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PubMed1986

Purification and analysis of a proteinaceous aphrodisiac pheromone from hamster vaginal discharge.

Hormonally regulated proteinaceous material secreted in hamster vaginal discharge is detected via the vomeronasal organ and elicits copulatory behavior in males. The major soluble protein in estrous vaginal discharge has been isolated, characterized by molecular weight and amino acid content, and shown to have substantial aphrodisiac activity. The aphrodisiac activity of the purified protein is abolished by heating or proteolysis, and the native protein retains the activity after procedures for removing possible ligands such as volatile odorants, steroids, and peptides. This evidence that the protein is a reproductive pheromone indicates that the mammalian vomeronasal organ can mediate sensory detection of behaviorally relevant macromolecules.

Amino Acids↗
PubMed2004

Low prevalence of cervical infections in women with vaginal discharge in west Africa: implications for syndromic management.

OBJECTIVES: To measure prevalence and risk factors for cervical infections among a large sample of women consulting for vaginal discharge in west Africa and to evaluate its syndromic management through a two visit algorithm. METHODS: In 11 health centres in Bénin, Burkina Faso, Ghana, Guinée, and Mali 726 women who presented with a vaginal discharge without abdominal pain and who denied being a sex worker (SW) were enrolled. Cervical samples were tested for the detection of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) with polymerase chain reaction (PCR) assays. All participants were treated with single dose (2 g) metronidazole and clotrimazole cream for 3 days. They were randomised to be told either to come back on day 7 only if there was no improvement in the discharge (group A), or to come back on day 7 regardless of response to treatment (group B). RESULTS: Overall, the prevalence of NG and CT was only 1.9% (14/726) and 3.2% (23/726) respectively. Risk factors previously recommended by the WHO were not associated with the presence of cervical infection, with the exception of the number of sex partners in the past 3 months. When taken together, these risk factors had a positive predictive value of only 6.4% to identify cervical infections. Prevalence of cervical infection was not higher in women who came back on day 7, regardless of the strategy used. Prevalence of NG/CT was lower in Ghana and Bénin (5/280, 1.8%), where comprehensive interventions for SW have been ongoing for years, than in the three other countries (27/446, 6.1%, p = 0.01). CONCLUSIONS: NG and CT infections are uncommon in west African women who consult for vaginal discharge and who are not SW. Syndromic management of vaginal discharge should focus on the proper management of vaginitis. The control of gonococcal and chlamydial infection should be redesigned around interventions focusing on sex workers.

Adolescent↗
PubMed2004

Sorting out common causes of abnormal vaginal discharge.

A chief complaint of abnormal vaginal discharge requires a broad differential diagnosis of both infectious and noninfectious causes. The patient's history and the physical exam should guide the choice of laboratory studies, and a complete physical exam that includes a thorough examination of both the external and internal genitalia will yield additional important information. Empirical treatment is unacceptable, considering the low cost of pH testing and saline and KOH preps compared to the cost of inappropriate treatment, repeat office visits, and the likelihood that eventually these tests will need to be performed. Some of the infectious causes of abnormal discharge may lead to serious complications with inappropriate treatment.

Anti-Infective Agents↗
PubMed1992

A microbiological study of vaginal discharge in women attending a Malaysian gynaecological clinic.

Vaginal discharge is a common complaint of women attending gynaecological clinics. The purpose of this study was to compare the occurrence of commonly implicated microorganisms in vaginal discharge amongst women with or without the complaint, attending a gynaecological and family planning clinic. The association of Gardnerella vaginalis with bacterial vaginosis was also studied. It was found that there were no significant differences between the cases and controls in the isolation rate of Gardnerella vaginalis, Torulopsis glabrata, Ureaplasma urealyticum, Mycoplasma ssp and Group B streptococcus (p greater than 0.05). Only the isolation rate of Candida albicans was significantly higher in the cases than controls (p less than 0.01). However, there was a significant association of G. vaginalis with bacterial vaginosis.

