Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 1  |  Page : 87-91

Vaginitis among married women attending primary healthcare in Tanta District, El-Gharbia governorate , Egypt


1 Department of Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission30-Sep-2015
Date of Acceptance03-Nov-2015
Date of Web Publication25-Jul-2017

Correspondence Address:
Dina H Abdl-Sameh
Department of Family Medicine, Tanta Family Health Center, Elgharbia, Tanta, 31511
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.211496

Rights and Permissions
  Abstract 


Objective
The aim of this study was to improve women health through studying the causes of vaginitis and evaluating the risk factors causing the infection.
Background
Vaginitis is an inflammation of the vagina. It affects all age groups from adolescents to postmenopausal women and is the most common gynecological problem faced by the primary care providers. It affects women's daily activities through changes in the amount and odor of vaginal discharge, dyspareunia, dysuria, and may get complicated with cervicitis, salpingitis, endometritis, urinary tract infections, and pelvic inflammatory disease.
Patients and methods
The study was carried out in two randomly selected family healthcare centers in urban and rural areas in Tanta district, El-Gharbia governorate, conducted from the beginning of May 2014 till April 2015. A cross-sectional analytical study was conducted involving 160 cases, including women who experienced vaginal symptoms during child-bearing and postmenopausal period. Women who had chronic diseases or psychological problem or were taking systemic therapy were excluded. After selecting the cases, 240 women who did not have vaginal symptoms were selected as controls. Questionnaire was designed to obtain full history and analysis of vaginal complaint, speculum vaginal examination, and laboratory examination of discharge.
Results
The mean age of the studied group was 29.47 ± 6.9 years. Results of the cases showed that 38.8% had fungal infection, 31.3% had bacterial vaginosis, and 8% had trichomoniasis. The study showed a statistical significant difference between cases of different types of vaginitis with regard to age of patients, intrauterine device use, previous attack, vaginal douche, menstrual hygienic pads, drying after vaginal wash, and using of public water closet.
Conclusion and recommendation
The study showed that there is relationship between bacterial vaginosis, trichomoniasis and the use of intrauterine devices and hormonal contraception and bad menstrual hygiene, and mixed infections and did not dry vagina after wash risk factor. Health education programs are recommended.

Keywords: infectious vaginitis, risk factors, primary health care


How to cite this article:
Abu Salem ME, Alkot MM, Salama AA, Abdl-Sameh DH. Vaginitis among married women attending primary healthcare in Tanta District, El-Gharbia governorate , Egypt. Menoufia Med J 2017;30:87-91

How to cite this URL:
Abu Salem ME, Alkot MM, Salama AA, Abdl-Sameh DH. Vaginitis among married women attending primary healthcare in Tanta District, El-Gharbia governorate , Egypt. Menoufia Med J [serial online] 2017 [cited 2019 Sep 21];30:87-91. Available from: http://www.mmj.eg.net/text.asp?2017/30/1/87/211496




  Introduction Top


Vaginitis is an inflammation of the vagina that is caused usually by the disturbance in the normal pH balance of vagina, which occur due to change in normal vaginal flora or infection [1],[2].

Symptoms and signs of vaginitis may include the following: change in color, odor, or amount of vaginal secretions, pain during intercourse, painful urination, and light vaginal bleeding or spotting. The characteristics of vaginal discharge may indicate the type of vaginitis [3].

There are two types of vaginitis: infectious vaginitis and noninfectious vaginitis. Common causes of infectious vaginitis include bacterial vaginosis (BV) (40–50%), vulvovaginal candidiasis (20–25%), and trichomoniasis (15–20%). Less common causes include gonorrhea, chlamydia, and mycoplasma. Noninfectious vaginitis comprises irritant vaginitis, allergic–traumatic vaginitis, and atrophic vaginitis [4].

The study has the following objectives:

General objective: The general objective is to improve women health.

Specific objectives: Specific objective is to study the prevalence of vaginitis among the studied group and find the risk factors associated with vaginitis among married women in Tanta district, El-Gharbia governorate, Egypt.


