Background. Vulvovaginal candidiasis is characterized by curd-like vaginal discharge and itching, and is associated with considerable health and economic costs. Materials and Methods. We examined the incidence, prevalence, and risk factors for vulvovaginal candidiasis among a cohort of 898 women in south India. Participants completed three study visits over six months, comprised of a structured interview and a pelvic examination. Results. The positive predictive values for diagnosis of vulvovaginal candidiasis using individual signs or symptoms were low (<19%). We did not find strong evidence for associations between sociodemographic characteristics and the prevalence of vulvovaginal candidiasis. Women clinically diagnosed with bacterial vaginosis had a higher prevalence of vulvovaginal candidiasis (Prevalence 12%, 95% CI 8.2, 15.8) compared to women assessed to be negative for bacterial vaginosis (Prevalence 6.5%, 95% 5.3, 7.6); however, differences in the prevalence of vulvovaginal candidiasis were not observed by the presence or absence of laboratory-confirmed bacterial vaginosis. Conclusions .F or correct diagnosis of vulvovaginal candidiasis, laboratory confirmation of infection with Candida is necessary as well as assessment of whether the discharge has been caused by bacterial vaginosis. Studies are needed of women infected with Candida yeast species to determine the risk factors for yeast’s overgrowth.

/pdf/epidemiologic-features-of-vulvovaginal-candidiasis-among-1rfdysrm8b.pdf

Epidemiologic Features of Vulvovaginal Candidiasis among Reproductive-Age Women in India

Aims and objectives.  To examine the validity and effectiveness of a symptomatic approach based on symptoms, administered by a nurse working in women’s health area, in identifying vaginal infections in women with or without vaginal discharge.



Design.  Survey.



Methods.  Between November 2005–August 2006, 300 married women were included. A questionnaire and vaginal discharge assessment form were used for data collection. The modified algorithm of a symptomatic approach without speculum examination was used to manage participants. Three diagnoses were made for each participant. The first diagnosis was made by the research nurse using the vaginal discharge assessment form; the second diagnosis is the clinical diagnosis which was made after the gynaecological examination by a physician; and the third diagnosis is the microscopic diagnosis made by the physician when assessing the collected specimens.



Results.  In the methodological part of this study, the sensitivity, specificity, positive predictive value and negative predictive value of the symptomatic approach were 91·5, 69·7, 87·7 and 77·5%, respectively. The symptomatic approach had 27·7% sensitivity for bacterial vaginosis, 16·6% for trichomonas vaginalis and 62·8% for candida albicans, compared to the microscopic results. The sensitivity of the approach was higher for the identification of candidiasis compared to bacterial vaginosis and trichomonas vaginalis.



Conclusion.  From the results, it is suggested that the symptomatic approach model can be used by nurses who work in women’s health area to diagnose vaginal infections.



Relevance to clinical practice.  This study showed that trained clinician nurses will be able to diagnose and manage vaginal infections – especially candidiasis – by using the symptomatic approach. Moreover, the symptomatic approach will encourage women not to delay or fail to seek treatment for their health problems, especially for vaginal infections in conservative societies.

Validity of the symptomatic approach used by nurses in diagnosing vaginal infections

Reproductive Tract Infections and SexuallyTransmitted Infections of Women in Bangladesh:A Literature Review.

Background: Reproductive tract infections (RTIs) in women are becoming major public health problem not only in India but also over the world. Syndromic approach is advocated by World Health Organization (WHO) to manage common RTIs using clinical flow charts based on identifying a syndrome that cause the symptoms reported by patients. The most commonly reported among the women with RTIs is abnormal vaginal discharge or Leucorrhea. Single dose regimen is not preventing the recurrence of infections. A second course of treatment is required followed by standard single dose regimen for achieving better cure rate in chronic vaginal discharge. Objective of the study was to compare the efficacy of single dose drug combination regimen with multiple dose regimens in the treatment of leucorrhoea . Methods: Quasi-experimental study was done in Urban field service area, RMMCH – Chidambaram among Married women in the reproductive age group (15-49 years) with complaints of abnormal vaginal discharge for ≥15 days coupled with any one of the symptoms suggestive of RTI. The study subjects were categorized into two groups – one with single dose regimen and the other with multiple dose regimen. Follow up was done on day 7, 15 and after 6 months of therapy. Results: A total of 113 subjects were recruited with 57 participants in single dose group and 56 in multiple dose groups. The subjects who received single dose had a better cure rate as compared to multiple dose group on day 7(87.7% & 85.7%), day 15 (94.7% & 89.3%) and after six months (84.2% & 76.8%) assessment respectively. Recurrence rate was found to be equal in both the groups. Our study indicates that variables such as age of the study subjects and type of flow had significant association with the outcome . Conclusions: Single-dose therapy is as effective as multiple- dose in the management of vaginal discharge based solely on symptoms. The multiple drug regimens can be given if the symptoms persist after single drug regimen as the chances of developing complications due to chronic vaginal discharge are high.

