The authors report a cross-sectional descriptive study over 6 years, from December 8th, 2003 to October 27th, 2009, involving 911 women involved in the sex trade within the Yèrêlon group in Bobo-Dioulasso. Objectives: To describe the epidemiological, clinical and etiological aspects of vaginal discharge in women in the Yèrêlon group of the city Bobo-Dioulasso. Results: Frequency of vaginal discharge was 48.89%. The mean age was 28.4 years with extremes of 16 and 54 years. Single, divorced and widowed women accounted for 78.8% of the study population. Women who never attended school and those with primary education accounted for 74.3% of the study population. HIV serology was positive in 38.4% of cases. The main symptoms were genital itching, dyspareunia and urinary signs. The main germs identified in the laboratory were Candida albicans, Trichomonas vaginalis and Gardenerella vaginalis. Conclusion: vaginal discharge was found in 48.89% of women in the Yèrêlon group of Bobo-Dioulasso. The clinical study of the discharge and the laboratory results allowed a diagnosis and a better management of the leucorrhea in the group Yèrêlon.
Leucorrhea is non-bloody female genital discharge. It can be pathological, in this case translating a genital infection. If the vaginal discharge is usually mild, it may have an impact on the couple’s sexual and emotional life, and also could have dramatic consequence, such as ectopic pregnancy or infertility [
Like other sexually transmitted infections (STIs), vaginal discharge promotes sexual transmission of the human immunodeficiency virus [
Sex workers have multiple partners, and this behavior promotes the spread of HIV and STIs. We undertook this study on the vaginal discharge in women of the Yèrêlon group in order to study the epidemiological, clinical and etiological aspects.
A cross-sectional, descriptive study over a 6 years period, from December 8, 2003 to October 27, 2009 was carried out, in Bobo-Dioulasso, as part of a research project called Yèrêlon on the prevention and management of sexually transmitted infections and the human immunodeficiency virus in professional sex workers and women infected with HIV from the Associations of People Living with HIV.
1) Inclusion and non-inclusion criteria
Inclusion criteria
- be a woman aged 18 years and over;
- be sexually active;
- agree to participate in HIV testing and testing.
Non-inclusion criteria
- to be pregnant;
- refusal of screening Of HIV.
2) Conduct of the study
The visits included conducting a behavioral questionnaire, an Information- Education-Communication (IEC) session, counseling for HIV testing, a medical examination with genital specimens (vaginal specimen culture and sensitivity) and blood tests (serology Syphilis and HIV serology). The visit ended with a distribution of condoms and possibly drugs.
For the collection of data, a behavioral questionnaire, a follow-up register and a laboratory record were used. The variables studied were: Socio-demographic and behavioral characteristics―Clinical characteristics of the discharges and specimen’s laboratory results.
Data were entered and analyzed with the software Epi Info 2000.
1) Frequency of vaginal discharge
A total of 911 women consulted, 445 had vaginal discharge, making a frequency of 48.8% [95% CI (45.6 - 52.1)].
2) Epidemiological characteristics
a) Socio-demographic characteristics
The mean age was 28.4 years with extremes of 16 and 54 years. The age group 20 - 29 years represented 47.1% of the (429/911). According to the marital status, singles, divorced and widows accounted for 78.8% of the population (718/911), Married 17% (155) and concubines 6.4% (58). Sex workers accounted for 23.2% of the population, while occasional prostitution was of the order of 76.8% of the group. The women out of school and those with primary education accounted for 74.42% (678/911).
For the distribution according to religion, Catholics accounted for 53.2% of the population, Muslim 46.3% and animists 0.5%.
b) Past obstetrical history
The mean gravity was 2 with extremes of 0 and 15. The mean parity was 2 with extremes of 0 and 10. Pauciparous accounted for 52.1% of the population.
c) Contraceptive methods used by women.
There is a diversity of contraceptive methods used by women in the Yèrêlon group.
A contraceptive method was used by 60% of women (547/911). The proportion of women using condoms alone as a contraceptive method was 43.3% (395/911). Combined oral contraception was used by 8, 7% of women (79/911) as shown in
d) Sexual hygiene
The vaginal douching was practiced by 85.8% of women (779/911). They were 93.6% practicing it more than once a day (729/779). Products such as diluted
Characteristics | Numbers | Frequency (%) |
---|---|---|
Age (Years) | ||
Less than 20 | 116 | 12.7 |
20 - 29 | 429 | 47.1 |
30 - 39 | 265 | 29.1 |
40 - 49 | 97 | 10.7 |
More than 49 | 4 | 0.4 |
Occupation | ||
Professional sex workers | 211 | 23.2 |
Occasional sex workers | 700 | 76.8 |
Education level | ||
None | 388 | 42.5 |
Primary | 290 | 31.8 |
Secondary | 228 | 25.1 |
Tertiary | 5 | 0.5 |
Number of women | 911 | 100.0 |
bleach (5 women), potassium permanganate (2 women) and lemon juice (5 women) were also used for the vaginal douche.
e) HIV serological status
HIV screening was positive in 350 women, making a frequency of 38.4%. There were 5 cases of HIV2 and 6 cases of co-infection HIV1 and HIV2.