  Patients and Methods Top


A cross-sectional analytical study was conducted including 160 cases and 240 controls. It included all married women with vaginal complaints attending a family healthcare center from an urban area and one from a rural area in Tanta district, El-Gharbia governorate, during the period from beginning of May 2014 to April 2015.

Inclusion criteria

The inclusion criteria were all married women in child-bearing and postmenopausal period with vaginal complaints.

Exclusion criteria

Female patients who had chronic diseases such as diabetes mellitus, hypertension, and congestive heart failure, who were diagnosed as having a psychological problem or receiving treatment for it, and who were receiving systemic therapy or radiation were excluded from the study.

An interview questionnaire was designed to obtain information from all studied women by the investigator herself, which involved full history taking regarding sociodemographic characteristics, medical history, obstetric and gynecological history, analysis of complaint, associated symptoms, family history, and a complete physical examination. The complete physical examination placed special emphasis on weight, height, and BMI and ended with genital examination of the vagina and the cervix, with comments on the amount, odor, color, and consistency of vaginal discharge. The vaginal pH was measured directly using pH indicator strips against the lateral vaginal wall.

The diagnoses of different vaginal infections are as follow:

BV was diagnosed depending on the Amsel criteria [5], with the presence of three or four of the following points: homogenous frothy low-viscosity vaginal secretions, vaginal fluid pH more than 4.5, positive result on whiff test, or foul smelling secretions. Through laboratory investigation it was diagnosed when clue cells were seen in more than 20% of vaginal epithelium.

Candidiasis was diagnosed by the following: clinically showed vulvar itching, vaginal burning, irritation, dyspareunia, dysuria, and discharge (thick, odorless, and white); vaginal pH was 4.0–4.5; whiff test result was negative; and laboratory findings included presence of pseudohyphae (~70%) on microscopy after adding drops of 10% KOH to the vaginal smear [6].

Trichomoniasis was diagnosed by the following criteria: clinically showed profuse greenish yellow purulent (frothy or foamy) discharge with vaginal mucosa erythema, or cervical petechiae; laboratory finding showed motile pear-shaped trichomonads; vaginal pH was 5.0–6.0; and the whiff test (Amine) result was positive [7].


  Results Top


[Table 1] shows the sociodemographic data of the studied group: mean age was 29.47 ± 6.93 years, 65% were from the urban area, 52.5% belonged to the middle socioeconomic class, and 82.5% had a family size of more than five members.
Table 1 Sociodemographic data of the studied group

Click here to view


[Table 2] shows the distribution of cases according to the causative agent.
Table 2 Distribution of cases according to the causative organism

Click here to view


The current study showed that 31.3% of cases were of bacterial vaginitis, 38.8% fungal infection, 25% mixed infection, and 5% trichomoniasis.

[Table 3] shows the risk factors of vaginitis according to the type of infection.
Table 3 Risk factors of vaginitis according to the type of infection

Click here to view


The study showed statistical significant difference (P < 0.5 and <0.001) between cases with different type of vaginitis regarding age of patients, intrauterine device (IUD) as contraception, previous attack, antibiotic use in last 3 months, body weight, vaginal douche, menstrual hygienic pads, dryness after vaginal wash, and using of public WCs.

[Table 4] showed symptoms and signs according to the type of infection.
Table 4 Symptoms and signs according to the type of infection

Click here to view


The study showed statistical significant difference between cases with different type of vaginitis regarding lower abdominal pain and dysuria.


  Discussion Top


This study was conducted to assess risk factors of vaginitis among female patients during child-bearing and postmenopausal period, randomly selected from an urban family healthcare center and a rural family health unit in Tanta district, El-Gharbia governorate. It included 160 cases and 240 controls.

The mean age of the studied group was 29.47 ± 6.93 years. This is in agreement with the study by Domeika et al. [8] who mentioned that vaginitis was diagnosed among young women 20–30 years of age, and they measured ~15–30% of symptomatic women visiting a clinic.

In the current study, women in the studied groups were of middle (52.5%) and low (47.5%) socioeconomic status, and ~82.5% of them had a family size of more than five members. This is in agreement with the study by Eckert [9] who reported that socioeconomic factor and insufficient resources increase the risk of having vaginitis; this might be related to low immunity and improper hygiene.

