Tropical Doctor, October I979
BACTERIOLOGY OF VAGINAL-DISCHARGE IN SUDANESE WOMEN
Bacteriology of vaginal discharge in Sudanese women E. E. Omer, MB, BS, DPBact, DipVen M. H. Kleida, MB, BS, MRCOG M. Hagali, BPh, MSc(Microbiol) Faculty of Medicine, University of Khartoum, and Medical Research Council, Khartoum, Sudan TROPICAL DOCTOR,
1979,9,161-163
Vaginitis is an exceedingly troublesome condition, not only because of the associated pain, burning, and itching but more so as a result of the concomitant vaginal discharge (Kraus 1967). Bacteria causing vaginitis and leucorrhoea have been studied by many workers all over the world (Slotnick et al. 1963; Edmunds 1959; Haines and Taylor 1975). Different organisms were identified and some of them blamed for causing infection in the vagina. Many views had been raised concerning the significance of these organisms and their role in the causation of vaginal discharge. Little work has been carried out on this subject in Africa and other tropical areas. In the Sudan no study has yet been done on this subject, although many patients are attending the gynaecologicalclinics and health centres complaining of copious irritating vaginal discharge. Hence the object of this study is to determine the bacterial strains prevailing in the vagina in patients complaining of vaginal discharge. Also the study aims at discussing the pathogenicity of the organisms isolated, and determining their sensitivity to the common antibiotics in routine use in the Sudan. This may be of benefit when attempts are made to diagnose and treat such a condition in the Sudan and similar countries. MATERIALS AND METHODS
The study was carried out during the period from January I, 1977, to December 26, 1977. It was carried out in the University Hospital at Soba (Khartoum). The patients were attending either the gynaecological or the sexually transmitted diseases clinic with symptoms of vaginal discharge. All of them were adult females above 16 years old.
Bacteriological examination High vaginal specimens were collected from 1,049 patients. Each patient was asked to lie in the lithotomy position on an examination couch. With the
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help of an electric lamp and good vision, a sterile vaginal speculum (without a disinfectant) was inserted and specimens were collected from the posterior vaginal fornix using a sterile wire loop. The specimens were inoculated immediately on standard specific solid and fluid media according to Cruickshank and his colleagues (1975). Also smears were made on microscope slides, dried and fixed for staining with Gram stain and Zeihl-Neelsen stain. The inoculated media were transported to the bacteriologicallaboratory (100 yards away) immediately in polythene bags. The media were incubated for aerobic and anaerobic culture. Carbon dioxide atmosphere was obtained by a candle jar when indicated. All cultures were incubated for 48 hours before being discarded as negative (Cruickshank et al. 1975). Organisms isolated were again subcultured for purity and identified according to Cowan and Steel's Manual for the Identification of Medical Bacteria (1974). Group A haemolytic streptococci were identified by inhibition of growth on crystal violet blood agar by a bacitracin disc (Oxoid, London). All staphylococci were tested for coagulase activity to determine the pathogenic strains.
Sensitivity testing Pure isolated pathogenic organisms were tested by the plate diffusion method for antibiotic-sensitivity. Oxoid Diagnostic Sensitivity Test Agar was chosen for the tests, except in the case of Streptococcus faecalis where Mac Conkey agar was used. Filter paper discs (Oxoid, London) were employed for the test (Salim and Gumaa 1975). The antibiotics used and their concentrations per disc were as follows: chloramphenicol (C.50 JLg), penicillin G (P.5 units), streptomycin (S.25 JLg), tetracycline (Te.50 JLg), erythromycin (E.50 JLg), kanamycin (K.5 JLg) and ampicillin (Ap.25 JLg). The sensitivity plates were incubated aerobically or anaerobically according to the nature of the organism. After 18 hours' incubation, the zone of inhibition was noted. The antibiotics chosen were the most commonly used antibiotics in hospitals in the Sudan. RESULTS
Bacteriological investigation of 1,049 specimens of vaginal discharge from Sudanese women showed that 513 samples contained pathogenic organisms. One pathogenic organism was isolated from 443 specimens, two from 64 specimens, and three organisms from six specimens. These organisms included: Neisseria gonorrhoeae, Staphylococcus aureus (coagu-
162 I BACTERIOLOGY
lase positive), Streptococcus faecalis, beta-haemolytic Streptococcus pyogenes Lancefield group A, Escherichia coli, Proteus species, Klebsiella species, Pseudomonas species, and coliforms (other than species of Salmonella, Shigella, Proteus, Klebsiella, and E. coli). E. coli was the predominant organism isolated (26.4%). N. gonorrhoeae (0.85'1
