Authored by Pedro Rolando Lopez Rodriguez*
Summary
Introduction: Vaginal discharge syndrome is an infectious process of the vagina with a florid symptomatology and psychosocial impact on the female population. Objective: To characterize the patients of childbearing age with vaginal discharge syndrome in the Basic Working Group number 2 of the Párraga polyclinic between January and December 2018. Method: Observational, descriptive, and cross-sectional study. 195 patients of childbearing age [between 15 and 49 years of age] of the medical office 10 were studied in the period from January to December 2018 who attended the medical consultation referring to presenting vaginal discharge and / or associated symptoms performing anamnesis, physical examination, and microbiological study.
Result: 32.8% were between 25 and 29 years old and 41.7% were black. At least half were 52.3% pre-university, more than 59.0% were workers. The majority began sexual intercourse before the age of 20. 90.3% presented risk factors associated with vaginal discharge. The white, lumpy caseous flow represented 63.1%. At least 9 out of 10 patients presented vaginitis. More than 75% had Monilia or Gardnerella vaginalis. It was found that 95% of patients with vaginitis had risk factors.
Conclusion: Patients predominated between the second and third decade of life, of the black race, with the pre-university concluded and workers. The majority were single or accompanied, had begun their sexual life at an early age and presented risk factors. Patients with vaginitis prevailed, with white, lumpy, case-like discharge and with Monilia as the germ causing vaginal discharge. There was a statistically significant relationship between the presence of risk factors and the flow classification.
Keywords: Vaginal discharge syndrome; Risk factor; Sexual risk behavior
Introduction
Vaginal discharge is a common reason for gynecological consultation at any age, being highly frequent in women of childbearing age, who are concerned about their reproductive health [1]. Vaginal discharge syndrome is an infectious process of the vagina characterized by one or more of the following symptoms: leucorrhoea, vulvar pruritus, burning, irritation, dysuria, dyspareunia, vaginal fetus, determined by the invasion and multiplication of any microorganism and as a result of an environmental imbalance in the vaginal ecosystem [2]. This pathology has a wide range of causal germs and is easy to diagnose and its complications are frequently related to infantile and reproductive maternal morbidity [2,3]. They continue to be a public health problem in the world, they are more frequent in young, single adults and in urban areas, but without anyone with active sex life being exempt from suffering them. They can also cause complications or sequelae in both women and men and children, for example orchiepidimitis, acute pelvic inflammatory disease [hereinafter EIPA], sterility in both sexes, penile or cervix cancer, pregnancy complications, miscarriages, death fetal and / or maternal, premature birth, low birth weight, neonatal infections, congenital malformations and at risk of transmitting or becoming infected by the human immunodeficiency virus [hereinafter HIV] as demonstrated by several studies. [4-7]. In medical practice, vaginal infections represent a frequent health problem, representing approximately 75% of the patients who are consulted by vaginal discharge, according to the number of patients attending the medical consultation of some studies in Venezuela. Taking into account that in the same woman more than one clinical form can coexist [vaginitis and / or cervicitis] and if the gynecological examination does not allow to affirm the presence of a particular causative agent, the treatment should be focused in a syndromic way, at three infections most frequently associated with vaginal discharge syndrome: trichomoniasis, candidiasis and bacterial vaginosis; less frequently, these infections are caused by Neisseria Gonorrhoeae and Clamydia trachomatis [6,8].
