginae,and Megasphaera phylotypeⅠ)of bacteria after treatment between both groups.Additionally,there was no difference in therapeutic effect between the intervention group and the control group.Conclusions: Clindamycin along with synbiotics is no more effective for treated bacterial vaginosis than clindamycin without synbiotics.Megaesphaera is the most commonly found bacteria,which cannot be eradicated with clindamycin.

Current Concepts of <i>Gardnerella vaginalis</i>Biofilm: Significance in Bacterial Vaginosis

Gardnerella vaginalis (GV) has been implicated in BV development. Further, biofilm is accepted as one, if not the principle reason, for recurrent or recalcitrant BV. GV has defined virulence factors that contribute to biofilm, though more may be discovered within genomic information. Key players in genital tract microecology include GV, other species of the microbiome, and the epithelial base on which microbial interactions occur. The epithelium is influenced by various forces such as douching, smoking, diet, and estrogen: other potential factors are yet unidentified. All of these factors may contribute to bacterial vaginosis. Further, biofilms usually contain microbial species in addition to GV, and the mechanisms for supporting roles of these other species provide an opportunity for elucidation. Gaps in knowledge still exist in effective therapeutics aimed at biofilm, and better understanding of the process of bacterial quiescence, persistence, and biofilm formation is a key step in future research. Purpose: This review examines current literature for information about biofilm significance in relation to GV and bacterial vaginosis. Methods: Structured literature review.

How Vaginal Infections Impact Women’s Everyday Life <br/>—Women’s Lived Experiences of Bacterial Vaginosis and Recurrent Vulvovaginal Candidiasis

Reoccurring symptoms and persistent problems that continue post treatment can be characteristic of the vaginal infections Bacterial Vaginosis (BV) and recurrent vulvovaginal candidiasis (RVVC). The purpose of this study was to describe women’s life experiences in managing the symptoms of bacterial vaginosis and Candida. Sixteen women were recruited and participated in an interview study when they contacted a Swedish gynecology clinic with vaginal complaints that ranged from and included abnormal discharge, irritation itching along with serious malodor. An interpretive phenomenological approach was used with an individual interview to get a more intimate understanding of the women experiencing these problems. The finding of this study shows that managing the recurrent symptoms of the infections remains to be a challenge for women as it has a clearly negative impact on the quality of their lives. Four themes developed: frustration and mood disorders, intimacy changes in the relationship, exposure, hope and relief. The women had high hopes of eliminating the symptoms within the six-month study period. The treatment program, with its well-developed guidelines and continuity of care within the context of the study greatly improved the quality of life of these women. Women had feelings of frustration and anxiety when nothing could cure their problem while they had also a great hope to get rid of the symptoms with a long striking treatment. Well-developed guidelines and continuity of care can help these women to have an improved quality of life.

Prevalence of Bacterial Vaginosis among Antenatal Patients at Federal Teaching Hospital Abakaliki, South East Nigeria

Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women of child bearing age. About half of these women are asymptomatic. Adverse outcomes are consistently associated with bacterial vaginosis in pregnancy and in the puerperium. This study, which was done to look at the prevalence, involved recruiting 230 participants, and screening them for BV using the Amsel’s criteria. It is hoped that identification and treatment of these women will help prevent some of the sequela associated with BV. Restoration of the vaginal microflora by treating identified cases of BV will also help reduce the transmission of HIV and herpes simplex virus (HSV) as BV propagates their replication and vaginal shedding. Two hundred and thirty women in the age range 16 - 40 years were screened for BV. All the participants douched, soap and water being predominantly used. 55 women (23.9%) had BV based on Amsel’s criteria. Women with only one sexual consort had the highest incidence of BV (51.9%).

Is There an Association between Bacterial Vaginosis Infection and HIV-1 Infection Acquisition among Women Aged 18 - 35 Years in Soweto?