BACTERIOLOGY OF VAGINAL-DISCHARGE IN SUDANESE WOMEN
Bacteriology of vaginal discharge in Sudanese women E. E. Omer, MB, BS, DPBact, DipVen M. H. Kleida, MB, BS, MRCOG M. Hagali, BPh, MSc(Microbiol) Faculty of Medicine, University of Khartoum, and Medical Research Council, Khartoum, Sudan TROPICAL DOCTOR,
1979,9,161-163
Vaginitis is an exceedingly troublesome condition, not only because of the associated pain, burning, and itching but more so as a result of the concomitant vaginal discharge (Kraus 1967). Bacteria causing vaginitis and leucorrhoea have been studied by many workers all over the world (Slotnick et al. 1963; Edmunds 1959; Haines and Taylor 1975). Different organisms were identified and some of them blamed for causing infection in the vagina. Many views had been raised concerning the significance of these organisms and their role in the causation of vaginal discharge. Little work has been carried out on this subject in Africa and other tropical areas. In the Sudan no study has yet been done on this subject, although many patients are attending the gynaecologicalclinics and health centres complaining of copious irritating vaginal discharge. Hence the object of this study is to determine the bacterial strains prevailing in the vagina in patients complaining of vaginal discharge. Also the study aims at discussing the pathogenicity of the organisms isolated, and determining their sensitivity to the common antibiotics in routine use in the Sudan. This may be of benefit when attempts are made to diagnose and treat such a condition in the Sudan and similar countries. MATERIALS AND METHODS
The study was carried out during the period from January I, 1977, to December 26, 1977. It was carried out in the University Hospital at Soba (Khartoum). The patients were attending either the gynaecological or the sexually transmitted diseases clinic with symptoms of vaginal discharge. All of them were adult females above 16 years old.
Bacteriological examination High vaginal specimens were collected from 1,049 patients. Each patient was asked to lie in the lithotomy position on an examination couch. With the
I 161
help of an electric lamp and good vision, a sterile vaginal speculum (without a disinfectant) was inserted and specimens were collected from the posterior vaginal fornix using a sterile wire loop. The specimens were inoculated immediately on standard specific solid and fluid media according to Cruickshank and his colleagues (1975). Also smears were made on microscope slides, dried and fixed for staining with Gram stain and Zeihl-Neelsen stain. The inoculated media were transported to the bacteriologicallaboratory (100 yards away) immediately in polythene bags. The media were incubated for aerobic and anaerobic culture. Carbon dioxide atmosphere was obtained by a candle jar when indicated. All cultures were incubated for 48 hours before being discarded as negative (Cruickshank et al. 1975). Organisms isolated were again subcultured for purity and identified according to Cowan and Steel's Manual for the Identification of Medical Bacteria (1974). Group A haemolytic streptococci were identified by inhibition of growth on crystal violet blood agar by a bacitracin disc (Oxoid, London). All staphylococci were tested for coagulase activity to determine the pathogenic strains.
Sensitivity testing Pure isolated pathogenic organisms were tested by the plate diffusion method for antibiotic-sensitivity. Oxoid Diagnostic Sensitivity Test Agar was chosen for the tests, except in the case of Streptococcus faecalis where Mac Conkey agar was used. Filter paper discs (Oxoid, London) were employed for the test (Salim and Gumaa 1975). The antibiotics used and their concentrations per disc were as follows: chloramphenicol (C.50 JLg), penicillin G (P.5 units), streptomycin (S.25 JLg), tetracycline (Te.50 JLg), erythromycin (E.50 JLg), kanamycin (K.5 JLg) and ampicillin (Ap.25 JLg). The sensitivity plates were incubated aerobically or anaerobically according to the nature of the organism. After 18 hours' incubation, the zone of inhibition was noted. The antibiotics chosen were the most commonly used antibiotics in hospitals in the Sudan. RESULTS
Bacteriological investigation of 1,049 specimens of vaginal discharge from Sudanese women showed that 513 samples contained pathogenic organisms. One pathogenic organism was isolated from 443 specimens, two from 64 specimens, and three organisms from six specimens. These organisms included: Neisseria gonorrhoeae, Staphylococcus aureus (coagu-
162 I BACTERIOLOGY
lase positive), Streptococcus faecalis, beta-haemolytic Streptococcus pyogenes Lancefield group A, Escherichia coli, Proteus species, Klebsiella species, Pseudomonas species, and coliforms (other than species of Salmonella, Shigella, Proteus, Klebsiella, and E. coli). E. coli was the predominant organism isolated (26.4%). N. gonorrhoeae (0.85'1
