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.

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.

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.

Impact of data balancing a multiclass dataset before the creation of association rules to study bacterial vaginosis

Background Bacterial vaginosis is a polymicrobial syndrome in which the homeostasis exerted by the Latobacillus species that protect the vaginal mucosa has been lost.This study explored the data balancing process with the intention of improving the quality of association rules.The article aimed to balance the unbalanced multiclass dataset to improve association rule creation.Methods A dataset with 201 observations and 58 variables was analyzed.A preconstructed dataset was used.The authors collected the data between August 2016 and October 2018 in Tabasco,Mexico.The study population comprised sexually active women ages 18 to 50 who underwent gynecological inspection at the infectious and metabolic diseases research laboratory at the Universidad Juarez Autonoma de Tabasco.To determine the best κ-value,the random-forest algorithm was used and the balancing was performed with the synthetic minority over-sampling technique(SMOTE),random over-sampling examples(ROSE),and adaptive syntetic sampling approach for imbalanced learning(ADASYN)algorithms.The Apriori algorithm created the rules and to select rules with statistical significance,the is.redundant(),is.significant(),and is.maximal()functions and quality metric Fisher’s exact tes were used.The biological validation was carried out by the expert(bacteriologist).Results The ADASYN algorithm at K=9 the out of the bag(OOB)error was zero,this was the best𝐾-values.In the balancing process the ADASYN algorithm show best the performance.From the dataset balanced with ADASYN,the apriori algorithm created the association rules and the selection with the quality metric Fisher’s exact test,and the biological validation reported 13 rules.Gram-bacteria Atopobium vaginae,Gardnerella vaginalis,Megasphaera filotipo 1,Mycoplasma hominis and Ureaplasma parvum were detected by the apriori algorithm from the balanced dataset.Conclusion Balancing may improve the creation of association rules to efficiently model the bacteria that cause bacterial vaginosis.

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.

Effectivity and efficacy probiotics for Bacterial Vaginosis treatments:Meta-analysis

Introduction:Bacterial Vaginosis(BV)is the most common cause of vaginal discharge.However,in some cases,side effects and resistance rates have been reported when anti-biotics are administered.This problem has prompted several investigations on the administration of probiotics as an adjunct therapy to treat this infection.Objection:This study aims to conduct a meta-analysis based on evidence to determine the efficacy and safety of probiotic and antibiotic treatments.Methods:The meta-analysis was performed using PRISMA guidelines.The literature review was conducted in December 2020 using PubMed,Science Direct,Cochrane Library,and RevMan V.5.3.Result:The results showed a high and significant cure rate from the analysis of 1006 and 528 samples of probiotics and non-probiotics or control in 16 studies.The recurrence rate was statistically significant with probiotic treatment.Furthermore,neither procedures nor therapy failure showed a significantly lower adverse event rate than the control group.Conclusion:Probiotic shows better results compared to the control group.However,both have the same occurrence of adverse event.

Incidence and factors influencing postpartum bacterial vaginosis： a controlled study

Vaginitis is a common infectious disease often associated with abnormal vaginal flora.Previous studies have shown that abnormal vaginal flora often cause bacterial vaginosis （BV）,a risk factor of preterm delivery.Therefore,BV is a concern in pregnant women.Until now,few studies have focused on changes in vaginal flora in postpartum women.Watts et al1 identified BV as a risk factor for post-cesarean endometritis.However,Yang et al2 found that the incidence of BV is higher in postpartum women than in nonpregnant women.Our study measured the incidence of BV in postpartum patients and the factors influencing the disparity in incidence.Our study was designed to identify whether BV drug therapy is necessary in postpartum women.Keywords：bacterial vaginosis; postpartum

The Utility of Voided Urine Samples as a Proxy for the Vaginal Microbiome and for the Prediction of Bacterial Vaginosis

Recent work has shown that the vaginal microbiome exerts a strong impact on women's gynecological health.However,collection of vaginal specimens is invasive and requires previous clinical training or the involvement of a trained clinician.In contrast,urine sample collection is routine and noninvasive and does not require involvement of a clinician.We sought to compare the vaginal and urogenital microbiomes to assess the utility of voided urine samples as a proxy for the vaginal microbiome.Paired urogenital and vaginal samples were collected from pregnant women and characterized by 16S rRNA taxonomic profiling.We examined diversities and compositions of paired urogenital and vaginal microbiomes using five discrete strategies to explore the similarity between the vaginal and urogenital microbiomes.A strategy comparing the paired urogenital and vaginal microbiomes in which taxa were assigned using the STIRRUPS database and urine-specific taxa were removed showed no significant difference in diversity and composition between the paired urogenital and vaginal microbiomes.Moreover,the relative abundances of common vaginal taxa were linearly correlated with those in the paired urogenitalmicrobiomes.These similarities suggest that voided urine samples could represent a noninvasive protocol for accurate profiling of the vaginalmicrobiome with likely clinical applications.Finally,a machine learning model was established in which the voided urine microbiome was compared favorably to the vaginal microbiome in predicting bacterial vaginosis.

