Persistence of group B Streptococcus vaginal colonization and prevalence of hypervirulent CC-17 clone correlate with the country of birth: a prospective 3-month follow-up cohort study

To identify factors associated with vaginal colonization and persistence by group B Streptococcus (GBS) and by the hypervirulent neonatal CC-17 clone in late pregnancy and after delivery, a multicentre prospective observational cohort with 3-month follow-up was established in two university hospitals, Paris area, France. Pregnant women were recruited when antenatal screening for GBS vaginal colonization at 34-38 weeks of gestational age was positive. Vaginal samples were analysed by conventional culture methods at antenatal screening, delivery, and 21 and 60 days following delivery. Identification of the hypervirulent neonatal GBS CC-17 was performed. Colonization was defined as persistent when all vaginal samples were positive for GBS. A total of 754 women were included. GBS vaginal colonization was persistent in 63% of the cases (95% CI 59%-67%). Persistent colonization was more likely in women born in Sub-Saharan Africa compared with women born in France (OR = 1.88, 95% CI 1.05-3.52), and GBS CC-17 was overrepresented in women born in Sub-Saharan Africa (OR = 2.09, 95% CI 1.20-3.57). Women born in Sub-Saharan Africa are at higher risk for GBS vaginal persistence than women born in France. This observation correlates with an increased prevalence of the hypervirulent GBS CC-17 in the former group, which likely reflect variations linked to ethnicity and vaginal community-state types and might account for the increased susceptibility of black neonates to GBS infections.

Prevalence and factors associated with postpartum vaginal infection in the Khyber Agency federally administered tribal areas, Pakistan

OBJECTIVE

To estimate the prevalence and to identify the factors associated with vaginal infection among the married women between the ages of 15-49 years residing in the Khyber Agency (FATA), Pakistan.

METHODS

A cross-sectional study was conducted in the month of July 2005 on 1084 mothers by using random sampling strategy in Khyber Agency Pakistan by trained nurses. The descriptive and multivariate statistics were computed.

RESULTS

The multivariate analysis showed that the associated factors with vaginal infection were the use of unhygienic material to soak up the lochia [aOR = 3.45, 95% CI (1.36, 8.75)], bathing after 40 days [aOR = 2.10, 95% CI (1.55, 3.14)], and women who did not receive antenatal care [OR = 3.87, 95% CI (1.93, 7.75)]. Also women who did not have medical facilities available [OR = 2.45, 95% CI (1.23, 5.06)] reported of vaginal infection.

CONCLUSIONS

This study concluded that there is considerable need for health education among women and the entire community for the maintenance of hygiene, safe delivery through medical personnel and improvement in the mobility of mothers and female education.

Women's douching practices and related attitudes in eastern Turkey

AIM

Vaginal douching is a common hygiene practice for many women all over the world, but it is associated with several health risks. Little is known about the beliefs and attitudes that promote and maintain douching practices. Therefore, the objective of the present study was to evaluate the status of vaginal douching practices of women in the Malatya province of eastern Turkey.

METHODS

This was a cross-sectional study. A sample of 465 Muslim women was interviewed to ascertain the status of vaginal douching practices. All participants were between 15 and 49 years of age and all were married. Data were collected by using a questionnaire in the process of conducting face-to-face interviews in June 2004. Data analysis included descriptive statistics and logistic regression modeling.

RESULTS

The present study revealed that the frequency of douching was 61.5% among women. The participants were frequently douching for feminine hygiene (47.6%). Vaginal douching practices were associated with several factors including education level (odds ratio [OR] = 1.991, 95% confidence interval [CI] = 1.154-3.434), family income (OR = 0.996, 95% CI = 0.994-0.998), marital age (OR = 0.402, 95% CI = 0.223-0.715), frequency of sexual intercourse (OR = 2.335, 95% CI = 1.532-3.554), and presence of genital syndromes/infections (OR = 1.813, 95% CI = 1.215-2.739).

