- : Ms Word, Ms Word Format
- : 80 Pages
- : ₦5000
- : 1-5 Chapters
- Click to DOWNLOAD Materials
PATTERN OF VAGINITIS AMONG INTRA-UTERINE CONTRACEPTIVE DEVICE (IUD) USERS AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA
Abstract
BACKGROUND: Concerns have been raised about the intrauterine contraceptive device
IUD-related vaginitis which some authors have described as a malodorous, homogenous,
grey, thin and non purulent discharge which occurs in 20% of women using the IUD. Its
significance and pathogenesis have not yet been fully understood and its etiology varies with
geographical locations, family planning clinics and type of IUD used. One of the concerns
raised is that IUD- related vaginitis, when persistent is a documented reason for
discontinuation by clients thereby negating efforts made to improve the unmet need for
family planning. The objective of this study is to investigate the pattern of IUD-related
vaginitis at the family planning clinic of University College Hospital Ibadan, South-western
Nigeria- its presentation, etiology, the relationship between IUD-related vaginitis, duration of
IUD use and socio-demographic characteristics.
METHODOLOGY: A prospective study of a cohort of IUD users presenting with abnormal
vaginal discharge at the family planning clinic of the University College Hospital, Ibadan was
conducted between the 1st of May 2010 and the 30th of June 2010. Patients were counseled on
the purpose of the study and informed consent obtained. High vaginal and endocervical
swabs of consenting clients were taken for microscopy, culture and sensitivity. Swabs for
detection of Neisseria Gonorrhoea were transported using Amies transport medium in
charcoal. Each sample collected underwent wet preparation, gram staining, microscopy and
culture except for swabs built for detection of chlamydia. Detection of chlamydia was by
immunohistochemistry using the QuickVue rapid chlamydia detection kit while diagnosis of
bacterial vaginosis was made based on gram stained vaginal smear using the standard
Nugents criteria. Other aetiological agents were identified either on wet preparation or culture
using standard techniques. Treatment given was by the family planning nurse, as was the
protocol at the family planning clinic. Data was collected using a proforma containing
participant’s socio-demographic characteristics, parity, type of IUD used and duration of use,
characteristics of vaginal discharge and number of unscheduled visits. Results of
microbiological studies and treatment were listed in the data collection form and provided
free of charge to the clients for their mangement. Data entry and analysis were done using
SPSS 18 (Statistical Package for Social Sciences) software by generation of frequency tables,
chi-square test, Fisher’s Exact tast and logistic regression model. The results were presented
with the aid of tables and charts.
RESULTS: 43 IUD users presented at the family planning clinic. Their ages ranged from 28
to 51years. (38.7 +/-5.8 years). Mean parity was 4.6+/-1.4. All the women were married and
all used CuT 380A. Duration of IUD use was 1 – 60 months. 13 (30.2%) had used it for less
than a year, 9 (20.9%) 1-3 years, while majority 21 (48.8%) had used it fot 3-5 years. The
mean duration of IUD use was 31.42+/- 21.68 months. Most (72%) of the visits were
unscheduled. All the clients complained of abnormal vaginal discharge which was copious,
watery and foul smelling, or clumpy. 17 users (39.5%) complained of pruritus vulvae, 3 users
(7%) lower abdominal pain, 3 users (7%) dysuria and 1(2.3%) dyspareunia. The diagnosis of
bacterial vaginosis was made in 28 (65.1%) and vaginal candidiasis in 15 (34.8%). 3 patients
tested positive for chlamydia antigen. The prevalence of Chlamydia infection was 6.9%. All
the patients diagnosed with Chlamydia infection were less than 40 years and of low parity. 2
out of the 3(66.7%) had co-existing bacterial vaginosis. On bivariate analysis there was a
statistically significant relationship between IUD use above 3years and diagnosis of bacterial
vaginosis (p=0.001). Christianity and higher educational attainment were significantly
associated with bacterial vaginosis while Muslim religion and lower educational attainment
were significantly linked with candidiasis both at 10% (p=0.078 and 0.086) Age, religion,
and educational status were not significantly associated with Chlamydia infection. Chlamydia
infection was only significantly associated with lower parity (p<0.05). On multivariate
analysis these relationshionships were found to be present although no longer statistically
significant. On backward stepwise logistic regression, religion and educational status were
found to be weaker predictors of IUD-associated vaginitis. Duration of IUD use was noted to
be the strongest predictor of IUD associated vaginitis. IUD use more than 3 years was
associated with a 10- fold risk of having bacterial vaginosis (OR 10.43 CI 2.029 -53.642) and
was protective against candidiasis (OR 0.096, CI 0.019 – 0.493), while duration of IUD use
less than 3 years was associated with a 10-fold risk of vaginal candidiasis (OR 10.43 CI 2.029
-53.642) and was protective against bacterial vaginosis (OR 0.096, CI 0.019 – 0.493). 14
(32.6%) clients were treated for candidiasis using oral fluconazole or clotrimazole vaginal
pessaries, 26 (60.5%) were given oral metronidazole, 2 were treated with oral doxycycline
while the three patiens were referred to the gynaecological emergency unit where they were
treated using using the syndromic management of STI.
CONCLUSION: IUD associated vaginitis is a disturbing condition causing unscheduled
visits among IUD users. Its etiology at the University College Hospital, Ibadan is mainly
endogenous organisms (Bacterial vaginosis and Candidia albicans) and is not associated with
an increased incidence of pelvic inflammatory disease. Persistent discharge is a documented
reason for discontinuation of IUD use. In our environment where health care is unaffordable
to many and health seeking behaviour is also poor, syndromic treatment of clients with IUD
associated vaginitis for candidiasis and bacterial vaginosis for women with IUD use less than
3 years and above three years respectively is recommended. Additional treatment with
antichlamydial agent may be included when there is an associated risk factor of low parity.
Periodic evaluation of IUD users for candidiasis and bacterial vaginosis is also advocated.
This may reduce the discomfort caused by IUD-related vaginitis, the risk of PID and other
risks exposed to the IUD users and ensure continued use of the IUD.
BUDGET: The project was funded by the researcher.
RELEVANCE OF THE STUDY: It is hoped that the results obtained from this study will
improve the management of women with IUD- associated vaginitis. This may ensure better
client satisfaction, ensure continued use of the IUD and reduce in the long term, the unmet
need for family planning.
