The effectiveness of the Gram stain of high vaginal swabs in the diagnosis of bacterial vaginosis at the University Hospital of the West Indies [abstract]

OBJECTIVE: To correlate the gram-stain of high vaginal swabs (HVS) with the diagnosis of bacterial vaginosis (BV) and to compare this with bacterial culture reports to determine whether any useful additional information is gained by culture. METHODS: HVS submitted to the microbiology laboratory (UWI) from patients diagnosed clinically with vaginal infection were used in this study. Specimens were submitted from the Family Planning, Gynaecology and Antenatal clinics at the University Hospital of the West Indies. Swabs were placed in Stuart's Transport Medium and taken to the microbiology laboratory within 24 hours. The specimens were subjected to standard bacteriological procedures of culture on blood and MacConkey agar and microscopic procedures of wet prepartion and gram stain. The gramstain was recorded on a specially designed data sheet for each patient with a standardized scoring method for the evaluation of gram-stained smears based on the recognition of both presence and amount of significant morphotypes. This result was then compared with the bacterial culture, available a few days later, to see the degree of correlation and to determine whether any relevant additional information was gained. Almost 60 percent of the specimens collected yielded no pathogens on culture. However, one-third of this 60 percent was diagnosed as BV by standardized scoring method. One-third of all specimens submitted yielded yeast (Candida albicans and yeast not-Candida albicans) on culture and by gram stain. Streptococcus group B was isolated in < 4 percent of all specimens and a miscellaneous group of organisms including Klebsiella sp, Pseudomonas sp and anaerobic Streptoccus made up the rest of bacterial isolates. CONCLUSIONS: The standardized scoring method of evaluating the HVS gram stains yielded a more accurate and rapid diagnosis of BV than the traditional culture method. This is worthy of further study, as implementation of this method would result in considerable cost and time saving. (AU)

Aetiology of vaginal infections in pregnant and non-pregnant women in Barbados

The aetiology of vaginal discharge was studied in 175 Barbadian women. Pregnant women accounted for 52 percent (91) of the population studied. Candida albicans was detected in 45 percent of the women, bacterial vaginosis in 28 percent and Trichomonas vaginalis in 8.6 percent. Bacterial vaginosis was more common in non-pregnant women (33 percent vs 23 per cent) whereas C. albicans was more common in pregnant women. Mixed infections were found in 10 women and an aetiological agent was detected in 75 percent of the women studied. These data emphasize the need for laboratory investigation of vaginal discharge since each of these infections can be treated effectively with specific agents (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)