In this study, the commonest type of vaginitis among studied women was candidiasis (38.8%), with the second being BV (31.3%), followed by mixed infection (25%) and trichomoniasis (8%). This is in disagreement with the CDC study fact sheet [10], whichreported that BV was the commonest type of vaginitis (52.6%) followed by candidiasis (29.5%) However, it is in agreement with the study by Kenyon et al. [11] who reported that the percentage of women affected by BV varies between 5 and 70%, and the rates vary according to the country.

The current study showed the risk factors of vaginitis according to the type of infection, with a significant relationship between vulvovaginal candidiasis and age of the studied women, which varied between 20 and 35 years; 85.5% of the studied female patients were diagnosed through laboratory finding as having candidiasis. This is in agreement with the study by Sobel [12] who reported that candida vaginitis was frequently diagnosed among young women, affecting as many as 15–30% of symptomatic women visiting a clinic.

IUD use is considered a risk factor for trichomoniasis (100% of cases) followed by BV (72%). This was in agreement with the study by Pham et al. [13] who reported a significant positive association between BV and IUD use.

Hormonal contraception is considered a risk factor for fungal infection (32.2% of cases). This was in agreement with the study by Brown and Laurence [14] who reported that estrogen levels were a contributing factor of candida vaginitis occurrence among reproductive-aged women (especially those using oral contraceptives).

Half of the women (50%) with bacterial and fungal infections were obese. Moreover, there was a significant relationship between BMI and types of vaginitis; the highest BMI was for women who had BV. This disagrees with the results by Mastrobattista et al. [15] who found that there was no relation between vaginitis and BMI.

In this study, 50% of women with trichomoniasis infection, 46.8% with fungal infection, and 38% with bacterial infection used vaginal douches. This finding was in agreement with the study by Eckert [9] who reported that douching and use of other chemical 'hygiene' products can alter the vaginal ecosystem and may result in vaginitis. Lack of drying of genitalia after bath and wrong direction of cleaning process after defecation are not considered risk factors of vaginitis. This is in agreement with the study by Behavior Risk Factor Surveillance System [16] which reported that these practices were found significant in only a small proportion of their patients and are not considered as risk factors.

The current study shows the distribution of symptoms and signs of each type of vaginal infection. Women with BV typically presented with vulvar itching (60%), burning and irritation (36%), dyspareunia (28%), and dysuria (40%) [17]. Women with yeast vaginitis typically presented with a complaint of vulvar itching (54.8%), vaginal burning (33.9%), dyspareunia (29%), and dysuria (19.4%) [18]. Women with trichomoniasis typically presented with vulvar itching (100%), burning and irritation (62.5%), dyspareunia (50%), and dysuria (87.5%) [19].


  Conclusion and Recommendation Top


From the present study, we can conclude the following:

  1. The most common cause of vaginitis among studied women was candidiasis (38.8%), then BV (31.3%), followed by mixed infection (25%) and trichomoniasis (8%).
  2. The use of IUDs is considered the main risk factor in BV and trichomoniasis. Hormonal contraceptive methods are considered as the main risk factor in candidiasis trichomoniasis. It also had the highest ratio of female patients who used vaginal douches, who did not dry their vagina after washing, and who followed bad menstrual hygiene. Mixed infections had a higher percentage of women who used IUDs, were obese, who did not dry their vagina after washing, and who followed bad menstrual hygiene.
  3. It is recommended that health education programs should be conducted to explain certain practices such as bath or shower each day; using sanitary pads during menstruation; avoiding self-diagnosis and treatment of vaginitis; and avoiding soaps or detergents, feminine hygiene sprays, perfumed toilet paper, or perfumed tampons that cause irritation; and avoiding nonrecommended vaginal douching.