Adolescent↗
PubMed2004

Genital syndromes and syndromic management of vaginal discharge in a community setting.

The objective of the study was to determine the community prevalence of genital syndromes in women and evaluate the syndromic management of vaginal discharge in this setting. A representative sample for the state of Tamilnadu was chosen using probability proportional to size cluster technique. Thirty clusters were selected from three districts. Demographic, sexual behaviour, risk factors, clinical and laboratory data were collected from the selected population using a structured questionnaire. Direct smear examination for Trichomonas vaginalis, culture for Neisseria gonorrhoeae and Haemophilus ducreyi, serological tests for syphilis (RPR and TPHA), hepatitis B (Hbs Ag ELISA), IgM and IgG antibodies to HSV2 (Novum diagnostics, Germany) and PCR test for detection of C. trachomatis from urine were done. There were 1157 women in the selected population. On examination, vaginal discharge was the most common genital syndrome (38.4%). The sensitivity, specificity, positive and negative predictive value of vaginal discharge as a marker for STD in women was found to be 43.3%, 61.6%, 10.7% and 91.1%, respectively. We concluded that treatment on the basis of syndromic management would result in over-treatment of 90% of women with vaginal discharge.

Adult↗
PubMedDate not supplied

Vaginal discharge in the prepubertal girl.

Vaginal discharges are commonly seen in the prepubertal girl. Because of the anatomy of young girls, any offending agents have easy access to the genital area. The discharge can be caused by numerous organisms, including those associated with sexually transmitted disease. Also, chemical and mechanical reactions, as well as poor hygiene on the part of the child, may cause genital irritation. Treatment is based on the historical events and a physical examination that includes cultures of the discharge. The goal is to effectively treat the underlying cause of the discharge, either by initiating proper therapeutic measures or by teaching the child about proper hygiene.

Child↗
PubMed2004

How is the high vaginal swab used to investigate vaginal discharge in primary care and how do GPs' expectations of the test match the tests performed by their microbiology services?

OBJECTIVES: To describe the management of vaginal discharge in general practice, with particular regard to the use of the high vaginal swab (HVS), and to compare GPs' expectations of this test with the processing and reporting undertaken by different laboratories. METHODS: A postal questionnaire survey of 2146 GPs in the North Thames area and postal questionnaire study of the 22 laboratories serving the same GPs were carried out. GPs were asked how they would manage a young woman with vaginal discharge and what information they would like on an HVS report. Laboratories were asked how they would process and report on the HVS sample from the same patient. RESULTS: Response rate was 26%. 72% of GPs would take an HVS and 62% would refer on to a genitourinary medicine (GUM) clinic. 45% would offer empirical therapy and 47% of these would treat for candida initially. 75% of GPs routinely request "M,C&S" on HVS samples but 55% only want to be informed about specific pathogens. Routine processing of HVS samples varies widely between laboratories and 86% only report specific pathogens. 78% of GPs would like to be offered a suggested diagnosis on HVS reports, and 74% would like a suggested treatment. 43% of laboratories ever provide a diagnosis, and 14% provide a suggested treatment. CONCLUSIONS: GPs frequently manage vaginal discharge and most of them utilise the HVS. GPs' expectations of the test are not well matched to laboratory processing or reporting of the samples.

Attitude of Health Personnel↗
PubMed1986

Vaginal discharge. Its causes and cures.

Vaginal discharge is a common complaint, the cause of which can be diagnosed on the basis of the distinguishing characteristics of the fluid itself, the course and symptoms of the infection, and the results of a few simple office laboratory tests. Accurate diagnosis is important because treatment can then be selected specifically rather than empirically. Optimal treatment differs with each of the four major causative agents: Candida, Gardnerella, Trichomonas, and Chlamydia. Prompt eradication of the infection promotes patient and public health.

Anti-Bacterial Agents↗
PubMed2005

A comparative study of clinical management strategies for vaginal discharge in family planning and genitourinary medicine settings.