Background: Studies suggest that there is association between Bacterial Vaginosis and Human Immunodeficiency Virus infection but its temporal effect has not been sufficiently investigated. Methods: It is a secondary data analysis following a cohort study. It was carried out to describe Bacterial Vaginosis infection association to Human Immunodeficiency Virus acquisition. The primary cohort study registered 750 study participants. A gram stain slide prepared from a vaginal swab was used to measure Bacterial Vaginosis as the primary exposure. A score of 7 or above was considered positive for Bacterial Vaginosis. The determination of the dependent variable Human Immunodeficiency Virus infection was achieved through dual rapid tests which were confirmed by using a third generation ELISA. Incident Human Immunodeficiency Virus infection rate was calculated. To test significance, Kaplan Meier survival time analysis and log rank test were carried out. The association of Bacterial Vaginosis with Human Immunodeficiency Virus infection was investigated using Cox regression. Results: The baseline prevalence of Bacterial Vaginosis was 52%, 95% CI;45 - 59. There were 21 Human Immunodeficiency Virus seroconversions in total of which 7 had no Bacterial Vaginosis results and were left out in the analysis. The analysis only involved 14 seroconversions and these were followed for a mean time of 0.40 of a year and total time at risk of 286 person years. This shows incident rate of Human Immunodeficiency Virus infection of 4.9 per 100 person years of follow up, 95 % CI: 2.9 - 8.27. Kaplan Meier curves revealed a higher risk of incident infection among women who were Bacterial Vaginosis positive than the women who were Bacterial Vaginosis negative. A log rank test showed that the probability of incident infection differed among the women depending on Bacterial Vaginosis status, X2 value 3.8, p value 0.05. Adjusting for the other variables, incident Human Immunodeficiency Virus infection was high among Bacterial Vaginosis positive women, adjusted hazard ratio 3.21;95% CI;0.85 - 12.12, p value 0.08, though significance was not attained. Conclusion: The study showed an association between Bacterial Vaginosis and Human Immunodeficiency Virus seroconversion risk though statistical significance was not achieved. Education on vaginal cleansing, screening and treating women with Bacterial Vaginosis could maintain normal vaginal flora and reduce their vulnerability to Human Immunodeficiency Virus.

Bacterial Vaginosis and Correlates in Women of Reproductive Age in Thika, Kenya

Background: Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge among women of childbearing age which is associated with STI/HIV and adverse birth outcomes. The Main objective of this study was to determine the prevalence and correlates of BV among women of reproductive age in Thika. Methods: Between July 2010 and February 2011, 193 women of reproductive age (18 - 49 years) were enrolled from family planning and ante-natal clinics in Thika District Hospital, Kenya. The study was descriptive cross sectional in which organisms were identified from vaginal specimens using culture, biochemical testing and Nugent score method. Statistical analyses included conventional descriptive statistics and multivariable analysis using regression. Results: Of one hundred and ninety three specimens, 9.3% were Mobiluncus isolates, 23.0% Bacteriodes species and 67.7% Gardnerella vaginalis. Among the study participants, 77.7% had non-classical BV with a score of 7 - 8 while 22.3% classical BV with a score of 9 - 10 indicating complete depletion of Lactobacillus species. Whiff test was positive for 89.1% (74) of the 83 patients with BV. Though, 32.5% of women with BV had a vaginal pH of more than 4.5, only 66.0% of women fulfilling the criteria of BV had a characteristic discharge. Conclusions: In this population, the prevalence of BV was relatively high when compared with other community settings. BV was associated with condom use and multiple sexual partners. Further research is needed to understand their role in BV and the socioeconomic context surrounding the condition in Kenya.

Identification and Antibiotic Resistance Profile of Uropathogenic Bacteria from Sexually Active Women with Bacterial Vaginosis

Background: Urinary tract infections (UTIs) in women with bacterial vaginosis (BV) continue to pose tremendous health concerns and require appropriate use of antibiotics for effective case management. This study determined the prevalence, etiology and antibiotic resistance profile of uropathogenic bacteria isolated from sexually active women with BV in Lagos Nigeria. Method: A total of 258 sexually active women presenting with gynaecological complaints at the maternal and child unit of twenty Primary Health Care Centres in Lagos Nigeria from May 2017 to March 2018 were consecutively enrolled with consent. Bacterial vaginosis was diagnosed based on Amsel criteria. Midstream urine samples were collected aseptically, analyzed for bacterial pathogens and antibiotic susceptibility using standard microbiological methods. Results: BV was diagnosed in 184 (71.3%) with 69.2% also having UTI. Ninety four (36.4%) had UTI predominantly caused by Gram negative bacteria (96.8%). The organisms isolated were Escherichia coli 79 (84.0%), Klebsiella pneumoniae 5 (5.3%), Pseudomonas aeruginosa 4 (4.3%), Proteus mirabilis 3 (3.2%) and Staphylococcus saprophyticus 3 (3.2%). The pathogens elicited high resistance (66.7% - 100%) to tetracycline, amoxicillin-clavulanic acid, nitrofurantoin and cephalosporins, and moderate resistance (50%) to ofloxacin by P. aeruginosa strains. The isolates were susceptible (100%) to piperacillin-tazobactam and meropenem. Multi-drug resistance (MDR) was observed among 97.8% of the bacteria isolated. Conclusion: Findings from this study indicate high occurrence of UTI caused by MDR pathogens among sexually active women with BV with emerging evidence of poor clinical utility of nitrofurantoin and other commonly used first-line antibiotics against UTI. Further studies on non-bacterial aetiology of BV, molecular characterization of S. saprophyticus and Gram Negative Bacteria UTI are recommended.

