International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Seth AR et al. Int J Reprod Contracept Obstet Gynecol. 2017 Nov;6(11):4863-4865

www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789

DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174651
Original Research Article

Prevalence of bacterial vaginosis in females in the reproductive age

group in Kadur, Karnataka, India
Akshita R. Seth, Chaitra S.*, Vaishnavi S., Sharath Chandra G. R.

Department of Obstetrics and Gynecology, ESIC PGIMSR Medical College, Bangalore, Karnataka, India

Received: 22 September 2017

Accepted: 26 September 2017

*Correspondence:
Dr. Chaitra S.,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Bacterial vaginosis, well known as the nonspecific vaginitis is caused by the normal resident flora of
the vagina, predominantly by the peroxides producing lactobacillus species, when there is a disparity in their
proportion and replaced by Gardinerella vaginalis, Mycoplasm hominis, Mobilunceus species, Bacteroids species,
Prevotela species, Fusobacterium species and Porphyromonus species, Peptostreptococcus species.
Methods: A cross section study was performed to study the prevalence of bacterial vaginosis in the reproductive age
group women and the associated risk factors. The diagnosis of the vaginosis was made from the smear and Amsle’s
clinical criteria.
Results: Out of 250 patients 112 (44.8%) were diagnosed to have BV, 20-29-year age group had the largest
percentage of infection 69 (61.6%). IUCD users 36 (32.14%) are found to be suffering from BV. Vaginal candidiasis,
trichomonas vaginalis and atypical cell of unknown significant was seen in 32 (28.5%), 9 (8.03%) and 17 (15.17%)
women respectively.
Conclusions: A routine high vaginal swab for smear and culture must be performed for every woman presenting with
chronic white discharge and itching, to prevent misuse usage of antibiotic. Further studies are needed to study the
associated risk factors for BV.

Keywords: Bacterial vaginosis, Intrauterine contraceptive device, Prevalence, Reproductive age group

INTRODUCTION genital herpes.2,3 Bacterial vaginosis is the commonest

cause of abnormal vaginal discharges in the reproductive
In the sexually transmitted infections, which poses to be a age group women and also has a strong association with
major public health problem in developing country likes preterm labor, preterm premature rupture of membranes
our bacterial vaginosis contributes to as much as 40-50% and low birth weight.4,5 Multiple study has found that
by itself.1 Every minute there is a growth of the sexually there is a strong association between sexually transmitted
transmitted disease and diagnosing them at an early stage infections (STIs) and early age of first intercourse and
and treating them remains a major challenge in a multiple sexual partners.6,7
developing country like ours.
Discharge from the vagina is a normal phenomenon to
The burden of the disease is mainly in the maintain the normal vaginal flora and environment,
underprivileged population, due to lack of knowledge and normal vaginal discharge is clear or milky with no foul
widening health facility within the populations. Globally smell. Whereas an abnormal discharge there is an altered
it is estimated that 36 million adults are infected with color, amount, associated with itching/ malodor, which is
gonorrhoea, syphilis, trichomoniasis, chlamydia and caused by the alteration in the normal vaginal flora.

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 Seth AR et al. Int J Reprod Contracept Obstet Gynecol. 2017 Nov;6(11):4863-4865