OBJECTIVE: To compare strategies for management of women with vaginal discharge in genitourinary medicine (GUM) and family planning (FP) settings. METHODS: The setting was a centre housing both FP and GUM departments within a primary care trust in Scotland. The study participants were 200 women presenting with vaginal discharge. A randomised, controlled, crossover design was employed. Strategies typical of FP and GUM were performed on every participant in a randomised sequence. Day 1 diagnoses were made by the FP strategy (history and examination) and the GUM strategy (nearpatient microscopy added). Day 7 results were obtained from final analysis of all specimens. Days 1 and 7 results were compared with the reference standard provided by all the test results. The main outcome measures were incorrect diagnoses on Days 1 and 7. RESULTS: On Day 1 the FP strategy resulted in significantly more incorrect diagnoses than the GUM strategy when compared with the reference standard (73 vs 32; p <0.001). On Day 7 the GUM strategy resulted in significantly more incorrect diagnoses than the FP strategy when compared with the reference standard (32 vs 17; p = 0.019). CONCLUSIONS: Vaginal discharge can be managed effectively in community settings such as FP and primary care. The addition of near-patient microscopy produces a more accurate immediate diagnosis. The addition of a high vaginal swab for culture produces a more accurate final diagnosis. The costs of on-site microscopy must be considered.

Adolescent↗
PubMed2006

The syndromic management of vaginal discharge using single-dose treatments: a randomized controlled trial in West Africa.

OBJECTIVE: To evaluate whether single-dose treatments are as effective as standard therapy in the syndromic management of vaginal discharge. METHODS: A randomized controlled effectiveness trial compared single-dose tinidazole plus fluconazole (TF) with treatment for 7 days with metronidazole plus 3 days of treatment with vaginal clotrimazole (MC) among 1570 women presenting with vaginal discharge at primary health care institutions in Ghana, Guinea, Mali and Togo. Participants were randomly allocated to one of the two treatments by research nurses or physicians using precoded envelopes. Effectiveness was assessed by symptomatic response on day 14. CLINICAL IDENTIFIER ClinicalTrials.gov NCT00313131. FINDINGS: The two treatment regimens had similar effectiveness: complete resolution was seen in 66% (TF) and 64% (MC) and partial resolution in 33% (TF) and 34% (MC) of participants (P = 0.26). Effectiveness was similar among subgroups with vulvovaginal candidiasis, Trichomonas vaginalis vaginitis or bacterial vaginosis. The two treatment regimens had a similar effectiveness among human immunodeficiency virus (HIV)-infected (TF: n = 76, 71% complete resolution, 28% partial; MC: n = 83, 72% complete resolution, 25% partial, P = 0.76) and HIV-uninfected women (TF: n = 517, 68% complete, 32% partial; MC: n = 466, 65% complete, 33% partial, P = 0.20). Cervical infections with Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium were uncommon among women not involved in sex work, were associated with bacterial vaginosis or T. vaginalis vaginitis, and did not alter response to treatment with agents active against vaginal infections. Four-fifths of women not relieved by a single dose of TF had a favourable response when MC was administered as second-line treatment. CONCLUSION: Single-dose TF is as effective as multiple-dose MC in the syndromic management of vaginal discharge, even among women with HIV-infection. Given its low price and easier adherence, TF should be considered as a first-line treatment for vaginal discharge syndrome.

Adolescent↗
PubMed1997

Colorimetric one-tube nested PCR for detection of Trichomonas vaginalis in vaginal discharge.

