Vaginosis Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2012;34(5):209-214
DOI 10.1590/S0100-72032012000500004
PURPOSE: To assess the prevalence of bacterial vaginosis and to compare the accuracy of testing pH and KOH with the Nugent gradient, the gold standard for the diagnosis of bacterial vaginosis (BV) in asymptomatic and symptomatic pregnant women at low risk. METHODS: We conducted a cross-sectional study on 321 pregnant women with gestational age between 14 and 26 weeks, 218 of them asymptomatic and 103 with vaginal complaints suggestive of bacterial vaginosis. All women were assessed by the criteria of Nugent and subjected to the measurement of vaginal pH and to the 10% KOH test. The Kappa coefficient was used to evaluate the methods in terms of diagnostic agreement. RESULTS: Most patients were adolescents (mean age 21.0±5.6 years), nulliparous and mulattos. The prevalence of bacterial vaginosis was 33.3% as estimated by the pH and KOH method and 35.5% by the Nugent method. Excellent agreement of the methods was found among asymptomatic pregnant women, with 72.5% of them showing negative results to both tests, which resulted in a high Kappa coefficient (k=0.82). The group of symptomatic women showed 49.5% positivity to both diagnostic methods, with excellent agreement (k=0.74). CONCLUSION: The prevalence of bacterial vaginosis determined by both the pH and KOH method and the Nugent score was high. The pH and KOH method can diagnose bacterial vaginosis as accurately as the Nugent criterion.
Summary
Rev Bras Ginecol Obstet. 2012;34(5):209-214
DOI 10.1590/S0100-72032012000500004
PURPOSE: To assess the prevalence of bacterial vaginosis and to compare the accuracy of testing pH and KOH with the Nugent gradient, the gold standard for the diagnosis of bacterial vaginosis (BV) in asymptomatic and symptomatic pregnant women at low risk. METHODS: We conducted a cross-sectional study on 321 pregnant women with gestational age between 14 and 26 weeks, 218 of them asymptomatic and 103 with vaginal complaints suggestive of bacterial vaginosis. All women were assessed by the criteria of Nugent and subjected to the measurement of vaginal pH and to the 10% KOH test. The Kappa coefficient was used to evaluate the methods in terms of diagnostic agreement. RESULTS: Most patients were adolescents (mean age 21.0±5.6 years), nulliparous and mulattos. The prevalence of bacterial vaginosis was 33.3% as estimated by the pH and KOH method and 35.5% by the Nugent method. Excellent agreement of the methods was found among asymptomatic pregnant women, with 72.5% of them showing negative results to both tests, which resulted in a high Kappa coefficient (k=0.82). The group of symptomatic women showed 49.5% positivity to both diagnostic methods, with excellent agreement (k=0.74). CONCLUSION: The prevalence of bacterial vaginosis determined by both the pH and KOH method and the Nugent score was high. The pH and KOH method can diagnose bacterial vaginosis as accurately as the Nugent criterion.
Summary
Rev Bras Ginecol Obstet. 2008;30(11):544-549
DOI 10.1590/S0100-72032008001100003
PURPOSE: to compare the efficacy of tinidazole and cephazolin on the febrile and infectious morbidity of post vaginal and abdominal hysterectomy antibiotic prophylaxis. METHODS: randomized clinical study, where women admitted to hospital for hysterectomy were randomly allocated in one of the following antibiotic prophylaxis groups: Group C (2 g of IV cephazolin in the anesthetic induction); Group T (2 g of tinidazole orally, 12 hours before the surgery); or Group C+T (2 g of tinidazole orally 12 hours before the surgery and 2g of IV cephazolin in the anesthetic induction). Cervicovaginal smears were collected for specific cultures and the diagnosis of bacterial vaginosis (BV) was based in Amsel and Nugent's criteria. The patients were reevaluated 7 and 30 days after the surgery for signs of febrile and/or infectious morbidity. The χ2 or the Fisher's exact test was used to assess differences among the three groups, with a significance level of 5%. The sample power (1-β) was calculated through the SAS program. RESULTS: seven days after the hysterectomy, infectious morbidity was diagnosed in 6.6% of the women, but with no significant difference among the three groups studied (p=0.12). There was no febrile or infectious morbidity at the immediate post-surgical period or after 30 days from the surgery. BV ratio at the pre-surgical period was significantly higher among the women submitted to vaginal hysterectomy, rather than among the ones submitted to abdominal hysterectomy (27 versus 7%, p=0.02). BV ratio was also higher after 30 days, among the women submitted to vaginal hysterectomy (20 versus 8%), though without statistical significance (p=0.19). CONCLUSIONS: the use of tinidazole, isolated or associated with cephazolin has not presented higher efficacy, than the use of cephazolin, alone to prevent febrile or infectious morbidity post hysterectomy. The high ratio of BV at the immediate pre-surgery period among the women submitted to vaginal hysterectomy suggests that this infection must be better investigated and properly treated before the surgery.