Asymptomatic Bacterial Vaginosis in Cervical Cytology: A Preliminary Report of Incidental Finding in Routine Cervical Cancer Screening

Background: Bacterial vaginosis is a complex pathogenic group of bacteria which can cause a wide range of symptoms in affected women in Obstetric and Gynaecological practice. Its occurrence usually indicates alteration in the normal vaginal flora expected in majority of the women of reproductive age. Amongst the maintenance agents of the vaginal health, lactobacilli occupy a prominent place. Asymptomatic bacterial vaginosis is postulated to be linked to the development of cervical intraepithelial neoplasia by some researchers while some differ in this regard. Objective: To determine the rate of occurrence of asymptomatic bacterial vaginosis and associated factors in women who underwent cervical cytology for cervical cancer screening. Study Design: A cross sectional study involving microscopic examination of cervical smears of eligible clients presenting for routine Pap smear. Setting: The study was carried out in a well woman’s facility established and manned by female medical doctors in Enugu state with the assistance of trained nursing staff. Various female cancers and other communicable and non-communicable disease screening are performed at the centre. The services are available to the general public including various parts of the state and other nearby states. Methods: This preliminary study was carried out on women presenting for cervical cancer screening between February and July 2018 in a well woman’s centre in Enugu. Information on the socio-demographic and gynaecological history of the study participants were obtained and recorded in designated proformas. Smears that showed changes suggestive of bacterial vaginosis on microscopy were set aside for further evaluation. Such changes included: a conspicuous absence of normal flora of lactobacilli;filmy background of coccobacilli replacing the lactobacilli, individual squamous cells covered by a layer of bacteria (clue cells);viable squamous cells showing reactive changes identified as increased nuclear size, perinuclear halo and binucleation. Data entry and analysis were done using statistical package for social sciences (SPSS) computer software version 21.0. Results: 285 eligible women had cervical smear done during the first six months of the 2-year project at the centre. 50.9% were above reproductive age (>45 years), 38.2% were in second half of reproductive age (31 - 45), 10.9% were in the early reproductive age (15 - 30). 13% of the women were nulliparous, 51.9% were para 1 - 4, and 35.1% were grand multiparous. Of the 285 Pap smear slides viewed, 31 had bacterial vaginosis by the above criteria. This gave a prevalence of 10.8% in the reviewed cytological smears. There was an association of bacterial vaginosis with reproductive age. There was however, no association with age at coitarche and parity. There was also, no association of bacterial vaginosis with contraceptive use. There was no association between abnormal cervical cytology and asymptomatic bacterial vaginosis with absent lactobacilli. Conclusion: Prevalence of bacterial vaginosis is significant in our study population who were asymptomatic. Cervical smear should be taken advantage of as a tool for both cervical pre-cancer and bacterial vaginosis screenings since same sample can simultaneously be used for both conditions during cytology. Bacterial vaginosis may be unlikely involved in pathogenesis of cervical intraepithelial neoplasia. Recommendation: Researchers should harmonise the standards/criteria for the diagnosis of bacterial vaginosis because there are varied criteria for the diagnosis in the literature. Given, the dual advantage of pap smear in diagnosing cervical pre cancer stages and infections, more elaborate studies are needed to determine the usefulness of treatment or otherwise of bacterial vaginosis which constitutes significant incidental findings.

Prevalence and Factors Associated with Trichomoniasis, Bacterial Vaginosis, and Candidiasis among Pregnant Women in a Regional Hospital in Cameroon

Introduction: Several microorganisms cause vaginal infections. Some of them include: Trichomonas vaginalis, Gardneralla vaginalis, Bacteriodes spp., Mobilincus and Candida albicans. In pregnancy, these infections are associated with considerable discomfort and adverse pregnancy outcome including preterm delivery, low birth weight, spontaneous abortions among others. Aims: Bacterial vaginosis, vulvovaginal trichomoniasis and candidiasis in pregnant women are associated with considerable discomfort and adverse pregnancy outcome (preterm delivery and low birth weight). We attempted to determine the prevalence of these conditions in Regional Hospital Bamenda. Methods: A total of 200 vaginal swabs were collected from pregnant women after the administration of a semi-structured questionnaire. The samples were analyzed using wet mount (Trichomonas vaginalis and Candida spp.), and the Gram stain (Gardnerella vaginalis and Candida spp.). Bivariate and multivariate analyses were used to investigate association between vaginal symptoms and their risk factors. Results: The overall prevalence of vaginal infections was 49.5%, with trichomoniasis, bacterial vaginosis, and candidiasis being 2% (4), 27% (54) and 32% (64), respectively. No formal education (AOR = 0.908;95% CI: -20.72 - 35.62;p = 0.001) and practice of douching (16.93: -0.201 - 29.692;p = 0.005) were found to be independent risk factors for trichomoniasis. Malodourous greenish vagina discharges (18.52;2.96 - 60.307;p = 0.005) were associated with trichomoniasis and bacterial vaginosis. White (6.566;17.785 - 21.836;p = 0.004) and yellowish (3.404;20.127 - 23.457;p = 0.004) vaginal discharges were independent risk factors for mycotic vagina infections. Multivariate analysis revealed that the only risk factor significantly associated to VVC in this study was the use of both water cistern and pit toilet (AOR = 3.684;95% CI: 0.388 - 2.649;p = 0.010). Conclusion: There was a high prevalence of vaginal infections. Early treatment will reduce the disease burden and avoid complications associated with it.

