COMPARISON OF DIAGNOSTIC METHODS, EPIDEMIOLOGY AND CLINICAL CORRELATES OF BACTERIAL VAGINOSIS IN PREGNANCY AT IRRUA SPECIALIST TEACHING HOSPITAL, IRRUA, EDO STATE

Abstract

Bacterial vaginosis (BV) is a clinical entity that is characterized by a change in vaginal ecology where the normal flora lactobacillus morphotype is replaced by a mixed microbial consisting of anaerobes, gardnerella spp, mycoplasma and it appears to be particularly common in sub —sahara Africa but little is known about the pattern of vaginal flora associated with BV in our environment. To determine; the prevalence of bacterial vaginosis in our environment using Amsel criteria, Gram stain using Nugent’s scoring system, and culture of gardnerella vaginalis; sociodemographic characteristics associated with BV; the vaginal flora pattern associated with BV and the validity and reliability of the various methods of diagnosis compared with ‘Gold standard’ Amselcriteria. A descriptive cross-sectional study. Three hundred and forty four out of the 363 consecutive antenatal patients regardless of symptoms who satisfied the inclusion criteria was carried out at the gestational age of 13-20weeks between August-December, 2007 at Irrua Specialist Teaching Hospital Irrua (ISTH). Socio-demographic characteristics, past reproductive, social, sexual health history and vaginal hygienic practices of the enrolled pregnant women were obtained by questionnaire. Amsel criteria were used as a “gold standard” for the clinical diagnosis of Bacterial vaginosis. Other methods of diagnosis include Nugent’s scores, culture of gardnerella vaginalis and combination of Nugent and culture of gardnerella vaginalis were compared with the Amsel criteria using the tests of validity. The prevalence of 30.23% was found using Amsel criteria, 22.09% using Nugent’s method and 23.26% from culture of Gardnerella vaginalis. The mean age of the patients was 27±4.55 years and mean parity was 1.058±1.19. No statistical relationship was found between socio -demographic characteristics, sexual, social and vaginal hygienic practices and Bacterial vaginosis. However there were statistical relationship between report of fishy odor during and after sexual intercourse, gardnerella morphotypes, bacteriodes morphotypes and BV.(P<0.02, P<0.05, P<.0.01). There was inverse relationship between lactobacilli morphotypes and By. The prevalnce of HIV positive patients was 3.48% and all were diagnosed to have BV using Amsel criteria. Nugent’s method correlated strongly with Amsel criteria (P,<0.001), and when compared with Amsel criteria the ‘gold standard’ it had sensitivity (9.33) specificity of 98.30% and the lowest false positive rate of 1.72% and the highest accuracy rate of 88.37% and positive predictive value of
94.74%. Culture had sensitivity of 26.92%, specificity of 78.35%, positive predictive value of 35%, negative predictive value of 71.21%, false positive rate of 21.66% and accuracy of 62.79%. The prevalence rate was high and the study highlights the polymicrobial nature rather than specific organism associated with Bacterial vaginosis. Epidemiological risks popularly associated with BV did not seem to be important in the study. Future longitudinal studies will be needed to evaluate the adverse pregnancy outcome associated with the high incidence of BV in ourenvironment.

COMPARISON OF DIAGNOSTIC METHODS, EPIDEMIOLOGY AND CLINICAL CORRELATES OF BACTERIAL VAGINOSIS IN PREGNANCY AT IRRUA SPECIALIST TEACHING HOSPITAL, IRRUA, EDO STATE