DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20163876

Screening for lower genital tract infections in women of reproductive age group attending a tertiary care hospital

Malathi Murugesan, Vijayalakshmi Arumugam, Nithya Gomatheeswari, Sowmya AV

Abstract


Background: Lower genital tract infections are the major cause of gynecological morbidity and a great public health concern in India. Inadequate laboratory diagnostic facilities in all the levels of health care, limited resources in material and manpower, stigma and discrimination associated with RTI services are some of the reasons of lack of exact incidence/prevalence rate of RTI in India. Hence this study was conducted to provide a reliable laboratory based data on the occurrence of lower genital tract infections.

Methods: A prospective study was conducted on 110 women attending Gynecology OPD at a tertiary care teaching hospital over a period of one year (June 2014 to May 2015). After getting informed consent and brief history, vaginal swab and endocervical sample was collected and used for microscopic examination and culture. All the endocervical samples were subjected to Real Time PCR for detection of Chlamydia trachomatis.

Results: Among 110 samples, laboratory diagnosis of lower genital tract infections was positive in 43 subjects (39.09%). By Real time PCR assay among the 110 samples, 9 (8.8%) of the samples were positive for Chlamydia trachomatis infection. Candida sp., (17, 35.42%) was the most common organism identified followed by Escherichia coli (10, 20.83%).

Conclusions: Laboratory screening is must in all the symptomatic women in order to avoid the unnecessary treatment, which warrants the patients’ reliability. Chlamydia trachomatis screening is mandatory for all the child bearing age group women to avoid consequences like PID and infertility.

Keywords


Laboratory diagnosis, Genital infections, Reproductive age group, RTI, STI

Full Text:

PDF

References


WHO. Sexually transmitted and other reproductive tract infections. Available from: http://www.who.int/reproductivehealth/publications/rtis/9241592656/en/.

Reproductive Tract Infections Reproductive Health Epidemiology Series Module 3 - epi_module_03a_tag508.pdf. Available from: https://www.cdc.gov/reproductivehealth/productspubs/pdfs/epi_module_03a_tag508.pdf.

Malhotra M, Sood S, Mukherjee A, Muralidhar S, Bala M. Genital Chlamydia trachomatis: An update. Indian J Med Res. 2013;138(3):303-16.

Khatoon R, Jahan N, Ahmad S, Khan HM, Rabbani T. Comparison of four diagnostic techniques for detection of Trichomonas vaginalis infection in females attending tertiary care hospital of North India. Indian J Pathol Microbiol. 2015;58(1):36-9.

Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983;74(1):14-22.

Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991;29(2):297-301.

Schmale JD, Martin JE, Jr., Domescik G. OBservations on the culture diagnosis of gonorrhea in women. JAMA. 1969;210(2):312-4.

Health AGD of. Syphilis Laboratory Case Definition (LCD). Australian Government Department of Health; Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-phln-syphilis.htm.

Naidu NK, Bharucha ZS, Sonawane V, Ahmed I. Comparative study of Treponemal and non-Treponemal test for screening of blood donated at a blood center. Asian J Transfus Sci. 2012;6(1):32-5.

Ray K, Bala M, Bhattacharya M, Muralidhar S, Kumari M, Salhan S. Prevalence of RTI/STI agents and HIV infection in symptomatic and asymptomatic women attending peripheral health set-ups in Delhi, India. Epidemiol Infect. 2008;136(10):1432-40.

Nagarkar A, Mhaskar P. A systematic review on the prevalence and utilization of health care services for reproductive tract infections/sexually transmitted infections: Evidence from India. Indian J Sex Transm Dis. 2015;36(1):18-25.

Community-Based Study of Reproductive Tract Infections Among Women of the Reproductive Age Group in the Urban Health Training Centre Area in Hubli, Karnataka. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3326805/.

Prabha MLS, Sasikala G, Bala S. Comparison of syndromic diagnosis of reproductive tract infections with laboratory diagnosis among rural married women in Medak district, Andhra Pradesh. Indian J Sex Transm Dis. 2012;33(2):112-5.

Carr PL, Felsenstein D, Friedman RH. Evaluation and Management of Vaginitis. J Gen Intern Med. 1998;13(5):335-46.

Sha BE, Chen HY, Wang QJ, Zariffard MR, Cohen MH, Spear GT. Utility of Amsel criteria, Nugent score, and quantitative PCR for Gardnerella vaginalis, Mycoplasma hominis, and Lactobacillus spp. for diagnosis of bacterial vaginosis in human immunodeficiency virus-infected women. J Clin Microbiol. 2005;43(9):4607-12.

Chawla R, Bhalla P, Chadha S, Grover S, Garg S. Comparison of Hay’s criteria with Nugent’s scoring system for diagnosis of bacterial vaginosis. BioMed Res Int. 2013;2013:365194.

Modak T, Arora P, Agnes C, Ray R, Goswami S, Ghosh P, et al. Diagnosis of bacterial vaginosis in cases of abnormal vaginal discharge: comparison of clinical and microbiological criteria. J Infect Dev Ctries. 2011;5(5):353-60.

Jindal N, Gill P, Aggarwal A. An epidemiological study of vulvovaginal candidiasis in women of childbearing age. Indian J Med Microbiol. 2007;25(2):175.

Ahmad A, Khan AU. Prevalence of Candida species and potential risk factors for vulvovaginal candidiasis in Aligarh, India. Eur J Obstet Gynecol Reprod Biol. 2009;144(1):68-71.

Rathod SD, Klausner JD, Krupp K, Reingold AL, Madhivanan P. Epidemiologic features of Vulvovaginal Candidiasis among reproductive-age women in India. Infect Dis Obstet Gynecol. 2012;2012:859071.

Dwibedi B, Pramanik J, Sahu P, Kar S, Moharana T. Prevalence of genital Chlamydia infection in females attending an Obstetrics and Gynecology outpatient department in Orissa. Indian J Dermatol Venereol Leprol. 2009;75(6):614.

Patel AL, Sachdev D, Nagpal P, Chaudhry U, Sonkar SC, Mendiratta SL, et al. Prevalence of Chlamydia infection among women visiting a gynaecology outpatient department: evaluation of an in-house PCR assay for detection of Chlamydia trachomatis. Ann Clin Microbiol Antimicrob. 2010;9:24.

Jaton K, Bille J, Greub G. A novel real-time PCR to detect Chlamydia trachomatis in first-void urine or genital swabs. J Med Microbiol. 2006;55(Pt12):1667-74.

Arinze AUH, Onyebuchi NV, Isreal J. Genital chlamydia trachomatis infection among female undergraduate students of University of Port Harcourt, Nigeria. Niger Med J J Niger Med Assoc. 2014;55(1):9-13.

Mawak JD, Dashe N, Agabi YA, Panshak BW. Prevalence of Genital Chlamydia Trachomatis Infection among Gynaecologic Clinic Attendees in Jos, Nigeria. Shiraz E-Med J. 2011;12(2):100-6.

Madhivanan P, Krupp K, Hardin J, Karat C, Klausner JD, Reingold AL. Simple and inexpensive point-of-care tests improve diagnosis of vaginal infections in resource constrained settings. Trop Med Int Health TM IH. 2009;14(6):703-8.

Sood S, Kapil A. An update on Trichomonas vaginalis. Indian J Sex Transm Dis AIDS. 2008 Jan 1;29(1):7.

Shetkar S.Role of polymerase chain reaction (PCR) in the diagnosis of Trichomonas vaginalis infection in HIV infected patients. Jour Scien and Innov Rese. 2013;2(6):983-7.