Unsafe habits of overusing vaginal douching, sprays, 50% of the women were between the age group 20-24
bubble bath, antibiotics, steroids, abnormal sugar levels years of age, 87.4% of the women were married and had
lead to the alteration of the normal flora.8 This study was at least one child. Previous history of abortion, pelvic
conducted the study the prevalence of bacterial vaginosis organs infection and other sexually transmitted infection
among the reproductive age group women, in the rural was seen in 30.3%, 41.07% and 20.5% respectively.
population of Kadur, the associated risk factors and 41.07% of the women gave history of using barrier
associated vaginal infections and the organisms causing method of contraception.
it.
Vaginal discharge collected was smeared on glass slides,
METHODS dried, heat fixed followed by staining with Gram’s
staining. The bacterial morph type was studied using the
We conducted a community based cross sectional study, following scheme: 1+, 30 per field. Large Gram-positive
on all the women residing in Kadar taluk. The study was rods were lactobacillus morphotypes; small Gram-
conducted in March 2017, over a period of 7 days. negative to Gram-variable rods were considered as G.
Following a verbal consent of all the women in their vaginalis and Bacteroides spp. morphotypes; curved
reproductive age group who presented with complains of Gram variable rods were considered as Mobiluncus spp.
chronic white discharge. We collected basic patient like morphotypes.
name, age, parity, marital history, potential risk factors
were all collected in the questioner. A total of 120 Table 2: Nugents scoring of gram staining diagnosis of
women were examined, who were all sexually active, BV.
between the age group 16 to 40 years were included in
the study. Nugents scoring Positive patients Percentage
BV 112 44.8
Following a complete general examination, per abdomen Intermediate 34 13.6
examination and pelvic examination was performed. For Normal 104 41.6
the diagnosis, the Nugent’s scoring of gram staining was 0-3 = Normal, 4-6 = Intermediate, 7-10 = BV
used. Laboratory investigations were completed in the
Kadar pathology labs and diagnostics, Kadar. Data was Associated with bacterial vaginosis was candidiasis,
analyzed using the SPSS version 20.0. which was seen in 28.5% of the women, followed by
trichomonas’s in 8.03% of the women. In concurrence
RESULTS with other studies candidiasis was the commonest
associated infection, and was with white discharge for
Of the total 250 women who were enrolled in the study more than 6 months.
112 (44.8%) of the women had a positive result.
Table 3: Association between bacterial vaginosis and
Table 1: Characteristics of the women. presence of other laboratory confirmed sexually
transmitted or reproductive tract infections.
Characteristic Patients Percentage
Age Organisms Positive patients Percentage
<19 32 28.57 Trichomoniasis 9 8.03
20-24 56 50 Candiadiasis 32 28.5
25-29 13 11.6 HIV infection 1 0.89
≥30 11 9.8 Syphilis 8 7.14
Parity Gonorrhea 0 0
Nulligravida 14 12.5
1-3 94 83.9 DISCUSSION
>3 4 3.5
History of abortion 34 30.3 There has been multiple study performed in various parts
PID 46 41.07 of India on the prevalence of bacterial vaginosis. The
STD 23 20.5 prevalence of in our study was 44.8% which was much
Contraceptive usage higher than the study conducted previously by Sangeeta
Condom 46 41.07 et al (40.66%) and in bardados (33%).9,10 Various other
IUCD 36 32.14 studies have been reported between 25.4% to 38.6%.11
OCP 5 4.46
In present study, there was a statistically significant
Injectablable hormones 0 0
association between the parity of the women the
Habits
prevalence of bacterial vaginosis. Amsel et al reported
Tobacco chewing 29 25.8
that in women using intrauterine contraceptive device
Smoking 2 1.7 there was a higher prevalence.12 In present study, we
Alcoholism 12 10.71 found 32.14% IUCD user had bacterial vaginosis.

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 Seth AR et al. Int J Reprod Contracept Obstet Gynecol. 2017 Nov;6(11):4863-4865

Many a times a vaginal discharged is made un noticed as 5. Brotman RM, Klebanoff MA, Nansel TR, Yu KF,
not a major health problem, for which a woman does not Andrews WW, Zhang J, Schwebke JR. Bacterial
seek treatment, in rural India due to lack of facilities. The vaginosis assessed by gram stain and diminished
real prevalence of the bacterial vaginosis may be under colonization resistance to incident gonococcal,
estimated in the study dude to a small sample size and chlamydial, and trichomonal genital infection. J
also due to opt out of study of many women due to Infect Dis. 2010;202(12):1907-15.
shyness. Bacterial vaginosis is an important health 6. Bukusi EA, Cohen CR, Meier AS, Waiyaki PG,
problem which may lead to intermenstrual bleed, Nguti R, Njeri JN et al. Bacterial vaginosis: risk
prolonged menstrual bleeding, chronic itching and foul factors among Kenyan women and their male
smelling discharge and chronic lower back pain. Serious partners. Sexually transmitted diseases. 2006
morbidity like associated HIV and HPV infection and Jun;33(6):361-7.
carcinoma in situ were unaware by the study population. 7. Vishwanath S, Talwar V, Prasad R, Coyaji K, Elias
Vaginal candidiasis in our study was 28.5% and higher CJ, de Zoysa I. Syndromic management of vaginal
than trichomoniasis like the same found in Watcharotone discharge among women in a reproductive health
et al.13 clinic in India. Sexually Transmitt Infect. 2000
Aug;76(4):303-6.
CONCLUSION 8. Freshwater D, Masiln-Prothero S. Blackwell’s
Nursing dictionary. 2nd ed. Blackwell publishing Ltd
The study shows us the high prevalence of Bacterial 2005;642.
Vaginosis. There was significant association between the 9. Jogi SR, Babbar K. Prevalence of bacterial vaginosis
parity, uterine manipulation, IUCD user, history of STD in sexually active females in Chhattisgarh Institute of
with bacterial vaginosis. Health education to the rural Medical Sciences, Bilaspur, Chhattisgarh. Int J
areas and need of routine pap smear needs to be Reprod Contracept Obstet Gynecol. 2015;4:963-7.
emphasized to the women in the reproductive age group. 10. Levett PN, Taruvinga M, Maheswaran K, Rotchell
The easy mode of diagnosis and treatment needs to be Y. Genital tract infections in sexually active women
stressed on to prevent morbidities. in Barbados. West Indian Med J. 1995;44:128-9.
11. Bhalla P, Chawla R, Garg S, Singh MM, Raina U,
Funding: No funding sources Bhalla R et al. Prevalence of bacterial vaginosis
Conflict of interest: None declared among women in Delhi, India. Indian J Med Res.
Ethical approval: The study was approved by the 2007;125:167-72.
Institutional Ethics Committee 12. Amsel R, Totten PA, Spiegel CA, Chen KC,
Eschenbach D, Holmes KK. Nonspecific vaginitis.
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