A colorimetric one-tube nested PCR was developed for the detection of Trichomonas vaginalis in clinical vaginal discharge specimens. A family of 650-bp specific DNA repeats from the T. vaginalis genome was targeted. There was no cross-reaction with human DNA or other infectious agents, including Pentatrichomonas hominis and Giardia lamblia. The colorimetric assay was applied as an adjunct to nested PCR for semiquantitative determination of T. vaginalis DNA at levels corresponding to 1 to 1,000 parasites. PCR of samples prepared by a rapid boiling method was as sensitive and specific as PCR of samples prepared by the standard DNA extraction method: the equivalent of one T. vaginalis organism in 20 microliters of vaginal discharge could be detected. The colorimetric nested PCR was compared with wet mount and culture for the detection of T. vaginalis. A total of 378 clinical vaginal discharge specimens from symptomatic patients were examined; 31 patients were positive for T. vaginalis both by culture and by nested PCR. However, only 17 of these 31 patients were positive by wet mount examination. In addition, of 113 asymptomatic patients, 9 were positive for T. vaginalis by nested PCR. Of these nine PCR-positive patients, only two were also positive both by wet mount and by culture, four patients were positive by culture but negative by wet mount, and three patients were negative both by wet mount and by culture. No specimens negative by nested PCR were positive by wet mount or by culture. The three asymptomatic patients with PCR-positive but wet mount- and culture-negative samples were subsequently found to have T. vaginalis infection after repeated and prolonged culture was performed. This colorimetric nested PCR was very sensitive compared with culture for the diagnosis of vaginal trichomoniasis, especially asymptomatic T. vaginalis infection. It is also simple, specific, rapid, and semiquantitative.

Animals↗
PubMed1997

Incidence of Trichomonas vaginalis among women having vaginal discharge, in Manisa, Turkey.

Trichomoniasis characterise with a foamy yellowish odorous discharge, is an infection that causes superficial defects and necrotic ulcers in mucosa, and is spreadable with sexual contact. In T. vaginalis infection, the diagnosis can be made after the examination of saline wet mount preparations, stained smears preparation and cultivation of the vaginal discharge, the urine and the materials obtained from prostate secretion in males. In the present study, vaginal discharge samples obtained from 207 patients applied to Celal Bayar University, Medical Faculty Research Hospital, Manisa with vaginal discharge complaints were examined by utilising wet mount preparations, Giemsa staining method and CPLM cultivation method. In 27 of them (13.1%) T. vaginalis was detected by both saline wet mount preparation and Giemsa staining method. But as a result of the cultivation in CPLM media of the vaginal discharge materials collected from infected samples reproduction was observed in only 21 of them (10.2%). A treatment of Secnidazole by 2 gr. unique dose was applied to infected patients and their spouses and a complete recovery was followed up both microscopically and clinically.

Adult↗
PubMed1985

Vaginal discharge and Gardnerella vaginalis. Predisposing factors.

A total of 284 women in the reproductive years with vaginal discharge from which only Gardnerella vaginalis (GV) had been isolated, entered a questionnaire study on the possible causal relation between presence of GV and type of menstrual hygiene, type of contraception, number of deliveries, infertility and number of sexual partners. A control group consisted of 225 women without vaginal discharge. The study showed that patients with GV significantly more frequently used tampons for menstrual hygiene, sought medical assistance for vaginal discharge more often, and had more sexual partners. On the other hand, no difference was found between the two groups as to type of contraception, number of previous deliveries, and unsuccessful attempts of getting pregnant.

Female↗
PubMed1989

[The distribution of Candida species isolated from vaginal discharge].

In this study we performed swab cultures from vaginal discharge of 100 patients with various gynecological and obstetrical symptoms during visits to Ankara University Medical Faculty, Department of Gynecology and Obstetrics and Dr. Zekai Tahir Burak Women's Hospital Clinics. 23 Candida spp. were isolated and the distribution of the strains were as follows; C. albicans (16), C. glabrata (3), C. pseudotropicalis (1), C. parapsilosis (1). Two strains were untypable. Our findings indicate that C. albicans has an important role in patients with vaginal discharge.

Adult↗
PubMedDate not supplied

[A comparative study of the information value of the immunofluorescence and immunochromatographic identification of Chlamydia trachomatis antigens in smear material from the cervical canal and of the cytological picture of a vaginal discharge in pregnant women].

