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The technique of differentiation of ABO antigens in a mixed spot of sperm and vaginal discharge based on higher electrophoretic mobility of spermatic protein compared to that of vaginal secretion is proposed.
OBJECTIVE: The purpose of this study was to establish the cause of and treatment for chronic vaginal discharge after uterine artery embolization. STUDY DESIGN: This was a retrospective review of the diagnosis and treatment of the procedure at 3 months. RESULTS: In 94% of patients, the condition either completely resolved or diminished to a nonproblematic level. CONCLUSION: The persistent discharge in these patients was due to a superficial cavity within the infarcted fibroid tumor that was communicating with the endometrial cavity through a hole in the endometrium. This situation is indicated by a specific appearance on TII sagittal magnetic resonance images. Hysteroscopic resection of the necrotic fibroid tumor cavity was usually curative.
A total of seven Bacteroides ureolyticus strains were isolated from the cervix and the clitoral fossa of mares with vaginal discharge. No other bacteria capable of causing metritis or vaginitis were isolated from the samples. The isolated strains resembled Taylorella equigenitalis. Both species are catalase, oxidase and alkaline phosphatase positive, but, in addition to these characteristics, B. ureolyticus strains produced urease and they could not tolerate 10% O2. They also failed to be agglutinated in a hyperimmune serum raised against T. equigenitalis; however, B. ureolyticus and T. equigenitalis were agglutinated in the slide agglutination test in a serum produced against one of the B. ureolyticus isolates. Further investigations are needed to clarify the pathologic role of B. ureolyticus in genital infections of mares and other animals.
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Of 101 fertile women (15-50 years of age) consulting in general practice due to vaginal discharge and/or genital malodor, bacterial vaginosis was diagnosed in 34% and vaginal candidiasis in 23%. The presence of Chlamydia trachomatis, Trichomonas vaginalis, genital herpes virus and Neisseria gonorrhoeae was demonstrated in 15%, 9%, 7%, and 1% of cases, respectively. No specific genital tract pathogens were found in 25 patients, where the clinical diagnosis was psychological factors (n = 5), intra-uterine device-associated discharge (n = 5), cytolytic vaginosis (n = 5), urinary tract infection (n = 3), or other/unknown causes (n = 7). In most cases diagnosis of bacterial vaginosis, vaginal candidiasis or trichomoniasis was established by clinical examination and simple office tests (pH indicator paper, amine test, microscopy of wet smear, yeast culture kit). C. trachomatis and N. gonorrhoeae were diagnosed by means of culture, cervicitis being diagnosed clinically in five of 15 cases with culture-confirmed chlamydial infection, while gonorrhoea was suspected from findings in a stained cervical smear. Sexually transmitted micro-organisms were detected in 16% of women with bacterial vaginosis or candidiasis. Of 29 women with sexually transmitted agents, 14% harbored more than one such organism.
OBJECTIVE: This study aims to examine the aetiology, clinical features and response to treatment of childhood vulvovaginitis in general practice. METHOD: A longitudinal survey of consecutive premenarchal patients presenting with vulvovaginitis and/or vaginal discharge in the course of normal consultations with a general practitioner was conducted in a semi-rural, group general practice with 11,000 patients in Plymouth, UK. Forty-two premenarchal girls with vaginal inflammation or discharge were surveyed, with main outcome measures being clinical evaluation, microbiological assessment of urine and vaginal swabs, and patients' and parents' assessments of resolution and relapse of symptoms. RESULTS: Non-specific vulvovaginitis with mixed bacterial flora, associated with poor hygiene and atrophic vaginal mucosa, was the commonest cause; specific bacteria were found in 10 out of 42 cases, including six of Streptococcus pyogenes. No candida was isolated. Treatment with topical oestrogen cream was effective only with mixed infection, oral antibiotics were effective in both mixed and single organisms. No evidence of sexual abuse nor foreign body was found. CONCLUSION: Childhood vulvovaginitis is not uncommon in general practice, is usually associated with mixed growth of faecal organisms, and is seldom due to serious causes such as sexual abuse or foreign body.
Among women attending a sexually transmitted disease (STD) clinic in Nairobi with vaginal discharge, Neisseria gonorrhoeae and Chlamydia trachomatis were isolated from the cervix in 32 (26%) of 122 and four (7%) of 58 women respectively. Infection with Trichomonas vaginalis, Candida albicans, Gardnerella vaginalis, and Mycoplasma spp were diagnosed in 42 of 122 (34%), 26 of 110 (24%), 75 of 100 (75%), and 42 of 89 (47%) women respectively. Mixed infections with at least two pathogens were found in 23 (26%) of 89 women examined for all microorganisms. Infection with N gonorrhoeae was significantly associated with abdominal pain.