Syndromic management represents an alternative to efficiently address this problem and with this type of approach the treatment of the causes most frequently associated with the syndrome in question is achieved and therefore the solution of more than 95% of cases is guaranteed [9]. The World Health Organization [WHO] estimated that 333 million new cases of curable sexually transmitted diseases annually in people aged 15 to 49, mostly in developing countries, which include member countries of the European community. On the other hand, recent calculations report that each year more than 340 million Cases of curable sexually transmitted infections [STIs] [including only those fungal and parasitic bacterial infections], which have as a manifestation the vaginal discharge syndrome, susceptible to effective treatments and that at least one million infections occur every day. For Latin America and the Caribbean alone, between 35 and 40 million cases of this group of Sexually Transmitted Infection were infected with more than 100 thousand infections per day [4,5]. Vaginal candidiasis is caused by a fungus or yeast found in the vulvo-vaginal mucosa that proliferates favored by broad-spectrum antibiotics, oral contraceptives, pregnancy, menstruation, diabetes mellitus, tight clothing, HIV infection, poor hygiene habits, etc. Women usually present with vulvar irritation and scarce exudate. The vulva may appear inflamed with excoriations and fissures. The vaginal wall may be covered by white, sticky and sticky yeast colonies. This entity began to be considered as a Sexually Transmitted Infection as of 1967 and it is currently accepted that 50% of the reported cases are the product of sexual contact. Its treatment consists in the use of clotrimazole 100 mg, intravaginal twice a day for 3 days or nystatin 100 000 U [vaginal ovum] intravaginally, once a day for 14 days [10]. In primary health care services these infections in adolescents are among the first causes of consultation, with a much higher incidence in those young people with active sexual life, although they have also been found in virgin adolescents. [eleven]. Vaginal symptoms are the most frequent reason for gynecology, being responsible for 6 to 10 million medical visits a year in the world [7]. In the United States about 30% of women of reproductive age have bacterial vaginosis [BV]. Almost 75% of all adult women have had at least one fungal infection in their lives. About 3% of women of reproductive age have trichomoniasis. Many women with vaginal infections have no symptoms, for example, only 16% of women with bacterial vaginosis report having vaginal symptoms, while out of every 100 women who have symptoms, such as pain, itching and discharge; 40 to 45 women have bacterial vaginitis; 20 to 25 women have a fungal infection; 15 to 20 women have trichomoniasis [7-12]. The World Health Organization reported that since 2006 approximately 15,700 women annually go to vaginal health problems in primary care facilities in West African countries [Ghana, Guinea, Mali and Togo], with very low cure rates associated with the costs and non-compliances of the treatment [7]. The results in European countries are also relevant with an estimated 250,000 women who, of childbearing age, go annually to vaginal discharge consultations. Being the most significant figure in women during pregnancy [7].
In Colombia, the prevalence in Colombia of bacterial vaginosis has varied between 9% in asymptomatic pregnant pregnant women and 30% in non-pregnant women from the general population [8]. Cuba does not escape this situation, reporting 831787 consultations by these entities [7-12] Havana reports in 2017; 627 251 patients assessed by obstetrics consultation, while gynecology attended 208,589 women of childbearing age, if we take into account that approximately 75% of the consultations are due to vaginal discharge, the total number of patients treated is 156 441 [13]. In the Municipality, 19407 patients treated for vaginal infections in the analyzed period are reported [14]. Regarding the Párraga Polyclinic, they behave with 4317 patients assisted in gynecology due to this identity [15].
Methods
A descriptive and cross-sectional observational study was carried out. 195 patients of childbearing age [between 15 and 49 years of age] of the medical office 10 were studied in the period from January to December 2018 who attended the medical consultation referring to presenting vaginal discharge and / or associated symptoms performing anamnesis, physical examination, and microbiological study.
Inclusion and exclusion criteria
Inclusion criteria
Female patients of childbearing age with vaginal discharge who agreed to physical examination with speculum and attended vaginal and endocervical exudate.
Exclusion criteria Patients who do not belong to the health area.
Pregnant patients. Patients who have refused to participate in the investigation
Technical and procedures
Sources of obtaining the information
Application of a data collection form [Annex 1] to the patients from which the related variables were studied.
Data register
A database was created in the Microsoft Office Excel 2010 program where the variables contained in the Form being investigated were included.
Processing and analysis of information
The variables included in the Return were entered into a database in Excel and the statistical processing was carried out in the statistical package Stadistical Package for Social Science for Personal Computer [SPSS-PC] in its version 19.1 for Windows, from which it They will prepare tables that summarize quantitative variables in absolute values and percentages. In addition, statistical tests of independence χ2 [Chi-Square] will be performed on qualitative variables.
Ethical aspects
The research was endorsed by the Commission of Medical Ethics in Research of the Faculty of Medical Sciences “Julio Trigo López”. No new or experimental medications or techniques were used, which were not yet certified or endorsed for use. No experimental surgical procedures were performed
Result
(Table 1) The results in relation to the age groups reflect that the majority were found in the group between 25 and 29 years old with 64 cases [32.8%] and that less than 5.0% of the patients studied were between 45 and 49 years old (Table 2).
Source: Data collection form.
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