The cytological picture of the vaginal discharge and scrape material, obtained from 30 pregnant women of the control group (not infected with C.trachomatis) and 61 pregnant women with chlamydiosis; of these, in 42 women the comparative identification of chlamydiae by the methods of direct immunofluorescence and immunochromatography was carried out. Direct immunofluorescence was carried out with the use of a set of reagents "MicroTrak" (USA) and immunochromatographic identification was made with the use of a set of reagents "Clearview Chlamydia" (Britain). The comparison of the results of immunochromatography and direct immunofluorescence revealed that the sensitivity of the set "Clearview Chlamydia" was 100.0% in comparison with the data obtained in the examination of women with the use of the set "MicroTrak". The negative results coincided in 90.1% of cases. The common features of the cytological picture of vaginal samples taken from pregnant women were established. The optimum system of the examination of pregnant women suspected for chlamydiosis, as well as for the evaluation of the effectiveness of its treatment, was proposed.

Antigens, Bacterial↗
PubMed1986

Volatile fatty acid findings in vaginal fluid compared with symptoms, signs, other laboratory results, and susceptibility to tinidazole of malodorous vaginal discharges.

The relevance of volatile fatty acids as a diagnostic test in 79 women with abnormal vaginal discharge was evaluated by a blind, randomised, and placebo controlled trial of tinidazole as a single oral 2 g dose. Automated gas chromatography of ether extracts of discharges taken before treatment showed volatile fatty acids in 18. Volatile fatty acids correlated with malodorous, colour, and microscopically assessed altered bacterial flora and clue cells. At follow up one week later, the odour, colour, and volatile fatty acids in the vaginal discharge of women treated with tinidazole had become normal more often than in those receiving placebo. The disappearance of volatile fatty acids correlated with clinically assessed improvement in women treated with tinidazole. The volatile fatty acid test as an indicator of anaerobic bacterial flora is objective, technically simple and fast, has few problems of sample size and transportation, and may be useful in the aetiological classification and follow up treatment of non-specific vaginal discharges.

Body Fluids↗
PubMed1998

Validation of a WHO algorithm with risk assessment for the clinical management of vaginal discharge in Mwanza, Tanzania.

OBJECTIVES: (i) To determine the microbial aetiologies of vaginal discharge in STD clinic and antenatal clinic (ANC) attenders; (ii) to evaluate the performance and costs of a new WHO algorithm for the detection of gonococcal and chlamydial infections in women complaining of vaginal discharge and/or genital itching, using a risk assessment. METHODS: Two groups were enrolled: (i) 395 consecutive female patients attending a hospital outpatient clinic complaining of genital discharge or itching; and (ii) 628 consecutive pregnant women reporting at an urban ANC these symptoms. Patients were interviewed by a nurse, who applied the WHO risk score. They were then referred to the study room for interview concerning the same and other risk factors, examined, and sampled for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), and Candida albicans (CA). Sensitivity, specificity, positive predictive value, overtreatment and correct treatment rates, and cost of drugs per true case treated were estimated. RESULTS: The prevalence of NG and/or CT infections was 11.4% and 8% at the STD clinic and the ANC respectively. The most prevalent pathogens were CA (38% at both clinics) and TV (25% at the STD clinic and 34% at the ANC). The sensitivity of the WHO algorithm for NG and/or CT was 62% at the STD clinic and 46% at the ANC, and the specificities were 64% and 84% respectively. The operational feasibility of the method was good. The cost of drugs per true case treated in applying the risk assessment approach was $3.5 among nonpregnant women and $5.0 among pregnant women. This compared favourably with respective costs of $8.8 and $25.0 in applying the syndromic management alone. CONCLUSIONS: The WHO risk assessment algorithm for the diagnosis of NG and/or CT infections among women complaining of genital discharge can considerably reduce overtreatment of NG and/or CT in both pregnant and non-pregnant women, but in this study it failed to identify 38% of non-pregnant and 54% of pregnant women with these infections. The elements of the risk score may need adjustment in different settings.

Adult↗