Sexually transmitted infections (STIs) in gynae-ou

Vol.4, No.5, 268-270 (2012) Health

doi:10.4236/health.2012.45043

Sexually transmitted infections (STIs) in

gynae-outpatients: Experience from a tertiary health

centre

Harpreet Kaur1*, Parveen Marwah1, Surjit Kaur Bajwa1, Amarjit Kaur Gill2, Manjit Singh Bal3

1*Department of Obstertrics & Gynaecology, Government Medical College and Rajindra Hospital, Patiala, India;

Corresponding Author: ****************************, ******************.in2Department of Obstertrics & Microbiology, Government Medical College and Rajindra Hospital, Patiala, India

3Department of Obstertrics & Pathology, Government Medical College and Rajindra Hospital, Patiala, India

Received 26 June 2011; revised 1 July 2011; accepted 15 July 2011

ABSTRACT

Background: Prospective analysis of 500 cases

of vaginal discharge in tertiary health centre of

Punjab. Objective: To study the prevalence of

Sexually transmitted infections (STIs) in 500

outpatient of 15 - 49 years age group with vagi-nal discharge and to evaluate the various factors

influencing pattern of STIs. Method: All cases

were subjected to cervical cytology, HIV ELISA,

All Rights plasma reagen (RPR) test for syphilis and

Gram’s staining, Giemsa staining and wet mount

study of vaginal discharge. Results: Prevalence

of STIs was found to be 58% and majority of in-fection was caused by G. vaginalis, Candida and

Trichomonas. Pap smear showed koilocytosis

in 5.6%, mild dysplasia in 1.8% and carcinoma

cervix in 1.2% cases. Conclusion: Vaginal dis-charge is a common gynaecological complaint

and STIs are significant cause of vaginal dis-charge.

Keywords:

STIs; Vaginal Discharge; HIV; Pap

Smear

1. INTRODUCTION

Sexually transmitted infections (STIs) are a group of

communicable diseases that are transmitted predomi-nantly by sexual contact and in addition, a number of

other diseases which are generally acquired by other

means, may also be acquired during coitus and produce

genital lesions [1]. List of pathogens which are sexually

transmissible has expanded from five “classical” vene-real disease agents to include more than twenty agents.

STIs form a major public health problem in the world.

They rank among the five most important causes of loss

of years of productive life in developing countries. True

incidence of STIs is difficult to estimate not because of

inadequate reporting but because of secrecy and taboos

that surround them and their epidemiology depends upon

interaction between sexually transmitted disease (STD)

pathogens, behaviors that transmit them and effective-ness of preventive and control measures [1].

STIs compromise women’s health much more than

that of men as many of them are transmitted more effi-ciently from men to women than from women to men

and once infection occurs they produce complications

more often in women. Early in the disease course,

women are more likely to have asymptomatic infection

which can result in delayed diagnosis. They are respon-sible for significant amount of female morbidity includ-ing infertility, infant illness, increased susceptibility to

HIV infection, ectopic pregnancy, preterm labor, fetal

death, low birth weight and malignancy. In the era of

AIDS, there is resurgence of interest in STDs because of

their role in facilitating HIV infection. Some of STDs

agents like human papilloma virus (HPV) are known to

have definite etiological role in causation of carcinoma

cervix. Women attending STD clinic share two major

risk factors for cervical carcinoma—early onset of coitus

& multiple sex partners. Cervical cytology study has an

important role in detecting changes due to STIs and neo-plasia & preinvasive lesions at an early stage.

Present Study was undertaken to determine the preva-lence of STIs in women with vaginal discharge present-ing to gynaecology OPD.

2. MATERIAL AND METHODS

The present study was undertaken on 500 cases of

vaginal discharge in the age group of 15 - 49 years at-tending gynaecology OPD of Government Medical Col-lege and Rajindra Hospital, Patiala (Punjab), India to

determine the prevalence of STIs in women with vaginal

discharge and to evaluate various factors influencing the

Copyright © 2012 SciRes. Openly accessible at /journal/health/

H. Kaur et al. / Health 4 (2012) 268-270

269pattern of STIs. All the women were subjected to cervi-cal cytology by Pap smear examination so as to detect

any inflammatory or dysplastic changes. Women were

enquired regarding their knowledge about STIs. In each

case detailed history, thorough physical and local pelvic

examination along with various laboratory investigations

were carried out. Gram staining, Giemsa staining and

wet mount study of vaginal discharge was carried out to

detect causative agents. All the women were subjected to

HIV ELISA and RPR test for syphilis.

2.1. Statistical Methods

Descriptive statistical analysis has been carried out in

the present study. Results on continuous measurements

are presented on Mean  SD (Min-Max) and results on

categorical measurements are presented in Number (%).

Significance is assessed at 5% level of significance. Stu-dent t test (two tailed, independent) has been used to find

the significance of study parameters on continuous scale

between two groups (Inter group analysis) on metric pa-rameters, Chi-square/Fisher Exact test has been used to

find the significance of study parameters on categorical

scale between two or more groups. p-value of <0.05 has

been taken as significant.

2.2. Statistical Software

The Statistical software namely SAS 9.2, SPSS 15.0,

Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment

ver.2.11.1 were used for the analysis of the data and Mi-

crosoft Word and Excel have been used to generate

graphs, tables etc.

3. RESULTS

A total of 500 cases of vaginal discharge in the age

group of 15 - 49 years were evaluated. Majority of women

were in the age group of 25 - 34 years and were illiterate

and unemployed. Majority of the women were married

and staying with their husband and only two percent

were married but separated and 2.2% were unmarried.

