es in 252 patients (26%), followed by Staphylococcus aureus (15.6%) and Streptococcus species (0.8%). Candida and Staphylococcus aureus occurred as a mixed infection in 6.7% of cases. In 112 patients (11.6%) culture yielded no growth. About 144 patients had rapid HIV (human immunodeficiency virus) antibody testing and 127 (88.2%) were non-reactive and 17 (11.8%) were reactive). VDRL (venereal disease research laboratory test) for syphilis was done in 50 patients and were all non-reactive. Fasting blood sugar was done to screen for diabetes in 124 (12.8%) patients and all had normal blood sugar levels except one.

Figure 1. Type of vaginal discharge.

Table 1. Demographic characteristics of patients.

There was no information recorded at all about a history of recurrence of “vaginal discharge” for 703 patients (72.5%) while 57 (5.9%) patients had never had the symptom in the past and 209 (21.6%) had similar symptom in the past. Timeframe for recurrence of symptoms is shown in Table 2.

When compared, those with additional symptoms were more likely to present with whitish vaginal discharge, candidiasis and recurrence of symptoms (p < 0.05) as shown in Table 3 than those who had no additional symptoms.

Table 2. Time frame for recurring symptom of “vaginal discharge”.

Table 3. Comparing symptoms to nature of vaginal discharge, HVS (high vaginal swab) results and history of recurrence.

Note: χ2 = chi Square, df = degree of freedom, p = p-value.

4. Discussion

Vaginal discharge is a common symptom seen in clinics in Nigeria. Though vaginal discharge is one of the commonest symptoms of STIs [5] , the association between it and the presence of RTIs may be weak [4] .

In this study, vaginal discharge was commoner among those aged 21 to 30 years. This is similar to another study [8] that found a higher percentage of vaginal discharge in younger age and unmarried group. It is also consistent with findings from other studies [10] [11] and was attributed to higher incidence of sexual activity and contraceptive use among younger women. Sexual activity may have been under-reported in our study (44 out of 253 unmarried patients) as perceived promiscuity is stigmatized in our context. In contrast, studies elsewhere [12] found vaginal discharge to be more among females aged forty three and above (59.1%).

Vaginal discharge was most commonly characterized as being white (16.9%) which is similar to what was found in Saudi Arabia where white was the most common color of vaginal discharge, representing 50.8% of the complaints [2] and was not specific to a particular causative agent.

In our study, a high proportion (75.5% or 346 out of 458) of patients were investigated by using high vaginal swabs resulted in an etiologic diagnosis. In India however, laboratory diagnosis was lower; 51.75% [13] , (2013) and 33.1% [14] . High vaginal swabs (HVS) are often used to diagnose causes of vaginal discharge because they are more accessible to our labs, but they are actually of limited value [15] except in cases of inconclusive assessment, recurrent symptoms, treatment failure, or in pregnancy, postpartum, post-abortion or post-instrumentation [9] .

Candidiasis was the commonest etiologic agent found in our study (26%), followed by Staphylococcus (15.6%). This is very similar to what was found in Kano, also in northern Nigeria [16] , that among those with vaginal discharge of infective origin, Candida albicans was isolated in 94% of cases, while Staphylococcus aureus was isolated in 6%. This is also similar to other studies were higher rates of candidiasis (53.6% - 75%) was found; [3] [10] [11] [17] [18] .

The risk factors for candidiasis are well known and include douching, use of antibiotics, immunocompromised states and diabetes [9] . Few of the women studied had these risk factors. Though douching is a common cultural practice in this environment for personal hygiene, to prevent infections and as an aphrodisiac [19] [20] . The practice of douching is however discouraged [21] . Irrational use of antibiotics is also widespread [22] . Identification of species type would be useful especially in recurrent candida infection [9] but was not always done in this case. Roughly 80% of candidiasis are due to Candida albicans, while others are with other Candida species including Candida glabrata and Candida tropicalis. Some 15% to 20% of cases are however asymptomatic [7] . Recurring candidiasis without the common predisposing factors, may be an acquired candida-antigen specific cutaneous anergy in about 40% - 70% of cases leading to a relapse rather than reinfection [7] , especially when short treatment regimens are used. And in some cases, reinfection has been attributed to a persistent intestinal reservoir of candida [7] .

One study [13] , however found bacterial vaginosis to be commonest in 105 (26.25%) women, and other infections were also common; candidiasis alone (61, 15.25%), trichomoniasis alone (12, 3%), mixed infections (22, 5.5%). Bacterial vaginosis was also commonest, 14.3% - 17.4% according to some other [14] [23] .

Apart from the type of tests available, results are also affected by the quality of the tests and lab procedures as well as experience of personnel. Facilities for some cultures, transport media and storage conditions are not always available or adequate in resources poor settings. Yet reporting of commensal bacteria can cause anxiety and lead to overtreatment while poor quality of tests may lead to under-diagnosis of other causative agents [9] .

5. Limitations of the Study

Record keeping is generally poor in this part of the world. In this study uniform data of all women presenting to the clinic during the study period could not be reliable gotten to calculate actual prevalence. Characterization of vaginal discharge and educational level of patients was not well documented and missing data is a limitation of retrospective studies. The study is also facility based with a small sample size which may not necessarily reflect what obtains in the community. Lack of adequate laboratory resources limited investigation into causes of the symptom.

6. Conclusion and Recommendation

Vaginal discharge is a common symptom among women but it is significant to note that it may not always be pathological. Hence most women need to be educated and reassured to allay anxiety. Candidiasis was the commonest infectious cause in this population and was sometimes recurrent, so women should avoid its predisposing factors which are well known. More attention should be paid to proper record keeping, documentation of facts and improving laboratory services. More prospective and qualitative studies are needed to further study this symptom.

Cite this paper

Mohammed-Durosinlorun Amina,Muhammad-Idris Zainab,Abubakar Amina,Ojabo Augustine,Adesiyun Adebiyi, (2015) Pattern of Vaginal Discharge and Associated Demographic Characteristics among Female Patients Seen at a Gynaecology Clinic in Northern Nigeria. Open Access Library Journal,02,1-8. doi: 10.4236/oalib.1102231

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NOTES

*Corresponding author.

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