Nongonococcal And Nonchlamydial Microbial Isolates From High Vaginal Swabs Of Nigerian Women Diagnosed With Pelvic Inflammatory Disease
C Uneke, M Alo
bacteria, candida albicans, pelvic inflammatory disease, trichomonas vaginalis
C Uneke, M Alo. Nongonococcal And Nonchlamydial Microbial Isolates From High Vaginal Swabs Of Nigerian Women Diagnosed With Pelvic Inflammatory Disease. The Internet Journal of Infectious Diseases. 2006 Volume 6 Number 1.
High vaginal swabs from 1451 Nigerian women clinically diagnosed with pelvic inflammatory disease (PID) were investigated for nongonococcal and nonchlamydial microbial infections using standard techniques. Bacteria were isolated from 623(42.9%, 95% CI., 40.4-45.4%) women, comprising 474(76.1%) monobacterial and 149(23.9%) polybacterial isolates.
Pelvic inflammatory disease (PID) is the most important complication of the female genital tract, causing major medical, social and economic problems worldwide . PID comprises a spectrum of inflammatory disorders of the upper female genital tract, including any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis [2,3]. PID is a polymicrobial infection due to the ascending of normal endogenous microorganisms from the lower genital tract into the upper genital tract or the infection by microorganisms related to sexually transmitted diseases (STD) as
Despite advances in defining its aetiology, pathogenesis and availability of many powerful antimicrobial drugs, PID consumes a significant portion of the medical resources of numerous countries . In US for instance, at least 5.5 billion dollars are spent on PID annually and more than a million women are diagnosed with PID each year and for every four women who have PID, one will suffer a complication [1,9].Often the PID rates are highest in developing countries where medical resources are most severely limited and the number of women with unrecognized PID is estimated to be far higher [8,10]. It is estimated that in developing countries PID is related to 94% of all sexually transmitted infections (STI) related morbidity .
There is paucity of information on PID in sub-Saharan Africa and available statistics in the sub-region are rather focal [12,13]. This is largely attributed to the fact that clinical diagnosis of PID is at best difficult and imprecise, and laboratory criteria are neither highly specific nor sensitive [2,3]. Although it is well established that gonococcal (
Approval for the study was obtained from the Research/Ethical Committees of the FMC, Abakaliki. The approval was on the agreement that patient anonymity must be maintained, good laboratory practice/quality control ensured, and that every finding would be treated with utmost confidentiality and for the purpose of this research only. Prior to sampling, informed consent was duly obtained from each subject.
A total of 1451 women diagnosed with PID were studied. The age ranged from 20-54years old. Bacterial organisms were isolated from 623(42.9%, 95% CI., 40.4-45.4%) HVS specimens of the patients, comprising of 474(76.1%) monobacterial and 149(23.9%) polybacterial isolates.
When age of the women diagnosed with PID was associated with the different microbial isolates, higher prevalence of bacteria isolates was noted among the older women, with the highest prevalence in the 36-40 years age category (68.7%, 95% CI., 63.3-74.1%) and least prevalence among those aged 26-30 years old (28.8%, 95% CI., 22.5-35.1%) (Table 2). A statistically significant difference was also observed in the trend (?2 =107.97, df=6,
The aetiology of PID has been described as multimicrobial, and the pattern of organisms most frequently causing the condition fluctuates . This is evident from this study where bacterial, parasitic and fungal agents were isolated from the HVS and may be implicated in the PID diagnosed in the patients. This has a very important public health implication because clinicians often face the problem of knowing the exact aetiology of PID in order to treat appropriately. It has, therefore been suggested that in addition to the major PID causative agents (
In this study, microbial isolates of bacterial and fungal origin predominated with higher percentage of women with bacteria (42.9%) and
In conclusion, it is worth noting that a major limitation in this study was our inability to adequately prove that the microorganisms isolated were responsible for the PID diagnosed. A more complex study to achieve this goal using molecular biologic tools is advocated. Secondly, the non inclusion of women without PID in this study which would have provided a basis for comparison was yet another drawback. This is advocated in future studies. Thirdly, the Hager et al.  definition of PID used in this study, lacks specificity and consequently some patients included in this study may not have had PID. This problem is reportedly inherent to all studies of PID . Future studies that would investigate the pathological basis of the relation between the nongonococcal and nonchlamydial microorganisms of the lower genital tract
We wish to thank the authorities of the Federal Medical Center Abakaliki for logistical support.
CJ Uneke Department of Medical Microbiology/Parasitology, Faculty of Clinical Medicine, Ebonyi State University, PMB 053 Abakaliki, Nigeria. Tel: 234-08038928597, Fax: 234-04300222, E-mail: unekecj@ yahoo.com