This study was carried on 129 women of 16-62 age group, with complaints of vaginal discharge, genital itching and soreness, dysuria and pollakiuria. Endocervical specimens were investigated for Chlamydia trachomatis (C. trachomatis) antigen by ELISA. Risk factors for several gynecologic and obstetric pathologies and the role of C. trachomatis in mucopurulent cervicitis were emphasized. C. trachomatis antigen was found to be positive in 9 (7%) specimens. We concluded that, in cases of cervicitis, especially to prevent complications and social problems, the presence of C. trachomatis should also be investigated in addition to several viral, bacterial and fungal agents.
A proctocol to be administered by nurses for the management of dysuria, frequent urination, and vaginal discharge was validated. In a randomized, controlled trial, 146 women were seen by both nurse and physician and then assigned to either the nurse-proctocol treatment plan or the physician treatment plan. The clinical data collected by the nurse showed no important differences from the physicians' data. The protocol recommended that 89 percent of the patients be sent home without seeing the physician. The physicians agreed with the protocol-recommended disposition in all but two cases. All patients with complications were appropriately referred to the physician. In follow-up, more than 95 percent of both groups reported symptomatic improvement, and repeat urine cultures were negative. We conclude that the protocol can be accurately administered, makes sound recommendations, is safe, and efficiently saves physician time.
OBJECTIVE: To investigate the reproductive track infection (RTI) situation and risk factors for cervical infection (Neisseria gonorrhoeae or Chlamydia trachomatis) among different kinds of women of childbearing age in Shenzhen city, China. To assess the feasibility of the syndromic approach for vaginal discharge. METHODS: The survey was administrated to 4,744 eligible women in Shenzhen city during October 2001 and April 2002. The subjects included three different kinds of population: 3,895 cases of general population, 438 STD/gynecological clinic outpatients and 411 people with high risk behavior. Gynaecologic examination and RTI laboratory diagnosis were performed for each subject. PCR method-based test was used to detect the Neisseria gonorrhoeae and Chlamydia trachomatis infection. Standardized questionnaire were designed to collect the information about RTI related behaviors, and history of marriage and child bearing, et al. The risk factors, symptoms and signs of cervical infection were analyzed. Syndromic approach was established and its feasibility was assessed. RESULTS: 27.6% of women in Shenzhen were infected with at least one kind of RTI, including 5.0% with cervical infection. The risk factors for cervical infection were: individuals having had new sex partner within last 3 months (OR = 1.6, 95% CI: 1.1 - 2.4), having had the experience of abortion (OR = 1.6, 95% CI: 1.1 - 2.4), aged 25 or less (OR = 1.6, 95% CI: 1.1 - 2.4) and never using condom during sex intercourse (OR = 1.7, 95% CI: 1.1 - 2.4). The sensitivity of syndromic approach of risk assessment and signs for cervical infection among general population was 63.8%, while specificity was 55.1% with the positive predictive value 7.0%. CONCLUSIONS: RTI infection was common among all three kinds of childbearing women in Shenzhen city. The prevalence of RTI was the highest among high risk population, followed by STD/gynecological clinic outpatients. The efficacy of syndromic approach for cervical infection in general population was not ideal.
BACKGROUND: Bacterial vaginosis (BV) - a syndrome characterised by a shift in vaginal flora - appears to be particularly common in sub-Saharan Africa, but little is known of the pattern of vaginal flora associated with BV in Africa. We conducted a study aimed at determining the prevalence of BV and patterns of BV-associated vaginal micro-flora among women with vaginal discharge syndrome (VDS) in The Gambia, West Africa. METHODS: We enrolled 227 women with VDS from a large genito-urinary medicine clinic in Fajara, The Gambia. BV was diagnosed by the Nugent's score and Amsel's clinical criteria. Vaginal swabs were collected for T vaginalis and vaginal flora microscopy, and for Lactobacillus spp, aerobic organisms, Candida spp and BV-associated bacteria (Gardnerella vaginalis, anaerobic bacteria, and Mycoplasma spp) cultures; and cervical swabs were collected for N gonorrhoeae culture and C trachomatis PCR. Sera were tested for HIV-1 and HIV-2 antibodies. Sexual health history including details on sexual hygiene were obtained by standardised questionnaire. RESULTS: BV prevalence was 47.6% by Nugent's score and 30.8% by Amsel's clinical criteria. Lactobacillus spp were isolated in 37.8% of women, and 70% of the isolates were hydrogen-peroxide (H202)-producing strains. Prevalence of BV-associated bacteria were: G vaginalis 44.4%; Bacteroides 16.7%; Prevotella 15.2%; Peptostretococcus 1.5%; Mobiluncus 0%; other anaerobes 3.1%; and Mycoplasma hominis 21.4%. BV was positively associated with isolation of G vaginalis (odds-ratio [OR] 19.42, 95%CI 7.91 - 47.6) and anaerobes (P = 0.001 [OR] could not be calculated), but not with M hominis. BV was negatively associated with presence of Lactobacillus (OR 0.07, 95%CI 0.03 - 0.15), and H2O2-producing lactobacilli (OR 0.12, 95% CI 0.05 - 0.28). Presence of H2O2-producing lactobacilli was associated with significantly lower prevalence of G vaginalis, anaerobes and C trachomatis. HIV prevalence was 12.8%. Overall, there was no association between BV and HIV, and among micro-organisms associated with BV, only Bacteroides spp. and Prevotella spp. were associated with HIV. BV or vaginal flora patterns were not associated with any of the factors relating to sexual hygiene practices (vaginal douching, menstrual hygiene, female genital cutting). CONCLUSION: In this population, BV prevalence was higher than in corresponding populations in industrialised countries, but the pattern of vaginal micro-flora associated with BV was similar. BV or vaginal flora patterns were not associated with HIV nor with any of the vaginal hygiene characteristics.