Summary
Rev Bras Ginecol Obstet. 2008;30(11):544-549
DOI 10.1590/S0100-72032008001100003
PURPOSE: to compare the efficacy of tinidazole and cephazolin on the febrile and infectious morbidity of post vaginal and abdominal hysterectomy antibiotic prophylaxis. METHODS: randomized clinical study, where women admitted to hospital for hysterectomy were randomly allocated in one of the following antibiotic prophylaxis groups: Group C (2 g of IV cephazolin in the anesthetic induction); Group T (2 g of tinidazole orally, 12 hours before the surgery); or Group C+T (2 g of tinidazole orally 12 hours before the surgery and 2g of IV cephazolin in the anesthetic induction). Cervicovaginal smears were collected for specific cultures and the diagnosis of bacterial vaginosis (BV) was based in Amsel and Nugent's criteria. The patients were reevaluated 7 and 30 days after the surgery for signs of febrile and/or infectious morbidity. The χ2 or the Fisher's exact test was used to assess differences among the three groups, with a significance level of 5%. The sample power (1-β) was calculated through the SAS program. RESULTS: seven days after the hysterectomy, infectious morbidity was diagnosed in 6.6% of the women, but with no significant difference among the three groups studied (p=0.12). There was no febrile or infectious morbidity at the immediate post-surgical period or after 30 days from the surgery. BV ratio at the pre-surgical period was significantly higher among the women submitted to vaginal hysterectomy, rather than among the ones submitted to abdominal hysterectomy (27 versus 7%, p=0.02). BV ratio was also higher after 30 days, among the women submitted to vaginal hysterectomy (20 versus 8%), though without statistical significance (p=0.19). CONCLUSIONS: the use of tinidazole, isolated or associated with cephazolin has not presented higher efficacy, than the use of cephazolin, alone to prevent febrile or infectious morbidity post hysterectomy. The high ratio of BV at the immediate pre-surgery period among the women submitted to vaginal hysterectomy suggests that this infection must be better investigated and properly treated before the surgery.
Summary
Rev Bras Ginecol Obstet. 2007;29(8):387-395
DOI 10.1590/S0100-72032007000800002
PURPOSE: to identify the main maternal risk factors involved in early-onset neonatal sepsis, evaluating the risk associations between bacterial vaginosis and isolated microorganisms found in the maternal urine culture and in the newborn blood culture in the delivery room. METHODS: randomized longitudinal cohort study involving 302 mothers and their newborns. All neonates were followed up for seven days in order to diagnose sepsis. RESULTS: the outcomes were the following: 16 (5.3%) early-onset neonatal sepsis cases (incidence of 53 cases per 1,000 live births). The average number of prenatal appointments with a doctor was 5.2 (SD=1.8). The number of women with prenatal follow-up was 269 (89.1%), but only 117 (43.4%) of them went to six or more medical appointments, 90 (29.8%) had premature rupture of membranes before delivery, but only 22 (7.3%) had it for more than 18 hours. A total of 123 women (40.7%) complained of vaginal discharge, but only 47 (15.6%) of them had bacterial vaginosis, 92 (30.4%) complained of urinary infection, but only 23 (7.6%) of them had bacteriuria, two (0.7%) had fever at home, 122 (40.4%) received intra-partum antibiotic prophylaxis, 40 (13.2%) had premature delivery and 37 (12.3%) had low-birth-weight babies. Gestational age was a significant risk factor (RR=92.9; IC95%:12.6-684.7), as well as the number of prenatal appointments (RR=10,8; IC95%:1,4-80,8), fever (RR=10,0; IC95%:2,3-43,5), low-birth-weight (RR=21,5; IC95%:7,3-63,2) and early neonatal death (RR=89,4; IC95%:11,16-720,6). A significant difference of 5% was found in the comparison of the averages of lower number of prenatal appointments, prematurity and lower birth weight. CONCLUSIONS: the major microorganism isolated in the newborns’ blood culture was the Streptococcus agalactiae. Prematurity, lack of prenatal follow up and low birth weight were the risk factors more associated with early neonatal sepsis.