Comparison of main lactobacillus species between healthy women and women with bacterial vaginosis

Background The normal microbial flora of the vagina plays an important role in preventing genital and urinary tract infections in women. Thus an accurate understanding of the composition and ecology of the ecosystem is important to understanding the etiology of these diseases. This study aimed to compare the characteristics of main lactobacillus species between healthy women and women with bacterial vaginosis （BV） by quantitative culture and PCR methods. Main lactobacillus species include L. crispatus , L. gasseri, L. jensenii and L. iners.Methods A total of 150 Women attending Gynecology Outpatient Clinic of Beijing Friendship Hospital, were diagnosed as having BV because three or more of the following criteria were met （standard of Amsel＇s composite criteria）： homogeneous discharge, elevated vaginal pH （pH 〉4.5）, production of amines, and presence of ＂clue＂ cells. Those with less than three of the criteria were considered as healthy. Simultaneously, smears were made of vaginal fluid and Gram stained, then were assessed qualitatively as normal （grade Ⅰ）, intermediate （grade Ⅱ）, or consistent with BV （grade Ⅲ）. Gardnerella vaginalis were identified by using Vitek 2 Compact and PCR methods. Lactobacillus species were identified by PCR methods. Gardnerella vaginalis and lactobacilli colony counts were determined by calculating the most number of colonies of each species in the appropriate plates （colonies between 10 and 300）, corrected by the dilution of the sample in the plates, and multiplied by 10 （to account for plating 100 μl）, in order to get colony forming units per milliliter of vaginal secretion.Results BV was diagnosed in 31% （46/150） patients using the composite criteria, the remainder being regarded as healthy. The majority of patients with BV had a smear assessed as grade Ⅲ （91%, 42/46） and minority of them had a smear assessed as grade Ⅱ（9%, 4/46）. The majority of healthy women had a smear assessed as grade Ⅰ （64%, 67/104）. Smears assessed as grade Ⅱwere found （36%, 37/104） among patients diagnosed as healthy, with less than three of the composite criteria. L. crispatus was cultured from 94% of healthy women and 83% of women with BV, with the former colonies count average value of 106 and the latter of 103. L. gasseri, L. iners, and L. jensenfi were cultured from 85%, 68% and 43% of healthy women; and 28%, 89% and 44% of BV women, respectively.Conclusions The quantities of four lactobacillus species except L. jensenii had a significant difference between healthy women and women with BV. Our results provide support for the negative association between L. iners and L. gasseri. Although L. crispatus were existent both in healthy and BV positive women＇s vagina, the numbers of L. crispatus were significantly different for the dominant number in healthy women. Smears of vaginal fluid and Gram stain play an important guiding role in bacteria culture.

Directed shift of vaginal flora after topical application of sucrose gel in a phase Ⅲ clinical trial： a novel treatment for bacterial vaginosis

Background Bacterial vaginosis （BV） is one of the most common infectious diseases among sexually active women and is associated with the increased acquisition of a variety of sexually transmitted diseases.This study aimed to compare the efficacy of a non-antibiotic sucrose gel against an antibiotic metronidazole gel for the treatment of BV.Methods A randomized, double-blinded, multi-center, parallel-group, placebo-controlled phase Ⅲ clinical trial was conducted at eight hospitals in China.A total of 560 subjects with clinically diagnosed BV were randomly assigned into three groups for vaginally receiving sucrose, metronidazole, and placebo gels, respectively, twice daily for five consecutive days.The efficacy of therapeutic cure, defined as an achievement of both microbiologic cure （a Nugent score of 3 or less） and clinical cure （a resolution of the clinical findings from the baseline visit）, was evaluated at the 1st and 2nd test-of-cure （TOC） visits at 7-10 and 21-35 days after the start of treatment, respectively.Results Therapeutic cure rates for sucrose, metronidazole, and placebo gel groups were 83.13%, 71.30% and 0.92%,at the 1st TOC, and 61.04%, 66.67% and 7.34%, at the 2nd TOC, respectively.While there was no significant difference between the sucrose and metronidazole gel groups at the 2nd TOC （P=0.305）, and sucrose gel was more effective than metronidazole gel at the 1st TOC （P=0.009）.Conclusion These findings suggest that sucrose gel restores normal vaginal flora more rapidly than metronidazole gel and can be used as a novel treatment for BV.