Although syndromic management of sexually transmitted diseases in highly endemic areas provides a short-term benefit to the individuals treated, it has no impact on decreasing prevalence rates. The numerous factors that contribute to this are discussed. Rapid reinfection from a large pool of infected symptomatic and asymptomatic individuals as well as the non-specific nature of presenting symptoms in women with vaginal discharge syndrome are major causes.
Three hundred and thirty Black pregnant patients attending the Baragwanath Hospital antenatal clinic were treated for symptomatic vaginal discharge with econazole (Ecostatin; Squibb). Patients with positive Candida albicans cultures were treated for either 7 or 14 days. The results of treatment in both groups are presented.
This report summarizes the studies carried out on 100 patients who were examined for vaginal discharge. The following observations were made: Mycoplasma hominis in 13.59% of the cases, Ureaplasma urealytycum in 8.73% of the cases, that is, the presence of at least one of these microorganisms in 22.32 of the cases. All these infections were treated by tetracyclines administered in appropriate doses.
Poor compliance and high discontinuation rates have been observed in users of injectable hormonal contraception in South Africa. The objective of this study was to assess the side effects and reasons for discontinuation in new users of both depot-medroxyprogesterone acetate (DMPA) and norethisterone oenanthate (NET-EN). One hundred and eighty nine women were recruited into a two-year follow-up study. At each visit for a repeat injection, users were asked about bleeding patterns and side effects. Vaginal discharge, often described as watery in consistency, was perceived to be a problem amongst women and their partners. In total, one fifth (20%) of women reported an increase in discharge during use of the method and three women cited this discharge to be the primary reason for discontinuation of the method. This side effect was mainly noted in the first few months of use. Health care providers believed that this was a side effect of both DMPA and NET-EN, and women who presented with this complaint were rarely investigated for presence of sexually transmitted diseases.
The effects of neonatal exposure of hamsters to androgen on the development of an adult preference for female hamster vaginal discharge (FHVD) were investigated. Three groups treated on Days 2-3 postpartum (females administered testosterone propionate (TP) in a peanut oil base, females administered oil alone, and males administered oil alone) were combined factorially with four sequential adult conditions (intact, post-gonadectomy, post-gonadectomy plus TP therapy, and post-gonadectomy) to produce twelve experimental conditions. Statistical analysis indicated that neonatal oil females did not show a significant FHVD preference in any adult condition. Neonatal TP females displayed a significant FHVD preference only in the post-gonadectomy plus TP condition. Males retained a significant FHVD preference in all the adult conditions, although the preference shown in the two adult hormonal conditions (intact and post-gonadectomy plus TP) was significantly higher than the preference shown in the two nonhormonal conditions.
Vaginal discharge from 119 dairy cows from 59 herds was examined bacteriologically, including application of the IDEIA Chlamydia test, to detect genus-specific chlamydial LPS-antigen. A putrid quality of specimens was closely correlated with isolation of Actinomyces pyogenes (p < 0.001). The IDEIA was positive for 39 of 65 (60.0%) non-putrid specimens and for 16 of 54 (29.6%) putrid specimens; a non-putrid quality of specimens was closely correlated with the detection of chlamydial antigen (p < 0.01). IDEIA-positive results were confirmed by a blocking-antibody assay and by polymerase chain reaction (PCR) using a set of primers based on the 16S rRNA sequences of Chlamydia psittaci. Chlamydia-positive non-putrid specimens generally yielded no other bacterial pathogens. The clinical history of repeat breeding and endometritis, as well as failure to isolate other bacterial pathogens on routinely used non-living media, were strongly suggestive of primary chlamydial involvement in these cases.
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