/pdf/a-comparative-interventional-study-on-the-efficacy-of-single-23bo1g7iqq.pdf

A comparative interventional study on the efficacy of single and multiple dose combination drug regimen of leucorrhea among women in reproductive age group

Background : Vaginal discharge syndrome is a clinical condition characterized by leucorrhea, which can be caused by reproductive tract infections (RTIs) Three RTIs are referred to as vaginal infections: bacterial vaginosis (BV), trichomoniasis (TV), and vulvovaginal candidiasis (VVC) Vaginal infections are known to increase susceptibility to sexually transmitted infections, including HIV, and to be associated with low birth weight and premature birth The prevalence and incidence of and risk factors for vaginal infections are not well-studied in many settings Further, the aforementioned consequences of these infections are highly prevalent in many low-income settings, providing ample justification for additional inquiry into the diagnosis and risk factors of these vaginal infections Methods : The Prerana dataset was collected as part of a prospective cohort study of 898 non-pregnant, reproductive-aged women living in and around Mysore, India between 2005 and 2006 The primary study objective was to evaluate the relationship between abnormal vaginal flora and the incidence of Herpes Simplex Virus - type 2 infection Participants completed three study visits - conducted at baseline, and at three and six months - each of which involved an interviewer-administered questionnaire in Urdu or Kannada; a pelvic examination; and collection of vaginal and blood specimens for laboratory testing for reproductive tract infectionsAnalyses investigating separate research aims will be conducted over three papers, as follows: Paper 1: Bacterial vaginosis and risk of Trichomonas vaginalis infection, Paper 2: Epidemiologic features of vulvovaginal candidiasis, and Paper 3: Syndromic diagnosis of vaginal infections using logic regression Discussion and significance : The Prerana cohort dataset is well-suited to filling in multiple gaps in the research literature The analyses are among the first to test (or re-test) specific hypotheses concerning vaginal infection using a community-based sample based in a low-income setting Paper 1 estimates the risk of Trichomonas vaginalis infection associated with the presence of bacterial vaginosis, which fills a conspicuous gap in the research literature If susceptibility to Trichomonas vaginalis infection is found to be heightened among women with bacterial vaginosis, the burden of sexually transmitted infections attributable to bacterial vaginosis will increase dramatically, given that both conditions are highly prevalent Next, paper 2 identifies factors associated with increased prevalence of vulvovaginal candidiasis, particularly with respect to the presence of vaginal Lactobacillus If vulvovaginal candidiasis is associated with decreased presence of Lactobacillus, there will be support for identifying interventions to enhance the presence of Lactobacillus, such as with probiotics, after women are treated with antibiotics Finally, paper 3 examines the sensitivity, specificity, positive predictive value and negative predictive value of vaginal infections in this population using a World Health Organization diagnosis algorithm Separate syndromic diagnosis models for vaginal infections are developed using logic regression, a machine-learning procedure; the models are evaluated for their diagnostic performance against laboratory-confirmed diagnoses of vaginal infections Logic regression models offer the potential to improve upon the performance of the WHO algorithm, using parsimonious models which are easy to develop, comprehend, and implement in clinical facilities in low-income settings

/pdf/epidemiologic-features-of-vaginal-infections-among-1llfkbq5nm.pdf

Epidemiologic Features of Vaginal Infections among Reproductive-age Women in South India

Early detection and treatment of RTIs/STIs and promotion of community awareness through behaviour change communication (BCC) are the key issues relating to their prevention. BCC messages should include topics such as safer sex practices and appropriate and timely healthcare-seeking behaviour. In improving RTI case management to date the focus has been on diagnosis and treatment. To achieve high rates of cure drug compliance referral and treatment of partners referral linkages and education of clients are all essential (7). A number of key issues relating to strategies for controlling RTIs/STIs have been identified by the intervention team of the former Operations Research Project (ORP) on prevention and management of RTI/STD through reviewing literature visiting projects in Bangladesh and discussions with the Government of Bangladesh (GoB) and NIPHP partners. The identified issues were shared and discussed formally with the United States Agency for International Development (USAID) and with all the NIPHP partners in the 3rd Intervention Design Workshop in June 1998 at ICDDRB. “Validity assessment of vaginal discharge-management flowcharts” was one of the operations research issues that was prioritized in this meeting and subsequently endorsed at two meetings of the NIPHP Operations Research Working Group meetings held in August 1998. (excerpt)

http://dspace.icddrb.org:80/jspui/bitstream/123456789/3348/1/ICDDRBWorkingpaper-158-RahmanS.pdf

Validity assessment of flowcharts for syndromic management of vaginal discharge.

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Validity assessment of flowcharts for syndromic management of vaginal discharge.