CONCLUSION

This study provides preliminary information about women's douching practices and attitudes in the Malatya region of Turkey. It may also provide information to health-care practitioners in their efforts to educate women on the adverse effects of vaginal douching.

Frequency and response to vaginal symptoms among white and African American women: results of a random digit dialing survey

The prevalence of vaginal symptoms and response to those symptoms in a nonclinic setting has not been previously described. Two thousand women living throughout the United States identified by random digit dialing completed a computer-assisted telephone interview about history of vaginal symptoms and use of healthcare services in response to these symptoms. The analysis was limited to 1698 white (WA) and 144 African American (AA) women (n = 1842). An episode of vaginal symptoms of any severity during 1995 was reported by 7.5% of WA women and 18.1% of AA women. Fifty-five percent of WA women and 83% of AA women with symptoms consulted a healthcare professional about their most recent episode. The racial difference in prevalence and consultation was not explained by marital status, education, employment, or lifetime number of sex partners. Most women purchased an over-the-counter antifungal preparation to treat their symptoms, whether or not a physician was consulted. The racial differences in prevalence and use of health services in response to vaginal symptoms observed here should be confirmed, and the potential causes should be explored.

Bacterial colonization of the vagina during pregnancy in four ethnic groups. Vaginal Infections and Prematurity Study Group

OBJECTIVE

Our purpose was determine whether there are ethnic differences in vaginal colonization with organisms reputed to be associated with preterm delivery.

STUDY DESIGN

In seven urban medical centers in the United States from 1984 to 1989, 13,747 predominantly low-socioeconomic-status women at 23 to 26 weeks' gestation were grouped according to ethnic origin. Each had a vaginal culture for multiple organisms and Gram's stain and pH test to diagnose bacterial vaginosis. Multivariate analyses with adjustment for maternal age, insurance status, marital status, smoking history, education level, age at first sexual intercourse, and number of male partners in the past year were also performed to determine the odds ratio for a black woman versus a white woman having a positive test result.

RESULTS

For nearly every organism studied, Asian-Pacific Islander and white women had the lowest percentages of positive test results whereas black women had the highest. When black and white women are compared, black women were more likely to be colonized with Chlamydia trachomatis, 16% versus 5%; Neisseria gonorrhoeae, 2.5% versus 0.4%; Bacteroides sp., 25% versus 14%; bacterial vaginosis, 23% versus 9%; and the four other organisms evaluated. Adjustment for potential confounders including certain health behaviors did not markedly change the risk of a black woman having a positive test result, with the odds ratios for colonization with each organism ranging from 1.8 to 6.4.

CONCLUSIONS

Highly significant differences exist in vaginal colonization patterns among women of different ethnic groups, with the highest rates of potentially pathogenic organisms observed in black women and the lowest in Asian-Pacific Islander women. Differences in health behaviors do not explain the variation in colonization rates.

The preterm prediction study: significance of vaginal infections. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

OBJECTIVE

Our purpose was to evaluate the association of bacterial vaginosis, trichomonas vaginitis, and monilial vaginitis with spontaneous preterm birth at < 35 weeks 0 days.

STUDY DESIGN

A total of 2929 women at 10 centers were studied at 24 and 28 weeks' gestation by Gram stain of vaginal smear, wet mount, and 10% potassium hydroxide preparations to detect vaginal infections.

RESULTS

The rates of detected infection at 24 and 28 weeks, respectively, were bacterial vaginosis 23.4% and 19.4%, trichomonas 3.3% and 2.7%, and monilia 21.1% and 19.5%. The occurrence of bacterial vaginosis at 28 weeks was associated with an increased risk of spontaneous preterm birth, odds ratio 1.84 (95% confidence interval 1.15 to 2.95, p < 0.01). Detection of Trichomonas vaginalis (by wet mount) or monilia (by potassium hydroxide preparation) had no significant associations with preterm birth.

CONCLUSION

The presence of bacterial vaginosis at 28 weeks' gestation is associated with an increased risk of spontaneous preterm birth.