Determining the Prevalence of Bacterial Vaginosis &Vulvovaginal Candidiasis among Married and Unmarried Women &Evaluating the Association Socio-Demographic Risk Factors &Symptoms-Related Variables in Women Attending Gynecology Clinic in Hargeisa Group Hospital, Hargeisa City, Somaliland

Background: Vaginitis refers to any inflammation or infection of the vagina. This is a common gynecological problem found in women of all ages, with one-third of women having at least one form of vaginitis at some time during their lives. The vagina is the muscular passageway between the uterus and the external genital area. When the walls of the vagina become inflamed, because some irritant has disturbed the balance of the vaginal area, vaginitis can occur. The most common types of vaginitis are: Candida or “yeast” infection, Bacterial vaginosis, Trichomoniasis vaginitis. Objectives of Study: Therefore, the present study was carried out to determine the prevalence of bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) among married and unmarried women and evaluate the association socio-demographic risk factors and symptoms-related variables in women attending gynecology clinic in Hargeisa group hospital. Methodology: A total of 150 married and unmarried women were investigated & diagnosed by a researcher in Hargeisa Group Hospital, Hargeisa City, Somaliland for determining of VVI prevalence in the present study. Vaginal swabs from these patients were processed for detection of bacterial vaginosis (BV), VVC and trichomoniasis based on guidelines of management of vagina infection. Species specific distribution of VVC was assessed by cultured of Candida on differential agar media, Germ tube test, rice meal agar and carbohydrates fermentation test and BV diagnosed by using gram staining test and biochemical testes. The nurse interviewers performed a comprehensive review of patients and completed the standardized baseline questionnaire containing information regarding the association socio-demographic risk factors and symptoms-related. Results & Discussion: The findings of the present study indicate that VVC was the most prevalent infection with 68 (45%) followed by BV 43 (29%). However, no case of trichomoniasis was detected. Candida albicans was found to be the most prevalent species with 47 (60.3%). Out of non-albicans Candida (NAC) species, C. tropicalis was found to be 9 (9.9%) and C. glabrata 7 (12.2%). On the other hand, the results of present study indicated that BV species Gardnerella vaginalis was most causative with 22 (19.5) and Lactobacillus spp. was 14 (9.3%). These results were also confirmed by gram staining test and biochemical testes. When VVI was compared among married and unmarried women, VVC was more prevalent in married women 47 (31.96) while, BV was more prevalent in unmarried women with 32 (13.76), discussed these results detected that prevalent found most highly with VVB and BV while, no case of trichomoniasis was detected. These findings are in consonance with various previous studies which have indicated VVC & BV to be the most prevalent in VI. Furthermore, the study showed statistical significant difference (P < 0.005) & relationship among prevalence of VVV & BV and some socio-demographic risk factors and some symptoms which have been identified as causes of variation in the prevalence rates of bacterial vaginosis & vagina candidasis. Conclusion: VVC was the most prevalent VVI followed by BV in Hargeisa City. C. albicans was the most prevalent species in VVC while among BV species, Gardnerella vaginalis was found to occur at highest frequency. However, further studies are needed to assess specific diagnosis and role of clinical risk factors. Urgent action is required to improve vagina infection control measures to reduce the prevalence and make new policies for treatment of vagina infection in HGH.

Comparison of Vaginal Flora in Patients with Spontaneous Abortion and Women with Normal First-Trimester

Objective: The effect of alterations in vaginal flora during pregnancy remains uncertain. We compared the flora distribution in women with spontaneous abortion(SA) and those in normal condition.Methods: Samples of vaginal discharge were obtained from 3,233 women attending the Gynecological and Public Health Centre of our hospital from January 2010 to December 2013. Pathogen culture testing was performed by the Microbiological Diagnostic Centre of our hospital, including SA group(n= 1,513), normal first-trimester group(NP group, n = 908), and nonpregnant women(control group, n= 812).Results: Of 3,233 vaginal discharge samples, 425 samples(13.15%) were positive for pathogen. The pathogen detection rate was19.96%(302/1,513), 7.93%(72/908), and 6.28%(51/812) in the SA, NP, and control groups, respectively. The five most common bacteria were Enterococcus faecalis, Candida albicans, Escherichia coli, group B Streptococcus(GBS), and Ureaplasma urealyticum(Uu) in the SA group; Uu, C. albicans, Candida tropicalis, GBS, and E.faecalis in the NP group; and Candida glabrata, Uu, E. coli, Gardnerella vaginalis,and C. albicans in the control group.Conclusions: In the SA group, the pathogen detection rate was markedly elevated. An infection of Candida sp. in pregnant women was relatively common. In routine antenatal care, overtreatment is not recommended in asymptomatic candidiasis. There was no significant difference in the detection rate of Uu between the SA group and the other two groups, suggesting that it does not cause SA.