A cross-sectional study of selected sexually transmitted diseases among antenatal women in Kingston, Jamaica

The lesions produced by many sexually transmitted diseases (STDs) enhance the risk of transmission of human immunodeficiency virus (HIV). Many STDs themselves increase infant maternal morbidity and mortality rates. In addition, they are a major cause of socio-economic concern as they impact on the lives of individuals, families and communities and increase the disease burden in the health services in Jamaica. Against this background, the aims of the present study were to identify the prevalence of selected sexual transmitted diseases (STDs) viz gonococcal infection, trichomoniasis, syphilis, and HIV infection among pregnant women attending the antenatal services at the Comprehensive Health Centre (CHC) in Kingston, Jamaica and to determine the possible associations there with the occurrence of STDs in these women. A cross-sectional study was conducted at the CHC between January 6th and February 24th, 1997, among 122 pregnant women, consecutively attending antenatal services for the first time in the current pregnancy. All the women (122) were interviewed and examined. A specimen of blood was taken from each participant for rapid plasma reagin (RPR) testing for syphilis and enzyme-linked immunabsorbent assay (ELISA) testing for HIV antibodies. High vaginal swabs were taken for gram stain and gonococcus culture and direct microscopy (wet preparation) for Trichomonas vaginalis from each woman. The results indicated that syphilis seroprevalence was 7.4 percent. The HIV seroprevalence was 1.67 percent. The prevalence of gonococcal infection from culture was 5.7 percent (7/120) and for Trichomonas vaginalis 6.7 percent from wet prep. There was a statistically significant difference between the number of women presenting in the second trimester and those presenting in other trimesters with respect to (a) positive serology for syphilis (p=0.026). (b) HIV positivity (2/51), (c) trichomoniasis 6.7 percent and (d) 63 percent of all the women testing positive for gonorrhea. There was a trend towards greater rapid plasma reagin (RPR) reactivity in single women in visiting relationship when compared with other women (p=0.06), indicating that a larger sample of first time attendees might show a correlation of statistical significance. The findings of the study reinforce the need for early diagnosis of STDs among pregnant women and the need to help the women protect themselves from contracting STDs.(Au)

Prevalence of chlamydia trachomatis infection in pregnant women in Barbados - abstract

Fifty-six pregnant women were investigated for the presence of genital tract infections during their first visit to the antenatal clinic. Their mean age was 23 years (range 17-39) and the mean gestational age was 31.6 weeks. Delivery occurred at a mean of 38.4 weeks and the mean birth weight of the infants was 2892g. Syphilis and gonorrhoea were not detected in this study. Candidiasis and bacterial vaginosis were each detected in 27 per cent of the women studied and Trichomonas vaginalis was found in 4.7 per cent. Infection with Chlamydia trachomatis was detected in 23 per cent of women by antigen EIA on endocervical swabs. Serology demonstrated anti-chlamydial antibodies in 75 per cent (IgG) and 23 per cent (IgA) of women. Women with positive EIA tests were treated with erythromycin. These data emphasize the need for an aggressive approach to the diagnosis and treatment of chlamydial infection. We suggest that C. trachomatis EIA should be adopted as part of the routine antenatal screening process (AU)

Clinical and laboratory studies of bacterial vaginosis in Barbados - abstract

Bacterial vaginosis (BV) is a non-inflammatory infection of the vagina, characterized by the presence of a thin, homogenous, grayish-white discharge. The purpose of this study was to investigate (1) the prevalence of BV in Barbados and evaluate methods for its diagnosis, and (2) the relationship between clinically and microbiologically-confirmed BV and abnormal PAP smear results. Initially, 29 consecutive patients presented with vaginal discharge which was tested for pH and amines, and high vaginal swabs were cultured for Gardnerella vaginalis and obligate anaerobes. Of 21 patients without another demonstrable cause of their discharge, 16 had a vaginal pH o 5; 14 had a positive amine test, clue cells were observed in 8 and a heavy growth of either obligate anaerobes or G. vaginalis was recovered from 10 patients. BV was found in 16 of 29 patients (56 per cent). In a further 43 patients with a clinical diagnosis of BV, a vaginal pH o 5, and a positive amine test, vaginal swabs were obtained for culture and cervical smears stained with Papanicolaou stain. Thirty of these 43 patients (70 per cent) had class II Pap smears, 24 (56 per cent) had evidence of concurrent infection, including yeasts (12 per cent), Trichomonas vaginalis (24 per cent), and cytological evidence of infection with chlamydia (23 per cent) or human papilloma virus (32 per cent). It is concluded that BV is common in Barbados, is easily diagnosed in the physician's office, responds to treatment with metronidazole and is often associated with other genital tract infections which require additional investigations (AU)

