Introduction Vaginal discharge (VD), a common gynaecological complaint, is often associated with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and Trichomonas vaginitis (TV). Prevention and control of these STIs/RTIs require understanding of demographic patterns and risk factors. Moreover, diagnosis in resource constrained settings can be facilitated using self-collected vaginal swabs, provided the reliability of the method is established. Aims were to establish the (1) association of sexual, demographic and hygienic practices for the above infections and (2) reliability of self-obtained over clinician-collected vaginal swabs for diagnosis.
Methods A total of 550 females aged 18–45 years (median: 32) attending two NACO designated STI/RTI clinics (Jan 2015-May 2016) with abnormal vaginal discharge were evaluated for relevant risk factors using a questionnaire. Swabs were self-collected by patients after instructions and subsequently by a physician under speculum examination. They were then examined by standard bedside tests, Gram staining, wet mount and culture.
Results BV, VVC and TV were observed in 79 (14.4%), 144 (26.2%) and 3 (0.5%) patients respectively. VVC coexisted with BV in 58 (10.5%) patients. C. albicans was isolated in 84 (58.33%) VVC cases. Prevalence of VD was higher in rural (p>0.5) and illiterate (p>0.5) patients. BV was strongly associated with douching (odds ratio 8.26) and moderately with use of condoms (odds ratio 1.6), whereas VVC showed minimal association. Use of cloths instead of sanitary pads was also a risk factor for BV (odds ratio 1.3) and with a minimal impact on VVC. Highly concordant self vs physician-collected results established the reliability of self-collected samples with Cohen’s Kappa values of 0.95 (BV), 0.99 (VVC) and 1.0 (TV).
Conclusion Avoiding douching, using condoms and sanitary pads help in reducing the risk of acquiring VD. Reliability of self-collected swabs for diagnosis shall go a long way in strengthening National STI/RTI Program, especially in resource constrained settings.
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