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PubMed2006

[Investigation of the prevalence of Trichomonas vaginalis in women with complaints of vaginal discharge and itching].

Trichomonas vaginalis (T. vaginalis) is the most common pathogen that is sexually spread in women. In this study, the presence of Trichomonas vaginalis was investigated in patients with vaginal discharge and itching who presented at the polyclinic of the Mustafa Kemal University Medical Faculty Department of Gynecology. These women were between 20-40 years of age. During gynecologic examination of patients, vaginal fluid samples were collected with swaps from the speculum and fornics to two tubes that contained sterile saline. One of the vaginal discharges collected with swaps was used for direct microscopic examination and Giemsa staining. The other one was used for culturing for T. vaginalis in Trichomonas medium that contained horse serum and antibiotics. While the fre-quency of T. vaginalis was found to be 1.81% (5 of the 275 samples) by the direct microscopic examination and Giemsa stain, this ratio was 2.18% (6 of the 275 samples) by the culture method. In conclusion, it was decided to use the culture method in diagnosis of T. vaginalis in addition to direct microscopic examination. This was the first study of T. vaginalis infection in our region and it was compared with other studies carried out in other regions of Turkey. Our results were somewhat lower than those in other regions.

Adult↗
PubMed2002

Vaginal discharge due to undiagnosed bilateral duplicated collecting system with ectopic ureters in a three-year-old female: an initial high index of suspicion for sexual abuse.

In prepubertal girls with vaginal discharge, consideration of the etiology must be given to respiratory pathogens (Streptococcus pyogenes, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, and Neisseria meningitidis), enteric pathogens (Escherichia coli, Shigella, and Yersinia), poor hygiene, foreign body, nonabsorbent undergarments, irritants, vulvar skin disease, anatomic abnormalities (double vagina with fistula, pelvic abscess, and ectopic ureter), and sexual abuse. Prepubertal girls, outside the newborn period, with suspected gonococcal infection should be strongly considered to be victims of sexual abuse, once congenital and other newborn acquired forms of gonorrhea are excluded. We present a case of a three-year-old female with vaginal discharge and fever with a clouded social history, disproportionate distress on physical exam, and initial laboratory gram stain suggestive of gonococcus.

Child Abuse, Sexual↗
PubMed2005

Trichomoniasis among women with vaginal discharge in Jeddah city, Saudi Arabia.

During the year of 2003, vaginal discharge specimens were collected from 1767 women aged (15-50) in 6 cardinal hospitals in Jeddah city of Saudi Arabia. The samples were examined for Trichomonas vaginalis, a prevalence rate of 12 (0.7%) were positive. Demographic characters did not show significant relation to the infection rate. All accompanied symptoms were insignificant (P>0.05) except the vaginal consistency which was significant (P<0.05). The studied risk factors were insignificant to the T. vaginalis infection. So, the symptoms were neither reliable to diagnose the vaginal trichomoniasis nor specific underlying factors provoke the infection.

Adolescent↗
PubMed1993

Vaginal discharge as an indicator of gonorrhea and Chlamydia infection in girls under 12 years old.

Cultures for sexually transmitted diseases (STDs) are frequently obtained as part of an evaluation for alleged sexual abuse, but the prevalence of STDs in abused children is very low. Furthermore, STDs in children may not be identified if the clinician does not maintain a high index of suspicion in the symptomatic child. A retrospective review was done to study the symptoms and presenting complaints of girls under 12 with gonorrhea and chlamydia infections and to examine the prevalence of STDs in asymptomatic girls. The charts of 622 patients were reviewed. All patients were females under 12, Tanner I or II, who were initially seen for evaluation of sexual abuse or who were diagnosed with an STD. During the study period, 28 girls were found to have STDs. Twenty-two of these girls had vaginal gonorrhea; vaginal chlamydia was diagnosed in eight. Twenty-three of the 28 girls (82%) with an STD were initially seen and cultured for a chief complaint of vaginal discharge. Of the 581 patients who were cultured for evaluation of abuse, only five STDs were diagnosed (0.7%). All 22 girls with gonorrhea had a vaginal discharge on examination. Of the eight girls with chlamydia, two also had vaginal gonorrhea. Of the six who had chlamydia without gonorrhea, asymptomatic infection was common; four gave histories of discharge but only one had a discharge on examination. Our review indicates that girls under 12 who present for evaluation of vaginal discharge may have an STD and should be cultured for gonorrhea and chlamydia whether or not sexual abuse is suspected.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed2006

The VI-SENSE-vaginal discharge self-test to facilitate management of vaginal symptoms.

