Abstract
objective: To screen women with vaginal discharge for Trichomonas vaginalis as well as other pathogens and to follow them up.
Setting: outpatient Gynaecologic Clinic, Family Planning Clinic, and Antenatal Clinic at Al- Batool Teaching Hospital for Gynaecology and Obstetrics.
Participants: a 440 women with vaginal discharge (July 1997 to June 1999).
Intervention: Full medical, gynaecological, sexual and social history was recorded. Clinical examination was carried out. Laboratory investigations including vaginal, cervical and urethral swabs for direct examination, gram-stained smear, as well as culture on appropriate media.
Results: The total number of Trichomonas vaginalis infection was 68 (15.5%). The isolated microorganisms in association with Trichomonas vaginalis were candida albicans in 19 women (27.9%), Staphylococcus epidermidis in 10 women ( 14.7%
), and Lactobacilli in six women constituting (8.8 %) . Both Diphtheroids and Neisseria ganorrheae showed lower incidences, as only eight women were positive (5.9 %) for each. Escherichia. Coli was present in one patient (1.5%).24 patients were positive for Trichomonas vaginalis only (35.3 %).
The remaining 372 women who were negative Trichomohas vaginalis showed a high rate of infection with Candida species (21.5%),followed by Staphylococcus epictermidis(18.3%) and lactobacilli (15.3%).other isolates included Streptococcus species (8.6%)., E.coli (5.9%), Klebsiella ( 3.8%) ,Enterococcus fecalis (3.0%), Gardnerella vaginalis (2.6%), Neissenria gonorrheae (2.4%), Proteus (2.2), Diphtheroid (1.9%), staphylococcrus aureus(1.3%) and Pseudomonas aeruginosa (0.8%). Moreover, 46 (10.5%) of women showed no growth. 50.0% of infection with Trichomonas vaginalis was at age 26-35 years Considering marital status, the highest rate (76.4 %) of infection was among married women followed by divorced (14.7 %), widows (5.8 %) and singles ( 2.9%). Pregnant women positive for Trichomonas vaginalis represented (45 .6 %) of cases. 61.7% of infection was among illiterate women.
Metronidazole (flagyl) was given to all in a dose of 250mg orally thrice daily for seven days.
Metronidazole was prescribed at the same time to husbands of infected women. other specific medications (antifungal, antimicrobial agents) were given when indicated either alone or in combination with metronidazole.
Two weeks later only 112 women came for reassessment clinically and by repeating direct smear and culture, that showed fifteen positive cases. Five of them still having Trichomonas vaginalis, eight were having Candida albicans, and two showed normal smears. Further courses of treatment were given as indicated.
conclusion: Vaginal discharge is common among women in reproductive life.
Culture is indicated for precise diagnosis
Key words: Trichomonas vaginalis. Vaginal discharge, Metronidazole.
