Research Article
Austin J Surg. 2019; 6(12): 1190.
Genital Infections with Gardnerella vaginalis at Fann University Hospital (Dakar) and Saint-Louis (Senegal)
Diagne R¹*, Lo S², Dia ML³, Ndour J³, Ka R¹, Ngom B³ Cobar G³, Sarr H³, Niang AA³ and Sow AI³
¹UFR des Sciences de la Santé, Université de Thies BP 967 Thies, Sénégal
²UFR des Sciences de la Santé Université Gaston Berger BP234 Saint Louis, Sénégal
³Faculté de Médecine, Pharmacie, et Odontologie Université Cheikh Anta Diop BP 22254, Sénégal
*Corresponding author: Rokhaya Diagne, UFR des Sciences de la Santé, Université de Thies BP 967 Thies, Sénégal
Received: April 11, 2019; Accepted: May 08, 2019; Published: May 15, 2019
Abstract
Background: Bacterial vaginosis is a very common infection in women, especially during sexual activity.
We took stock of Gardnerella vaginalis infections in women received for vaginal swabs at the laboratories of two hospitals in Senegal: the National University Hospital Center (CHNU) in Fann and the Regional Hospital Center (CHR) in Saint Louis.
Material and Methods: Our study is retro-prospective over two years between January 1, 2013 and December 31, 2014. We worked on a total of 5928 vaginal samples.
We performed the measurement of vaginal pH, the potash test, the macroscopic and microscopic examinations on vaginal secretions.
Results: We obtained 1240 (21%) cases of Gardnerella vaginalis vaginosis, of which 826 (66.6%) originated from CHNU de Fann and 414 (33.4%) cases from the CHR of Saint-Louis.
The majority age group was [24-29 years old] with 317 cases.
The prevalence at Fann was 23% and 17% at the CHR of Saint-Louis.
More than 75% of the patients had whitish leucorrhea.
Conclusion: Given this prevalence, early diagnosis and effective treatment are essential to avoid clinical symptoms and complications related to this disease.
Keywords: Gardnerella vaginalis; Bacterial vaginosis; Genital infections
Introduction
Bacterial vaginosis is a common infection in women. In black Africa, it affects 20 to 50% of women [1-9]. It is responsible for 16 to 29% of cases of prematurity, chorioamniotitis, spontaneous abortions and low birth weights [3,4].
It results from a disorder of vaginal flora and an abnormal proliferation of commensal bacteria of the vagina (Gardnerella vaginalis, mycoplasms and anaerobic species). The precise origin of that disorder is unknown [10-16].
Gardnerella vaginalis is theincriminated bacterium in that condition. In some conditions, this bacterium can become pathogenic and lead to disorders of the vaginal flora. Its presence is higher in frequency (83 to 98% and in a much larger quantity than in the normal flora [8].
The aim of this study was to assess the prevalence of infections due to Gardnerella vaginalis in women received for vaginal swabs in the laboratories of two hospitals in Senegal.
Our study intends to elucidate the vaginal exsudat characteristics, but also to set up criteria of fast diagnosis. This will allow to better understand and ameliorate the diagnosis, but also show the place occupied by this condition in vaginal infections.
Matérials and Methods
This was a two-year retro-prospective study carried out between January 1 and December 31 of 2014 in women for which a vaginal swab was done at the Fann University Hospital and St Louis Regional Hospital.
Studied population
The studied population was made of patients admitted in the laboratory of these two above structures for patients who had a vaginal swab during that period of study.
The swab
The sample is taken on the vaginal walls or at the level of the posterior cul de sac. We made a PH vaginal measurement and a potash test, but also carried out micoscopic examinations and an identification of the germs involved in this infection.
Study of the samples
A microscopic examination gave us the colour, aspect and smell of the secretions. The microscopic examination, after a Gram coloration, highlighted the replacement of lactobacillus by a mixed flora: small coryneform bacilli to variable Gram suggesting Gardnerella bacilli to incurved variable Gram suggesting Mobiluncus.
A direct examination, after a Gram coloration, enabled to set up the type of flora.
ARITAL STATUS
NUMBERS
Single
118
Divorced
29
Engaged
7
Married
617
Widows
14
TOTAL
785
Table 1: Distribution of women according to marital status.
GRAVIDITES
NUMBERSS
PERCENTAGES
G0
273
35,4
G1
170
22
G2
116
15
G3
82
10,6
G4
52
6,8
G5
29
3,8
G6
23
3
G7
11
1,4
G8
06
0,7
G9
04
0,5
G10 and above
02
0,3
Total
772
100
Table 2: Distribution of patients according to gravidity at Fann University Hospital.
Colour of leukorrhea
FANN University Hospital
ST-LOUIS Regional Hospital
Whitish
611
316
Greyish
1
3
Haematic
24
14
yellowish
132
70
Milky
4
1
Brown
22
7
greenish
21
1
Blackish
1
0
Total
816
412
Table 3: Distribution of patients according to the colour of leukorrhea.
Consistency of leukorrhea
Fann University Hospital
Saint-Louis Regional Hospital
Adherent
47
0
Curd
46
23
Thick
292
11
Fluid
91
11
Glairy
121
12
Homogenous
189
352
Soapy
15
2
Normal
9
2
Purulent
3
0
TOTAL
813
413
Table 4: Distribution of patients according to the consistency of leukorrhea.