OBJECTIVE: This study was undertaken to evaluate a diagnostic panty liner (VI-SENSE) (Common Sense, Caesarea, Israel) developed to facilitate diagnosis of vaginal infections by detecting disordered acidity level. STUDY DESIGN: Five hundred sixteen women with vulvovaginal symptoms were enrolled. Final clinical diagnosis included Amsel criteria, Gram stain analysis, pH determination, and Trichomonas vaginalis and Candida culture. VI-SENSE strip color status estimated by patients was compared with clinical diagnosis and pH measurement by using nitrazine paper. Statistical analysis included sensitivity and specificity calculations. RESULTS: The VI-SENSE test was positive in 226 of 249 patients (90.8%) with bacterial vaginosis or trichomoniasis. Nitrazine pH paper revealed elevated pH in 165 (66.5%) and the amine test was positive in 160 (64.3%) patients. The VI-SENSE test was negative in 217 of 267 patients (81.3%) without trichomoniasis or bacterial vaginosis. The VI-SENSE was positive in 85 of 92 women (92%), with mixed vaginal infection including Candida and bacterial vaginosis or trichomoniasis. Amine test, nitrazine pH paper and physician diagnosis relying only on speculum examination were inferior and positive in only 65 (70%), 59 (64%), and 66 (72%) patients, respectively. CONCLUSION: The VI-SENSE test was found to be superior to traditional individual tests in facilitating preliminary diagnosis of vaginal infections.

Adult↗
PubMed1989

Patients with vaginal discharge in general practice.

In a multi-practice study, 80 general practitioners registered 327 patients with spontaneous complaints of vaginal discharge. Forty-eight percent of the patients were between 20 and 29 years of age, compared with 20% in the general female population (p less than 0.001). An increase in discharge was reported by 89% of the women, itching by 53%, and malodour by 38%. More than one symptom was reported by 61%. The symptoms present were mutually independent and no correlation was found with age. Seventy-six percent of women 25 years or older had had earlier instances of vaginal discharge. In patients aged 15-19, 60% had experienced earlier episodes. Male consort symptoms were reported by 14% of patients less than 25 years old and by 7% of the patients 25 years or older (p less than 0.05). Symptoms had persisted for one week or less in 36% of the women, for between 1 and 2 weeks in 27%, and for more than one year in 5%.

Adolescent↗
PubMed2006

Clinical characteristics of vaginal discharge in bacterial vaginosis diagnosed by Nugent's criteria.

PURPOSE OF INVESTIGATION: To determine which clinical signs have an important contribution in bacterial vaginosis (BV) diagnosed by Nugent's criteria. METHODS: This was a cross-sectional study of 58 women undergoing vaginal examination at Hayashi women's clinic, Hyogo Prefecture. Characteristics of vaginal discharge (color, amount, odor, and pH level) and the number of clue cells were compared among normal, intermediate, and BV groups. BV was diagnosed by using Nugent's criteria. RESULTS: The incidence of BV in our study population was 25.9%. Compared to the non-BV group, women in the BV group were found more often to have yellowish color and a moderate amount of discharge (66.67% vs 33.33%, NS; 55.56% vs 44.44%, NS), odorous discharge (100% vs 0%, p < 0.05) and furthermore, pH level and the number of clue cells were significantly higher. CONCLUSION: Odor, pH level and the number of clue cells in the vaginal discharge were helpful clinical signs for early detection of BV diagnosed by Nugent's criteria.

Cross-Sectional Studies↗
PubMed1993

[Isolation of Gardnerella vaginalis from vaginal discharge specimens].

