Use of vaginal pH in diagnosis of infections and its association with reproductive manifestations

Mania‐Pramanik, Jayanti; Kerkar, S.C.; Mehta, P.B.; Potdar, S.; Salvi, Vinita

doi:10.1002/jcla.20273

Cited by 26 publications

(20 citation statements)

References 17 publications

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“…Bacteria vaginosis is the most common vaginal infection during the reproductive years. During bacterial vaginosis, the normal lactobacillus-dominated vaginal flora shifts to a population dominated by other organisms, including Neisseria gonorrhoeae, Chlamydia trachomatis, or anaerobic organisms (e.g., Clostridia species) (36). Bacterial vaginosis is characterized by vaginal pH values above 4.5 and is correlated with preterm birth in asymptomatic women and pelvic infections after induced abortions (27,44).…”

Section: Discussionmentioning

confidence: 99%

Requirements for Germination ofClostridium sordelliiSporesIn Vitro

Ramírez

Abel-Santos

2010

J Bacteriol

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Clostridium sordellii is a spore-forming, obligately anaerobic, Gram-positive bacterium that can cause toxic shock syndrome after gynecological procedures. Although the incidence of C. sordellii infection is low, it is fatal in most cases. Since spore germination is believed to be the first step in the establishment of Bacilli and Clostridia infections, we analyzed the requirements for C. sordellii spore germination in vitro. Our data showed that C. sordellii spores require three structurally different amino acids and bicarbonate for maximum germination. Unlike the case for Bacilli species, D-alanine had no effect on C. sordellii spore germination. C. sordellii spores germinated only in a narrow pH range between 5.7 and 6.5. In contrast, C. sordellii spore germination was significantly less sensitive to temperature changes than that of the Bacilli. The analysis of the kinetics of C. sordellii spore germination showed strong allosteric behavior in the binding of L-phenylalanine and L-alanine but not in that of bicarbonate or L-arginine. By comparing germinant apparent binding affinities to their known in vivo concentrations, we postulated a mechanism for differential C. sordellii spore activation in the female reproductive tract.

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Section: Discussionmentioning

confidence: 99%

Requirements for Germination ofClostridium sordelliiSporesIn Vitro

Ramírez

Abel-Santos

2010

J Bacteriol

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“…Other studies have shown low prevalence of cervical infections in India among similar populations (Sowmya et al 2001; Chawla et al 2004; Joyee et al 2004; Panchanadeswaran et al 2006; Patel et al 2006). While some research has shown that infection with CT does not change vaginal pH (Mania-Pramanik et al 2008), additional research is needed to assess the performance of POC among populations with a high prevalence of cervical infections. In this study, TV was diagnosed by culture instead of molecular methods so it is possible that some TV infections were missed (Crucitti et al 2003).…”

Section: Discussionmentioning

confidence: 99%

Simple and inexpensive point‐of‐care tests improve diagnosis of vaginal infections in resource constrained settings

Madhivanan

Krupp

Hardin

et al. 2009

Tropical Med Int Health

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Summary OBJECTIVE Bacterial vaginosis (BV) and Trichomonas vaginalis infection (TV) have been associated with adverse birth outcomes and increased risk for HIV. We compare the performance of simple inexpensive point-of-care (POC) tests to laboratory diagnosis and syndromic management of BV and TV in poor settings. METHODS Between November 2005 and March 2006, 898 sexually active women attending two reproductive health clinics in Mysore, India were recruited into a cohort study investigating the relationship between vaginal flora and HSV-2 infection. Participants were interviewed and screened for reproductive tract infections. Laboratory tests included serology for HSV-2; cultures for TV, Candida sp., and Neisseria gonorrhoeae; Gram stains; and two POC tests: vaginal pH; and Whiff test. RESULTS Of the 898 participants, 411 [45.7%, 95% confidence interval (95% CI): 42.4–49.0%] had any laboratory diagnosed vaginal infection. BV was detected in 165 women (19.1%, 95%CI: 16.5–21.9%) using Nugent score. TV was detected in 76 women (8.5%, 95%CI: 6.7–10.4%) using culture. Among the entire study population, POC correctly detected 82% of laboratory diagnosed BV cases, and 83% of laboratory diagnosed TV infections. Among women with complaints of vulval itching, burning, abnormal vaginal discharge, and/or sores (445/898), POC correctly detected 83% (60 of 72 cases) of laboratory diagnosed BV cases vs. 40% (29 of 72 cases) correctly managed using the syndromic approach (P < 0.001). Similarly, POC would have detected 82% (37 of 45 cases) of TV cases vs. 51% (23 of 45 cases) correctly managed using the syndromic approach (P = 0.001). CONCLUSIONS In the absence of laboratory diagnostics, POC is not only inexpensive and practical, but also significantly more sensitive than the syndromic management approach, resulting in less overtreatment.

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“…Bacterial vaginosis (BV) is a pathologic condition of the vagina, caused by an overgrowth of anaerobic bacteria, leading to a bothersome foul smelling discharge. Increased pH is one of the Amsel criteria to diagnose the disease and is often used as a surrogate marker for the presence of BV [1][2][3][4]. However, it needs to be taken into consideration that pH can also be increased by other factors, both infectious (e.g.…”

Section: Introductionmentioning

confidence: 99%

Increased vaginal pH in Ugandan women: what does it indicate?

Donders

Gonzaga

Marconi

et al. 2016

Eur J Clin Microbiol Infect Dis

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Abnormal vaginal flora (AVF), indicative of bacterial vaginosis (BV) and/or aerobic vaginitis (AV), amongst other abnormalities, is a risk factor for multiple complications in pregnant as well as non-pregnant women. Screening for such conditions could help prevent these complications. Can self-testing for increased vaginal pH reliably detect BV and other high-risk microflora types, and is this more accurate than performing Gram stain-based Nugent score when screening for high-risk microflora? A total of 344 women presenting at different outpatient clinics in Mulago Hospital and Mbuikwe Outpatient clinics in Kampala, Uganda, were asked to test themselves by introducing a gloved finger into the vagina and smearing it on a microscopy slide, on which a pH strip was attached. Self-assessed categories of normal (pH 3.6-4.4), intermediate (4.5-4.7) or high pH (>4.7) were compared with demographic and with centralised microscopic data, both in air-dried rehydrated wet mounts (Femicare), as well as in Gram-stained specimens (Nugent). AVF was present in 38 %, BV in 25 % and AV in 11 % of patients. High pH and AVF is correlated with human immunodeficiency virus (HIV), infertility, frequent sex, but not vaginal douching. Screening for raised pH detects 90 % of AVF cases, but would require testing over half of the population. As AV and non-infectious conditions are frequent in women with AVF and high pH, Nugent score alone is an insufficient technique to screen women for a high-risk vaginal microflora, especially in infertile and HIV-infected women.

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Use of vaginal pH in diagnosis of infections and its association with reproductive manifestations

Cited by 26 publications

References 17 publications

Requirements for Germination ofClostridium sordelliiSporesIn Vitro

Requirements for Germination ofClostridium sordelliiSporesIn Vitro

Simple and inexpensive point‐of‐care tests improve diagnosis of vaginal infections in resource constrained settings

Increased vaginal pH in Ugandan women: what does it indicate?

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