3) Clinical Features
a) Clinical features of vaginal discharge
The signs associated with vaginal discharge are given in
Urinary manifestations were made up of pollakiuria or dysuria.
b) Etiologic macroscopic aspects
Speculum examination revealed macroscopic features suggestive of vaginitis in 83.9% (374/445), cervicitis in 9.8% (43/445), and associated vaginitis to cer-
Contraceptive method | Numbers | Frequency (%) |
---|---|---|
None | 364 | 40.0 |
COC | 79 | 8.7 |
Implant | 35 | 3.8 |
IUD | 8 | 0.9 |
Male condom | 395 | 43.3 |
Injectable progestin | 27 | 3.0 |
Natural methods | 1 | 0.1 |
Traditional methods | 2 | 0.2 |
Total | 911 | 100.0 |
Products and/or solutions used | Numbers | Frequency (%) |
---|---|---|
Simple water | 465 | 59.7 |
Perfumed bath soap | 488 | 62.6 |
Marseille soap | 136 | 17.5 |
Antiseptics | 48 | 6.2 |
Others | 28 | 3.6 |
Signs | Numbers | Frequency (%) |
---|---|---|
Genital itching | 185 | 20.3 |
Dyspareunia | 139 | 15.3 |
Urinary symptoms | 42 | 4.6 |
vicitis in 6.3% of cases (28/445) (
4) Biological characteristics
a) Bacterial vaginosis
Gardenerella vaginalis was found in 41.8% of cases (381/911).
b) Genital candidiasis
Candida albicans was diagnosed in 7.7% of cases (70/911).
c) Infection with Trichomonas vaginalis
Trichomonas vaginalis alone was found in 0.8% of women (7/911).
d) Mixed vaginal infections.
Mixed infections were diagnosed in 7.2% of women (66/911).
The associations were as follows:
Gardenerella vaginalis and Trichomonas vaginalis in 44 cases;
Gardenerella vaginalis and Candida albicans in 15 cases;
A combination of Candida albicans and Trichomonas vaginalis in 1 case;
And Gardenerella vaginalis, Trichomonas vaginalis and Candida albicans in 6 cases.
The
e) Gonorrhea
The 724 endocervical swabs were examined directly and a culture in search of Neisseria gonorrhoeae was found to be negative.
f) Factors associated with vaginal discharge
Epidemiological characteristics of women
Most studies of sexually transmitted infections show that the majority of patients are between the ages of 20 and 35 [
Factors | VDS present | VDS absent | Prevalence of VDS | p |
---|---|---|---|---|
Occupation | 0.0078 | |||
Professional sex workers | 120 | 91 | 56.9 | |
Occasional sex workers & others | 325 | 375 | 46.4 | |
Vaginal douching | 0.64 | |||
Present | 383 | 396 | 49.2 | |
Absent | 62 | 70 | 53 | |
Male condom | 0.0621 | |||
Used | 179 | 216 | 45.3 | |
Non used | 266 | 250 | 51.6 | |
COC | 0.922 | |||
Used | 39 | 40 | 49.4 | |
Non used | 406 | 426 | 48.8 | |
VIH screening | 0.00013 | |||
Positive | 199 | 151 | 56.9 | |
Negative | 246 | 315 | 43.9 | |
Number of women | 445 | 466 | 48.8 |
VDS: vaginal discharge syndrome.
The mean age in our series was 28.4 years. It is identical to that of Desai [
In terms of educational level, most studies show that the majority of women engaged in sex work (occasional prostitution, or professional sex workers ) are out of school or just have the level of primary education [
In terms of marital status, the percentages are disparate. Wang [
Frequency of vaginal discharge
The prevalence of vaginal discharge in our study was 48.8%. Most data from the literature show high frequencies for vaginal discharge in this target population. It was found frequencies of 51.7%, 90% and 94% respectively in the studies of Desai in India [
Prevalence of genital infections
Many studies on sex workers show a high prevalence of genital infections [
Our rate of 50.4% is higher than those of Reed [
Etiologies of vaginal discharge
A variety of germs has been reported by most authors in vaginal discharge [
Factors associated with vaginal discharge
The prevalence of vaginal discharge syndrome was significantly higher in HIV- infected women [p < 0.00013, 95% CI (1.28 - 2.21)].
Indeed, the decline in immunity is recognized as a factor favoring opportunistic infections such as genital candidiasis [
Authors like Baisley [
True sex workers had a higher prevalence of vaginal discharge syndrome than occasional sex workers and other women in the population. This difference was statistically significant [p < 0.0078, 95% CI (1.11 - 2.07)].
With relation to age, couple life, condom use or pill use, and the practice of vaginal douching, there was no statistically significant difference. Wang and al noted no association between the practice of vaginal douching and vaginal discharge in sex workers in China. Similarly, Demba [
The use of vaginal douching is a relatively widespread practice among sex workers [
Condoms are effective means of fighting STIs and HIV when its use is optimal. Condom users accounted for 43.3% of the population.
At the end of this study in the Yèrêlon group of the city Bobo-Dioulasso, the prevalence of vaginal discharge syndrome was 48.8%. The main germs found in vaginal discharge were Gardenerella vaginalis, Candida albicans and Trichomonas vaginalis. Infections were mixed in 14.4% of cases.
Improving the situation requires preventive measures, diagnosis and management of vaginal discharge in women infected with HIV and sex workers.
Moussa, B., Louis, O.J., Niang, M., Azize, D.A. and Idrissa, Z. (2017) Vaginal Discharge in the Prostitutes of the Group Yèrêlon of Bobo-Dioulasso: Epidemiological, Clinical and Etiological Aspects. Open Journal of Obstetrics and Gynecology, 7, 871-879. https://doi.org/10.4236/ojog.2017.78088