In this study specimens taken from 93 patients who admitted to outpatient clinics of SSK Ankara Gynaecology and Obstetrics Hospital with vaginal discharge were examined for G. vaginalis, T. vaginalis, C. albicans and N. gonorrhoeae. We evaluated the smell, pH, direct microscopic examinations, stained preparations and specific culture results of the discharges which were taken from posterior fornix. We isolated G. vaginalis from 13 patients (13.9%), T. vaginalis from 5 patients (5.3%) and C. albicans from 19 patients (20.4%). N. gonorrhoeae could not be isolated from any of the specimens. In our control study, we isolated G. vaginalis in three out of 50 patients (6%) without vaginal discharge. We observed T. vaginalis in specimens of 3 control patients. C. albicans and N. gonorrhoeae could not be isolated in this study in this study.

Adult↗
PubMed1985

Quantitation of vaginal discharge in healthy volunteers.

The mean quantity of vaginal discharge measured on four occasions during one menstrual cycle in 22 asymptomatic volunteers was 1.55 g/8 h although the amount varied significantly between different days of the cycle. The maximum occurred at mid-cycle (1.96 g/8 h) and low mean values were seen on day 7 (1.38 g/8 h) and day 26 (1.37 g/8 h), contrasting with the widely held view that the discharge increases premenstrually. This cyclical variation was statistically significant (P less than 0.02) in celibate women using no contraception but was less marked in sexually active women taking the combined oral contraceptive pill.

Adult↗
PubMed1997

One-tube, nested-PCR assay for the detection of Trichomonas vaginalis in vaginal discharges.

To shorten the time and improve the accuracy of diagnosis of vaginal trichomoniasis, a novel, one-tube, nested PCR, which targets a family of 650-bp specific DNA repeats from the Trichomonas vaginalis genome, has been developed. Samples were prepared by a rapid boiling method and the PCR products analysed by gel electrophoresis. A 290-bp DNA fragment was observed in all positive cases. No cross-reaction with any other pathogens, including the Pentatrichomonas hominis and Giardia lamblia used as controls, was found. Using the assay, one genome-equivalent of T. vaginalis in 20 microliters vaginal discharge can be detected and diagnosis can be made within 6 h. When 165 clinical specimens were examined by wet amount, culture and the PCR assay, 16 were found positive for T. vaginalis by both culture and PCR, whereas only nine of these 16 cases were found to be positive by examination of wet mounts. No PCR-negative cases were positive by wet mount or culture. This new assay appears to be a simple, rapid, accurate and sensitive method for the diagnosis of vaginal trichomoniasis.

Animals↗
PubMed2004

Syndromic management of vaginal discharge and pelvic inflammatory disease among women in a rural community of Haryana, India: agreement of symptoms enquiry with clinical diagnosis.

World Health Organisation (1984) advocated syndromic approach for management of reproductive tract infections/sexually transmitted diseases. Some investigators have cautioned against using this approach to diagnose and treat vaginal discharge and pelvic inflammatory disease. The prevalence of RTIs in rural areas of Haryana is high and availability of per-speculum examination facility is scarce. The scope for laboratory diagnosis of RTI in rural areas is remote in near future. A community-based study was conducted to assess the agreement of symptoms enquiry with the syndromic diagnosis of RTIs/STDs (based upon per speculum examination). A total of 812 women were interviewed by ANMs and were examined by a lady doctor. History based ANM's diagnosis was found to be having high sensitivity (80.5%) and high positive predictive value (81.3%). However it had low specificity (48.6%) and low negative predictive value (47.5%) compared to clinical diagnosis. Level of agreement was found to be fair (Kappa = 0.28, 95% CI = 0.20-0.36). The chances of over treatment for vaginal discharge and pelvic inflammatory disease were only 16% and 15% respectively. However, history based syndromic protocols need revision. Proposed protocol is discussed in this paper.

Adolescent↗
PubMed1996

[Detection and significance of HCV RNA in saliva, seminal fluid and vaginal discharge in patients with hepatitis C].

To investigate the transmission of HCV infection through family contact, we detected HCV RNS in body fluids (saliva, seminal and vaginal discharge) of 16 serum HCV RNA positive patients (including 7 men and 9 women) and in sera of their family members. The positive rates of HCV RNA in the body fluids were 31.25% (5/16) in saliva, 57.14% (4/17) in seminal fluid and 22.22% (2/9) in vaginal discharge, respectively. Among the family members in our series, all were negative for both anti-HCV and HCV RNA, despite two spouses positive for HCV RNA. This result strongly suggested the potential possibility of the transmission of HCV infection through the family contact.