Clinical gonorrhoea in the female: laboratory findings

The practice of treating females with vaginal discharges and other pelvic symptoms, on the basis of a presumptive diagnosis of "Clinical gonorrhoea" without attempting to obtain adequate laboratory tests for N. Gonorrhoea, T. Vaginalis and C. Albican in female patients. All of whom had reported to a V. D. Clinic, (some because they were reported as contacts of male gonorrhoea patients), and who had been selected for penicillin treatment. All had vaginal discharges and other evidence of genital disease. The study was carried out at the Comphrensive Health Centre in Kingston, Jamaica. Tests for Gonorrhoea included cervical and vaginal gram-stained smears and cervical cultures. Due to shortages of media and personnel, cultures for the comparison of smear and cultures involved, for about half of the female studied, a single Transgrow bottle culture from the cervix and for the other half a Transgrow bottle culture and also a small (5.5cm) Thayer-Martin plate. Other patients had a rectal culture on a small Thayer-Martin plate also. These were included not alo in the comparison of results with overall tests for N. Gonorrhoea, E. Baginalis and C. Albicans. Transgrow cultures were incubated immediately. Tests for T. Vaginalis included wet preparations and cultures on "Trichomonas medium". Tests for C. Albicans involved cultures on Sabouraud's agar with yeast identified as C. Albicans by the germination test as described by Taschdjian and associates. A total of 107 or 45.9 percent of 233 females had positive tests for gonorrhoea. (In three of these the test were doubtful). 104 or 44.6 percent had positive tests for T. Vaginalis; 72 or 30.9 percent had positive tests for C. Albicans. Overall, 187 patients or 80.2 percent were positive (or doubtful) to one or more tests and 46 or 19.8 percent were negative to all three. Patients with mixed infections were: N. gonorrhoea + T. Vaginalis - 15.4 percent, n. gonorrhoea + C. Albicans - 7.3 percent, N. gonorrhoea + C. Albicans T. Vaginalis - 6.4 percent, T. Vaginalis + C. Albicans - 5.6 percent. Of 92 or 41.8 percent of a total of 220 females studied, and who were positive or doubtful, only 40 or 18.2 percent of the total had positive or doubtful smears, while 52 or 23.6 percent of the total had only positive cultures. The latter would have been missed had smears alone been done. (i.e. 56.5 percent of cases). Of 94 or 44.3 percent of 212 females studied by T-M and Transgrow media, 76 had both tests positive. A total of 18 had one test positive, 7 with Transgrow and 11 with T-M. Of 104 patients who had both rectal and cervical cultures, 8 or 7.7 percent had only the rectal culture positive. There were 23 positive rectal cultures compared with 51 cervical positives out of a total of 59 with positive cultures. Of 140 patients with Trichomonal infestation, 107 had positive wet preparations while 114 had positive cultures. The advantage of culture over wet preparation is therefore but slight. It is clear that smears are inadeqate as anything more than supplementary diagnostic aids and that cultures for gonorrhoea are absolutely essential in the diagnosis of gonorrhoea in the female. Rectal cultures were found to add substantial increase (15.7 percent) to the number of positive cases when used in conjunction with cervical cultures. This must be clear to all physicians and cultures made available for their use(AU)

Infections of the lower genital tract

The main symptoms of vaginitis is discharge, which is usually irritating and frequently odorous. The common causes of vaginitis in adults are fungi or protozoa (bacterial vaginitis occurs mainly in children and women who have passed the menopause). The cause can usually be determined quite easily from the clinical appearance of the vagina and from the findings on microscopic examination of a fresh sample of the vaginal secretion. Most vaginal infections respond well to the appropriate treatment, but the diagnosis must be accurate. Numerous proprietary preparations have been advocated for the treatment of vaginitis, have had their brief flurry of popularity, and are now forgotten. Pessaries containing various combinations of antibiotics are seldom effective and-because the vagina depends on a normal bacterial flora for its well-being-often do positive harm (AU)