Further research is needed to reveal the risk factors of each clinical type of vaginitis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sobel J. Approach to women with symptoms of vaginitis. Trichomoniasis 2013; 147:123.  Back to cited text no. 1
    
2.
Hainer BL. Vaginitis diagnosis and treatment. Am Fam Physician 2011; 83:807.  Back to cited text no. 2
    
3.
Schnatz RH, Miranda AM. Vaginal anatomy; 2011. Available at: http//:www.emedicine.medscape.com. [Accessed 20 July 2013].  Back to cited text no. 3
    
4.
Kenyon CR, Colebunders R. Strong association between the prevalence of bacterial vaginosis and male point-concurrency. Eur J Obstet Gynecol Reprod Biol 2014; 172:93–96.  Back to cited text no. 4
[PUBMED]    
5.
Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK, et al. Nonspecific, vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983; 74:14–22.  Back to cited text no. 5
    
6.
Esim Buyukbayrak E, Kars B, Karsidag AY, Karadeniz BI, Kaymaz O, Gencer S, et al. Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis. Arch Gynecol Obstet 2010; 282:515–519.  Back to cited text no. 6
[PUBMED]    
7.
Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2006; 55:1–94.  Back to cited text no. 7
[PUBMED]    
8.
Domeika M, Zhurauskaya L, Savicheva A, Frigo N, Sokolovskiy E, Hallén A, et al. Guidelines for the laboratory diagnosis of trichomoniasis in East European countries. J Eur Acad Dermatol Venereol 2010; 24:1125–1134.  Back to cited text no. 8
    
9.
Eckert LO. Clinical practice. Acute vulvo-vaginitis. N Engl J Med 2006; 355:1244–1252.  Back to cited text no. 9
[PUBMED]    
10.
Centers for Disease Control and Prevention. CDC fact sheet: bacterial vaginosis fact sheet. Available at: http://www.cdc.gov/std/bv/STDFact-Bacterial-Vaginosis.htm. [Accessed 19 March 2013].  Back to cited text no. 10
    
11.
Kenyon C, Colebunders R, Crucitti T. The global epidemiology of bacterial vaginosis: a systematic review. Am J Obstet Gynecol 2013; 209:505–523.  Back to cited text no. 11
[PUBMED]    
12.
Sobel JD. Candida vulvovaginitis. Lancet 2007; 369:1961–1971.  Back to cited text no. 12
[PUBMED]    
13.
Pham AT, Kives S, Merovitz L, Nitsch R, Tessler K, Yudin MH, et al. Screening for bacterial vaginosis at the time of intrauterine contraceptive device insertion. J Obstet Gynaecol Can 2012; 34:179–185.  Back to cited text no. 13
    
14.
Brown L. Pathology of the vulva and vagina. New York: Springer Science+Business Media; 2013. pp. 6–7.  Back to cited text no. 14
    
15.
Mastrobattista JM, Klebanoff MA, Carey JC, Hauth JC, Macpherson CA, Ernest J, et al. The effect of body mass index on therapeutic response to bacterial vaginosis in pregnancy. Am J Perinatol 2008; 25:233–237.  Back to cited text no. 15
    
16.
Behavior Risk Factor Surveillance System. 2009 summary data quality report (version no. 1); 2010. Available at: http//:ftp://ftp.cdc.gov/pub/Data/Brfss/2009_Summary_Data_Quality_Report.pdf. [Last accessed on 2015 Jan 15].  Back to cited text no. 16
    
17.
Anderson MR, Karasz A, Friedland S. Are vaginal symptoms ever normal? A review of the literature. Med Gen Med 2004; 6:49.  Back to cited text no. 17
    
18.
Mendling W, Brasch J, German Society for Gynecology and, Obstetrics; Working Group for Infections and Infect immunology in Gynecology and, Obstetrics; German Society of Dermatology, the Board of German, Dermatologists; German Speaking Mycological Society. Guideline vulvovaginal candidosis (2010) of the German Society for Gynecology and Obstetrics, the Working Group for Infections and Infectimmunology in Gynecology and Obstetrics, the German Society of Dermatology, the Board of German Dermatologists and the German Speaking Mycological Society. Mycoses 2012; 55 (Suppl 3) :1–13.  Back to cited text no. 18
    
19.
Anderson BL, Cosentino LA, Simhan HN, Hillier SL. Systemic immune response to Trichomonas vaginalis infection during pregnancy. Sex Transm Dis 2007; 34:392–396.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Patients and Methods
Results
Discussion
Conclusion and R...
References
Article Tables

 Article Access Statistics
    Viewed693    
    Printed2    
    Emailed0    
    PDF Downloaded90    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]