Adult↗
PubMed1975

Vulvovaginitis and vaginal discharge in general practice.

Ninety-four patients with vulvovaginitis and vaginal discharge were assessed clinically and had vaginal swabs taken in an effort to establish a definite diagnosis. A high incidence of fungous infection was found while there was a surprisingly low incidence of Trichomonal vaginitis. These findings vary markedly from recent surveys in other countries (Delaha et al. (1964); Gray and Barnes, 1965; Desai et al., 1966).

Adult↗
PubMed1991

Persistent vaginal discharge in a sexually active adolescent female.

With the high prevalence of unprotected sexual activity among adolescents, health-care providers are frequently called upon to evaluate patients with abnormal vaginal discharges. Usually, thorough pelvic and laboratory examinations will identify offending organisms which can be promptly eradicated with the judicious use of antibiotics. Occasionally, however, an abnormal discharge may persist despite these interventions. Health-care providers need to be aware of the fact that anal intercourse may be a common practice among sexually active teenagers. Penile-vaginal contact after anal intercourse may cause vaginal discharge due to contamination. Health-care providers should make it a routine part of their history-taking of adolescent patients to inquire about anal intercourse. Not only might it reveal useful clinical information, but it may indicate the need for additional health education and counseling.

Adolescent↗
PubMed1980

Vaginal discharge in children and adolescents. Evolution and management: a review.

Vaginal discharge is one of the most common gynecologic problems encountered in the pediatric and adolescent populations and may have many causes. A useful way of approaching the diagnosis of a discharge is by categorizing the patient as being prepubertal of postpubertal. In the prepubertal age group, discharge is generally associated with vulvovaginitis. In the postpubertal age group, discharge may be physiologic, or may associated with cervicitis or vaginitis. In each group, gonorrhea and sexual abuse must be ruled out. A practical approach to therapy is outlined.

Adolescent↗
PubMed1984

Primary isolation of curved rods from women with vaginal discharge.

The occurrence of motile anaerobic curved rods in vaginal discharge was studied in 94 samples from women attending an STD clinic. Almost all wet smear preparations of discharge contained motile rods. Anaerobic curved rods were isolated from 46% of the samples. Of 28 specimens studied by culture and immunofluorescence, 21 were confirmed to harbour motile anaerobic curved rods. Culture was performed with a dilution and sampling technique that is too time-consuming for diagnostic routines, but it enhanced the precision of information on motile anaerobic curved rods in vaginal secretion. More selective and rapid methods for identification of these bacteria are desirable.

Bacteria, Anaerobic↗
PubMedDate not supplied

[Evaluation of direct microscopic examination, acridine orange staining and culture methods for studies of Trichomonas vaginalis in vaginal discharge specimens].

Trichomonas vaginalis is the causative agent of human trichomoniasis which is a sexually transmitted disease mainly in women. The infection may be asymptomatic or symptomatic such as severe vaginitis and cervicitis. The aim of this study was to compare direct microscopic examination, acridine orange stained examination and culture in Modified Diamond medium, for the detection of T. vaginalis from the vaginal swab samples of 310 patients (age ranges: 17-45 years old) who were complaining from vaginal discharge. Of them 40 (12.9%) samples were found positive with culture, 20 (6.5%) were positive with direct microscopy and 19 (6.1%) were positive with acridine orange staining method. The positive results were obtained in 17 cases by each of the three methods, in 3 cases by direct microscopy and culture, in 2 cases by acridine orange staining and culture, and in 18 cases by culture only. T. vaginalis has been detected in 19.5% of 41 patients with itching, 15.7% of 190 patient with groin pain and 23.2% of 43 patients with cervical erosion, in addition to vaginal discharge, by at least one of the methods. In conditional evaluation, there were no statistically significant differences between T. vaginalis positivity with age groups and the contraceptive methods used. As a result, it was concluded that for the laboratory diagnosis of T. vaginalis, acridine orange staining technique does not have any superiority over direct microscopy. Although direct microscopy is a practical and economical method, it has low sensitivity, so all of the suspected samples which are found negative by this method, should be cultivated for a definite diagnosis.

Acridine Orange↗