الفهرس 
The Female Lower Genital TractOnly 14 pages are availabe for public view
 |  | from | 160 |  |  |
| | | from | 160 | | |
Abstract
Bacterial vaginosis is the most common vaginal infection among women of childbearing age. Bacterial vaginosis is not considered a serious disease by itself, but it appears to be a risk factor for the occurrence of many complications including PROM, chorioamnionitis, PTL, post-cesarean delivery endometritis, post-abortion endometritis, PID, risk of acquiring HIV infection and CIN. It may also be associated with postpartum complications in infants. It is a polymicrobial condition, characterized by depletion of vaginal lactobacilli and overgrowth of commensal vaginal anaerobic bacteria including (G. vaginalis and Bacteroides species), anaerobic organisms (Mobiluncus spp., Fusobacterium spp., Prevotella spp. and peptostreptococcus spp.) and genital Mycoplasmas (Mycoplasma hominis and Ureaplasma urealyticum). The etiology and pathogenesis of B.V. is still unclear. It is associated with several risk factors e.g. higher numbers of sexual partners, lower age of first intercourse, previous history of a STD, having a new sexual partner, vaginal douching, smoking and using ICUD. The aim of this study was:- 1-Clinical diagnosis of B.V. in the studied women and determining the role of different associated risk factors. 2-Laboratory diagnosis by isolation and identification of anaerobic bacteria in women suffering from B.V. This study was conducted on 150 women aged from 19 to 40 years, attending The Obstetrics and Gynecology Department of Benha University Hospital as out-patients and in patients after taking their consents, from June 2010 to June 2011. They were divided into 3 groups:- • Group I, included 75 pregnant women coming for antenatal care and those admitted for treatment of complications of pregnancy. • Group II, included 40 non pregnant women complaining of abnormal vaginal discharge. Women on antibiotic treatment were excluded from this group. • Group III, included 35 asymptomatic women as a control group. After history taking and clinical examination (general, local and obstetric), 2 vaginal swab samples from each woman were taken by high vaginal swabs and subjected to the following:- A)-Clinical diagnosis of B.V. by the presence of 3 out of 4 clinical criteria of Amsel. B) Laboratory confirmation by Gram-stained vaginal smear based on Nugent scoring system. C) - Culture on Robertson cooked meat medium, followed by Subculture on the general selective blood agar for anaerobes and then different selective blood agars for different anaerobes. D) - Antibiotic sensitivity testing of isolated strains according to Kirby-Bauer method. E) - Identification of anaerobic bacteria species by Rap ID-ANA II system Out of 150 vaginal samples collected, B.V was diagnosed in 62 women (41.3%). The percentage of B.V was 40% in group I, 70% in group II and 11.4% in group III . Bacterial vaginosis was most prevalent in women aged between 31 to 40 years old, of low educational level, used douching, using IUCD and in women with complicated pregnancy. Out of the 62 women diagnosed as B.V., anaerobes were isolated from 44 (71%). Out of 44 women had positive culture for anaerobes, 77 anaerobic strains were isolated, from which 46 (60%) were Gram positive and 31 (40%) were Gram negative (Peptostreptcocci and Bacteroides species were the most prevalent).
The in vitro activities of various antimicrobial agents against isolated anaerobes were studied; 19% of isolates were susceptible to penicillin, 89% to cefoxitin, 92% to clindamycin and 94% to metronidazole. from this study, it was concluded that . • B.V. is most prevalent in women aged between 31 to 40 years old, of low educational level, used douching, using IUCD and in women with complicated pregnancy.
• There was a significant statistical correlation between B.V. and using IUCD.
• There was a high significant statistical correlation between isolated anaerobic strains and complications of pregnancy (PROM). There was also a significant statistical correlation between using IUCD as a contraceptive device in patients with B.V. and isolation of anaerobes.
• Anaerobic bacteria are important pathogens in B.V. and most of them can be isolated by using simple media and culture techniques. Their isolation would help the clinicians in appropriate treatment of B.V.