Bacteriological Study Of Leucorrhea In Reproductive Age Group Women, With Special Reference To Anaerobes- A One Year Cross Sectional Study

Abstract

INTRODUCTION: Leucorrhea is a watery/thick, white/yellow purulent vaginal discharge, which is not blood stained, and may or may not be associated with obvious local pathology. Leucorrhea is one of the most common complaints in women of reproductive age. It may be physiological or pathological. In 90% of the women, pathological leucorrhea is mainly caused by Bacterial Vaginosis (BV), Candidal vulvovaginitis and Trichomonas vaginalis infection. When left untreated, it may lead to complications such as chronic pelvic inflammatory disease, chronic pelvic pain, infertility, ectopic pregnancy, PROM or chorioamnionitis. OBJECTIVES: 1. To isolate and identify the bacteria (aerobes and anaerobes) causing leucorrhea. 2. To perform antibiotic susceptibility testing of the isolated bacteria. MATERIALS AND METHODS: The study was carried out from January 2016 to December 2016 in the Department of Microbiology, Jawaharlal Nehru Medical College, Belagavi. 250 Women attending the Out Patient Department of Obstetrics and Gynaecology (OBG OPD) at KLE’S Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi with complaints of excessive watery/thick, white/yellow vaginal discharge with or without associated vaginal pruritus, burning micturition, backache or abdominal pain were included in the study. Three high vaginal swabs were collected from the posterior fornix of these women and transported in Thioglycollate broth. BV was diagnosed in these women by using the Amsel’s clinical composite criteria according to which three of the following four criteria must be positive: a) thin, homogenous vaginal discharge, b) presence of clue cells, c) positive Whiff test and d) pH of vaginal discharge > 4.5. Isolation and identification of aerobic as well as anaerobic bacterial isolates was done by using standard operating procedure. Antibiotic susceptibility of aerobic bacteria was done by Kirby-Bauer disk diffusion method and for anaerobic bacterial isolates, agar dilution method was used. RESULTS: Among 250 participants, 30% belonged to the age group of 18-25 years, 30.4% had completed only primary education, and 54.4% belonged to the middle class. 88% of them presented with thin, grey, homogenous, adherent vaginal discharge where as 12% of them had thick, white, non-fowl smelling discharge. 123 (49.2%) women were diagnosed to have BV by Amsel’s clinical composite criteria and 93 (37.2%) of these women showed positive bacterial culture. In 29 women, Candida species were isolated. None of the women in the study were infected with T. vaginalis. Amongst the 93 bacterial positive cultures, 86 (92.5%) were aerobes and 42 (45.2%) were anaerobes. Amongst the aerobic bacteria, Escherichia coli (34.9%) was the most common isolate followed by Klebsiella spp. (23.3%) and Enterococcus spp. (18.6%). Among the anaerobic bacteria, Porphyromonas spp. (55%) was isolated frequently, followed by Peptostreptococcus spp. (17%). 65.1% of the aerobic bacteria were resistant to Ampicillin. Gentamicin and Ceftazidime were found to act well against the aerobic bacteria. Among the anaerobic bacteria, 11.9% were found to be resistant to Metronidazole. They belonged to the genus Peptostreptococcus and Bacteroides. CONCLUSION: Bacterial Vaginosis, which was the main cause of leucorrhea in this study, is a state of microbial dysbiosis. The normally present Lactobacilli are replaced by pathogenic facultative anaerobes. Amsel’s clinical composite criteria is an easy and sensitive method to diagnose BV. However, microbiological diagnostic approach is necessary for etiological diagnosis. Anaerobic bacteria are a major cause of BV. Their identification and antibiotic susceptibility testing are important. The emergence of resistance pattern amongst anaerobes as reported by many studies is also reflected in this study. Hence, knowing the susceptibility pattern of these pathogenic bacteria will help in appropriate and effective treatment and thereby prevents complications.