Clinicoetiological study on vaginal discharge among sexually active women attending a tertiary center in North Kerala, India

Abstract

Background: Vaginal discharge is a common complaint among women attending the sexually transmissible infections (STIs) clinic and is a cause for concern and mental distress. It can be attributed to physiological or pathological causes. This study aims to understand the prevalence of various etiologies of vaginal discharge, which would help frame health policies based on local needs.

Objectives: (1) To estimate the prevalence of discharge per vaginum among sexually active women attending the STI clinic at a tertiary care center during a 1-year period, (2) To identify the organisms causing vaginal discharge, (3) To have a clinicoetiological correlation of the cases, and (4) To identify the subspecies of Candida causing vaginal candidiasis.

Materials and methods: A total of 126 patients with vaginal discharge attending the STI clinic at a tertiary care center were included in the study. A detailed clinical history, physical examination of the external genitalia, and vaginal examination were done on each patient. Five swabs were taken from the posterior fornix and lateral vaginal wall for evaluation of the organisms.

Results: The mean age of the study population was 31.51 ± 7.9 years. Vulvovaginal candidiasis (VVC) was found to be the most common cause of vaginal discharge, followed by bacterial vaginosis, mucopurulent cervicitis, herpes genitalis, and trichomoniasis. The most common species of Candida was found to be Candida albicans.

Conclusion: Even though VVC still remains the major cause, other viral infections like herpes significantly contribute. Vaginal discharge is an important indicator of women's reproductive health and its detailed evaluation helps identify the prevalence of various STIs in the community.

Keywords: Bacterial vaginosis; candidiasis; gonorrhea; leukorrhea; trichomoniasis.

Figure 1

(a) Sebaraud's dextrose agar showing creamy white colonies of C. albicans; (b) chrome agar showing blue colonies of Candida tropicalis and white to light green colonies of Candida albicans; (c) Candidiasis. Patient with curdy white discharge showing pseudohyphae on 10% KOH smear (×400); (d) Candidiasis. Pseudohyphae on Gram's stain (×400). C. albicans = Candida albicans; C. tropicalis = Candida tropicalis

Figure 2

(a) Bacterial vaginosis. Clue cells revealed in Gram's stain (×400); (b) speculum examination showing mucopurulent cervicitis; (c) revealing primary herpes genitalis with prolapse uterus and purulent discharge; (d) revealing yellowish green frothy discharge in trichomoniasis