Summary
Rev Bras Ginecol Obstet. 2007;29(8):387-395
DOI 10.1590/S0100-72032007000800002
PURPOSE: to identify the main maternal risk factors involved in early-onset neonatal sepsis, evaluating the risk associations between bacterial vaginosis and isolated microorganisms found in the maternal urine culture and in the newborn blood culture in the delivery room. METHODS: randomized longitudinal cohort study involving 302 mothers and their newborns. All neonates were followed up for seven days in order to diagnose sepsis. RESULTS: the outcomes were the following: 16 (5.3%) early-onset neonatal sepsis cases (incidence of 53 cases per 1,000 live births). The average number of prenatal appointments with a doctor was 5.2 (SD=1.8). The number of women with prenatal follow-up was 269 (89.1%), but only 117 (43.4%) of them went to six or more medical appointments, 90 (29.8%) had premature rupture of membranes before delivery, but only 22 (7.3%) had it for more than 18 hours. A total of 123 women (40.7%) complained of vaginal discharge, but only 47 (15.6%) of them had bacterial vaginosis, 92 (30.4%) complained of urinary infection, but only 23 (7.6%) of them had bacteriuria, two (0.7%) had fever at home, 122 (40.4%) received intra-partum antibiotic prophylaxis, 40 (13.2%) had premature delivery and 37 (12.3%) had low-birth-weight babies. Gestational age was a significant risk factor (RR=92.9; IC95%:12.6-684.7), as well as the number of prenatal appointments (RR=10,8; IC95%:1,4-80,8), fever (RR=10,0; IC95%:2,3-43,5), low-birth-weight (RR=21,5; IC95%:7,3-63,2) and early neonatal death (RR=89,4; IC95%:11,16-720,6). A significant difference of 5% was found in the comparison of the averages of lower number of prenatal appointments, prematurity and lower birth weight. CONCLUSIONS: the major microorganism isolated in the newborns’ blood culture was the Streptococcus agalactiae. Prematurity, lack of prenatal follow up and low birth weight were the risk factors more associated with early neonatal sepsis.
Summary
Rev Bras Ginecol Obstet. 2005;27(5):257-262
DOI 10.1590/S0100-72032005000500005
PURPOSE: to verify if the high frequency of vaginal intercourses and the use of doushing interferes with vaginal microbiota. METHODS: ninety-seven women were examined at a health center located in the prostitution area of the city of Campinas, and evaluated in a prospective cross-sectional study. Anamnesis determined the frequency of vaginal intercourse and the use of douching in the 44 sex professionals and 53 non-professionals studied. The vaginal content was collected with a sterile Dacron swab, from the right vaginal wall, and placed on to two glass laminas. The vaginal microbiota smear stained by the Gram technique was studied with light microcopy using immersion lens and the data were analyzed. The sex professionals and non-professionals presented mean age of 24.9±6.4 and 31.5±9.7, habit of smoking in 52.2 and 24.5%, the use of vaginal lubricants in 56.8 and 0%, and the use of condoms in 100 and 41.5% of the cases, respectively. RESULTS: only 1.8% of the women in the control group had seven or more sexual intercourses per week, contrasting evidently with the sex professionals (97.7%). There were no significant differences regarding race, educational level and number of pregnancies. Bacterial vaginosis and abnormal vaginal flora were more observed in sex professionals (p=0.02 and 0.001) and were associated with the high frequency (seven times or more) of weekly vaginal intercourses (p=0.04 and 0.001). Cytolytic vaginosis was more related to non-professionals (p=0.04) and to a lower frequency of sexual intercourses (p=0.04). The use of doushing was more common in the sex professionals (p=0.002). However, this practice was not associated either with the vaginal microbiota problems or with the presence of vulvovaginitis. CONCLUSIONS: sex professionals with seven or more sexual intercourses per week presented a higher frequency of bacterial vaginosis and abnormal vaginal flora. The doushing habit did not interfere with the vaginal environment ecosystem of the studied women.
Summary
Rev Bras Ginecol Obstet. 2005;27(5):257-262
DOI 10.1590/S0100-72032005000500005
PURPOSE: to verify if the high frequency of vaginal intercourses and the use of doushing interferes with vaginal microbiota. METHODS: ninety-seven women were examined at a health center located in the prostitution area of the city of Campinas, and evaluated in a prospective cross-sectional study. Anamnesis determined the frequency of vaginal intercourse and the use of douching in the 44 sex professionals and 53 non-professionals studied. The vaginal content was collected with a sterile Dacron swab, from the right vaginal wall, and placed on to two glass laminas. The vaginal microbiota smear stained by the Gram technique was studied with light microcopy using immersion lens and the data were analyzed. The sex professionals and non-professionals presented mean age of 24.9±6.4 and 31.5±9.7, habit of smoking in 52.2 and 24.5%, the use of vaginal lubricants in 56.8 and 0%, and the use of condoms in 100 and 41.5% of the cases, respectively. RESULTS: only 1.8% of the women in the control group had seven or more sexual intercourses per week, contrasting evidently with the sex professionals (97.7%). There were no significant differences regarding race, educational level and number of pregnancies. Bacterial vaginosis and abnormal vaginal flora were more observed in sex professionals (p=0.02 and 0.001) and were associated with the high frequency (seven times or more) of weekly vaginal intercourses (p=0.04 and 0.001). Cytolytic vaginosis was more related to non-professionals (p=0.04) and to a lower frequency of sexual intercourses (p=0.04). The use of doushing was more common in the sex professionals (p=0.002). However, this practice was not associated either with the vaginal microbiota problems or with the presence of vulvovaginitis. CONCLUSIONS: sex professionals with seven or more sexual intercourses per week presented a higher frequency of bacterial vaginosis and abnormal vaginal flora. The doushing habit did not interfere with the vaginal environment ecosystem of the studied women.