A total of 290 women were detected to have infection,

thus the prevalence of STIs was 58%. In 25.6% of cases,

cause of vaginal discharge was not determined. Various

other etiological factors for vaginal discharge were cer-vical erosion (11.6%), mild dysplasia in 1.8%, carcinoma

cervix in 1.2%, cervical polyp in one percent, senile

vaginitis in 0.8% (Table 1).

Out of 290 patients with infection 54% of cases had

mixed infection. G. vaginalis was the causative agent in

majority of cases (57.58%), followed by Candida albi-cans in 45.86%, T. vaginalis in 35.17% and HIV in

4.13% of cases. Syphilis (2.06%), gonorrhoea (0.68%)

and group B streptococcus (2.06%) infection was com-paratively less common. No case of Chlamydia trachom-

Copyright © 2012 SciRes.

atis was found in present study (Table 2).

Pap smear revealed non-specific inflammation in 76%

cases, infection with G. vaginalis in 14.4% and T. vagi-

nalis in 2.4%. Koilocytic changes suggestive of viral

infection were seen in 4.2% cases. There was evidence of

mild dysplasia in 1.8% and carcinoma cervix in 1.2% of

cases (Table 3).

Majority of the subjects were ignorant about STIs (78%)

and only 22% were having awareness about causes, treat-

ment or modes of prevention of STIs.

Thirty six percent women were taking oral contracep-tive pills. There was history of prolonged intake of anti-

Table 1. Distribution of patients according to causes of vaginal

discharge.

Causes of

Vaginal discharge

Number Percentage

Infection 290 58.0

Undetermined 128 25.6

Cervical erosion 58 11.6

Cervical dysplasia 9 1.8

Cervical carcinoma 6 1.2

Cervical polyp 5 1.0

Senile vaginitis 4 0.8

Total 500 100

Statistical Analysis

x2 DF p value Significance

541.4404 <0.001 HS

Table 2. Distribution of patients according to micro-organism

causing vaginal discharge.

Micro-organism Number Percentage

G. vaginalis

167 57.58

Candida 133 45.86

Trichomonas 102 35.17

HIV 12 4.13

Syphilis 6 2.06

Group B streptococci 6 2.06

N. gonorrhoea 2 0.68

Chlamydia 0 0

Total 290 100

Statistical Analysis

x2 DF p value Significance

170.2893 <0.001 HS

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270

H. Kaur et al. / Health 4 (2012) 268-270

Table 3. Distribution of patients according to Pap smear ex-amination.

Pap smear

exam

Non-specific

inflammation

G. vaginalis

Viral STD’s

T. vaginalis

clinic share two major risk factors for carcinoma cervix

i.e. early onset of coitus and multiple sex partners. So,

carcinoma cervix can be considered as one of 3rd genera-Number Percentage

tion STDs [7]. Majority of women were ignorant regard-380 76.00

ing causes treatment and prevention of STIs [8]. Life-style and behavior are important factors affecting spread

72 14.40

of STIs and these can be modified by proper knowledge

through appropriate health education.

21 4.2

Among the predisposing factors—OCP use, prolonged

12 2.4

use of antibiotics and diabetes mellitus were found to be

Mild dysplasia 9 1.8

Carcinoma

cervix

6 1.2

Total 500 100

Statistical

Analysis

x2 DFp value Significance

1303 5 <0.001 HS

biotics in 9.6% cases and diabetes mellitus was present

in 6.8% cases. However, no predisposing factors were

detected in 17.6% cases.

4. DISCUSSION

Vaginal discharge is the most common symptom of

STIs. Although vaginitis is not a serious condition, it

may have repercussions on women’s life. In the present

study infection was the cause of vaginal discharge in 290

cases thus giving prevalence rate of STIs to be 58%

[2,3].

Among these 290 cases of STIs—G. vaginalis was the

causative agent in majority of cases followed by candida

and Trichomonas [2,4,5]. HIV, syphilis, gonorrhoea and

group B streptococcus were found in small number of

cases. No case of chlamydia was detected in present

study which may be because of very non-specific and

insensitive method employed for its Giemsa

stain to detect inclusion bodies [6] as facilities for im-munoflourescent studies are not available in our institu-tion [4,6].

A total of 46.20% of subjects were having polymicro-bial infection, among these most common association

was of G. vaginalis with Trichomonas and candida. HIV

was associated mainly with Trichomonas, syphilis and

gonorrhoea which is explained by the fact that there is

loss of integrity of mucosal barrier in these infections

[4].

Pap smear examination showed the presence of dys-plastic cells in 1.8% cases and frank malignancy in 1.2%.

High percentage of non-specific inflammation suggests

the need for repeat smear after a course of antibiotics.

Trends in mortality from carcinoma cervix closely follow

t

rends in incidence of STIs as the women attending STD

Copyright © 2012 SciRes.

important factors. This is because of alteration of normal

vaginal ecosystem produced by these conditions [9].

5. CONCLUSION

Vaginal discharge is a common gynaecological com-plaint and STIs are important cause of vaginal discharge

thus leading to significant proportion of female morbid-ity. G. vaginalis, Candida and Trichomonas are three

important causes of vaginal discharge. Presence of STIs

indicates high risk sexual behaviour for HIV and carci-noma cervix. Early diagnosis and management of STIs at

an early stage will go a long way in improving women’s

health, economy and society.

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