Figure 1: Distribution of patients according to marital status at Fann
University Hospital.
Figure 2: Distribution of patients according to the colour of leukorrhea.
Figure 3: Distribution of patients according to the consistency of leukorrhea.
Results
Global results
We collected a total of 5928 samples of which 3493 (59%) came from the Fann University Hospital and 2435 (41%) from the St Louis Regional Hospital. We had 1240 cases of vaginosis to Gardnerella vaginalis of which 826 (66.6%) came from the Fann University Hosptal and 414 (33.4%) cases from the St Louis Regional Hospital.
The majority age group was [24 – 29 years old] with 317 cases.
The total prevalence of vaginosis to Gardnerella vaginalis was 21%. It was 23% at Fann University Hospital and 17% at St Louis Regional Hospital.
Sociodémographic results
Age distribution : The average age of patients was 31 years old.
At Fann University Hospital, portering was more common with age range [24-29 years old] with 28.1% followed by age ranges [30-35] years old, [18-23] years old, [36-41] years old, with respectively 25.3%, 17.5%, and 15%. At the St Louis Regional Hospital, the majority age group was [30-35] years old.
1. Distribution according to parity at Fann University Hospital
According to parity, the vaginosis to Gardnerella vaginalis was predominant in patients with less parity: 52% of women wit P0 parity; 17.7% for women with P1 parity; 13.2% for women with P2 parity; 7.4% for women with P3 parity; 3.8% for women with P4 parity; 3% for the P5; 1.2% for the P6 and less than 1% for each parity from P7 tp P14.
2. Other results
Flora IV types were the majority (73.3% in Fann) and (88.4% in St Louis).
The association rate Gardnerella vaginalis and Mobiluncus was 11.8% in Fann and 13.5% in St Louis.
Some association cases Gardnerella vaginalis and Chlamydia trachomatis were jotted down (2.7% in Fann and 17.8% in St Louis). However, it is worth noting that the Chlamydiae research was not systematic among all patients.
Discussion
During our study, the global prevalence of vaginosis to Gardnerella vaginalis in both structures was 21%. Our results are comparable to those obtained by Fofana (21.7%) in Bobo Dioulasso, but are inferior to those from Koueke in Cameroon (42%) [12].
Western writers jotted down rather badly matched prevalences between 15 and 60% [14,15].
The presence of Gardnerella vaginalis was higher in the age range between 24 and 35 years old in both structures. These results match with those of Faye-Kette who found out the same age ranges in Abidjan [5].
That situation could be explained by the fact that this age range is more active sexually. During that period, flora becomes favourable to infections [10].
Among women carrying Gardnerella vaginalis at vaginal smear, married women represented 78.5% of the cases against 15% for single women. These results match with those of Anagounou who found 60% of married women against 40% for single ones. On the contrary, Faye-Kette and coll. Found that single women were more numerous than married ones (59% against 41%) [2,5].
Leukorrhea was whitish in 76% and 75% of patients in St Louis and Fann respectively.The abundant leukorrhea was found in 46.2% in St Louis Regional Hospital and 45% in Fann University Hospital. while Faye-Keyette and coll. Found in greyish-white leukorrhea in the same proportions(76.5%) but abundance was more marked (62%) [6]. The distribution of bacterial vaginosis following the type of flora enabled to highlight the disorder of vaginal flora going with it. At Fann University Hospital, 11.8% of patients had the Gardnerella vaginalis and Mobiluncus spp association. In St Louis Regional Hospital, the association rate was 13.5%. These percentages are very low compared to those observed by Holst who had found bacerial vaginosis in more than 96% of women, and the presence of one or two Mobiluncus species [11].
The search for microplasm was carried out on 699 patients and that of Chlamydia on 629 ones.
In St Louis Regional Hospital, 36% of patients were positive to Gardnerella and Mycoplasma hominis, and as for Fann University Hospital, the association rate was 28.2%.
The association rate Gardnerella vaginalis and Ureaplasma urealyticum was of 62% at Fann University Hosptal and 36% at St Louis Regional Hospital. The M. hominis and U. urealyticum prevalences that we found in this study were higher to those reported by the literature, FAYE-KETTE while coll obtained 22% and 20% of women carrying Ureaplasma urealyticum of Mycoplasma hominis respectively [7]. The association rate Gardnerella vaginalis and Chlamydia trachomatis was of 17.8% at St Louis Regional Hospital and 2.7% at Fann University Hospital. This shows the difficulties in the treatment of this condition from multiple etiologies. As a result, a treatment targetting a single germ remains insufficient.
Conclusion
Gardnerella vaginalis constitutes the main agent of bacterial vaginosis. The diagnosis of this condition is easy to put in practice in laboratories. It can be responsible for complications like neonatal infections, repeated abortions, choroamnionitis and other obstetric infections. This study allowed us to show the place that occupy bacterial vaginosis in the infections of the uri-genital sphere.
With a 21% prevalence, we can conclude that vaginosis to Gardnerella vaginalis constitutes the first etiology of genital infections before candidiasis, trichomoniasis and infections to chlamydia and mycoplasms.
We recommend to strengthen the diagnosis to the laboratory of this condition so as to allow clinicians to have a good patient management but also to avoid complications related to that infection.
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